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  • Accident Compensation Corporation failed to explain reasons for decision made on independent review

    Case notes
    ACC failed to provide a full and detailed explanation as to why it declined to make an ex gratia payment as recommended by an independent reviewer
  • Agreement by ACC to stop regular rehabilitation assessments in light of information it already holds

    Case notes
    Whether the Accident Compensation Corporation (ACC) was reasonable to carry out regular assessments of a claimant for vocational rehabilitation despite already holding medical and occupational assessments confirming the claimant’s limitations—Ombudsman concluded this was not reasonable in the circumstances
  • ACC required to contribute towards client’s travel costs to attend hearing

    Case notes
    ACC client had difficulties with Individual Rehabilitation Plan and case manager—weekly earnings stopped—client sought review and later appealed decision to District Court but before hearing took place client moved to another town and had new IRP and case manager, and the earnings were reinstated—the client chose to continue with appeal in District Court but the appeal was unsuccessful—ACC refused to reimburse client for travel expenses but Ombudsman held this decision unreasonable
  • ACC delay to obtain opinion from Crown Solicitor unreasonable

    Case notes
    A 17 month delay by ACC in deciding whether to prosecute claimant for fraud but this delay due to 16 month delay by Crown Solicitor in providing ACC with written legal opinion — Ombudsman unable to investigate actions of Crown Solicitor but could consider how ACC dealt with the delay—three emails by ACC sent in 13 month period, then a formal request sent in writing for legal opinion—no agreed timeframes for when advice could be expected and Ombudsman of view that it was unreasonable for ACC to wait 14 months before formally raising concerns about the delay with the Crown Solicitor—ACC apologised to complainant and agreement reached between ACC and Crown Solicitor that legal opinions will be provided within 21 days of receipt of request
  • ACC has responsibility to meet statutory obligations despite uncooperative claimant

    Case notes
    Refusal to compensate for alleged ‘wrongful action’ – independent review of case incomplete because of complainant’s behaviour—treatment and rehabilitation compromised by stand-off between claimant and Corporation—complaints sustained and recommendations made but rejected by Corporation—Accident Insurance Act 1998
  • Accident Compensation payment backdated but delay to repay

    Case notes
    ACC claimant originally declined attendant care payment and review of decision found that claimant was entitled to payments and they should be backdated to 1983—ACC accepted review decision but payments not forthcoming. Claimant’s family complained to Ombudsman and ACC explained it was in the process of calculating amount owed and expected negotiations to begin shortly—Ombudsman kept informed on progress—meetings between ACC and claimant’s family occurred with final amount calculated and preparations made for payment to be forwarded upon appointment of claimant’s property manager—Ombudsman discontinued enquiries
  • ACC’s Advisory Committee Members cannot provide independent opinions on cases they then later consider

    Case notes
    Lack of independence alleged on part of medical expert—provider of independent advice also had deliberative role—perception of possible predetermination—complaint sustained and recommendation made—Accident Insurance Act 1998
  • ACC withheld document favourable to complainant’s case for review and accepted Ombudsman’s view that its service was inadequate

    Case notes
    Incomplete copy of file supplied—document favourable to claimant not revealed until after successful review—inadequate explanation offered—apology and remedial action instituted—Accident Insurance Act 1998
  • Accident Compensation Corporation exercise of discretion found to be misleading and deficient

    Case notes
    Exercise of ministerial discretion—effect of advice to Minister fettered exercise of discretion—matter resubmitted to Minister for reconsideration—complaint deemed resolved—Accident Rehabilitation and Compensation Insurance (Experience Rating) Regulations 1993, regulation 7
  • ACC overpaid compensation in error but agreed to write-off debt

    Case notes
    Accident Compensation Corporation overpaid compensation in error and then tried to recover the overpayment debt from young debtor in poor financial position—Ombudsman found for the complainant and ACC agreed to write off debt and revise debt recovery policy
  • Accident Compensation Corporation should clearly identify claimants’ rights in leaflet

    Case notes
    Reference to review and appeal rights contained in accompanying leaflets rather than incorporated in decision letter - Accident Rehabilitation & Compensation Insurance Corporation (ACC) agreed to include standard text in letter of advice to claimants - Accident Rehabilitation and Compensation Insurance Act 1992, s 67
  • Review and Appeal Rights available for ACC claimants

    Case notes
    Failure to compensate for medical error—review and appeal rights available therefore outside jurisdiction—ACC Complaints Investigator available to consider peripheral issues
  • Accident Compensation Commission offers payment and apology for delays in settling claim

    Case notes
    Claim declined—decision overturned by Appeal Authority—legislative changes in interim—entitlement lump sum payments lost—claim for ‘wrongful action’—claim for backdating of independence allowance—no authority to backdate—delay in settling ‘wrongful action’ claim—apology and token payment made—Accident Rehabilitation and Compensation Insurance Act 1992, ss 54 and 135
  • Accident Compensation Corporation delays to review case caused financial hardship

    Case notes
    Long term pain from back problem— ACC—manner of obtaining report-delays in review process