Woman wins A.C.C. payment appeal

Press, 25 January 1989, Page 6

Woman wins A.C.C. payment appeal

PA Wellington A decision by the Accident Compensation Corporation to cancel payment of an Auckland woman’s hospital fees because of its own administrative delays, has been successfully appealed. The Appeal Authority, Mr Brian Blackwood, said the A.C.C.’s attitude in the case had been “totally unjustified.” The woman, who injured her knee while skiing in 1985, required surgery two years later to reconstruct a torn ligament. Her orthopaedic specialist filed a request with the A.C.C. for payment of private hospital fees, because a delay of 12 to 18 months would be

expected in a public hospital. The woman’s A.C.C. file took three weeks to be retrieved from storage, and approval was given (for a maximum fee of $700) the day after the woman left the hospital after having surgery. The A.C.C. then refused to pay for the treatment, saying it did not give out “retrospective approval for private hospital treatment.” The decision was reviewed by the A.C.C. early last year and confirmed. It was noted that the woman and her specialist had been told written approval must be received before surgery is performed. The woman appealed

the decision on the ground that the A.C.C. might have been wrong in revoking the approval it had given. Counsel for the A.C.C. said retrospective approval could be given and the appellant should not be penalised because of the A.C.C.’s administrative delays. However, payment should be refused because of a new policy which said each claim for private hospital treatment should be considered'on its own merits, he said. The Appeal Authority granted the appeal because of the “exceptional circumstances,” and awarded legal costs of $5OO to the appellant.