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An Auckland lawyer has asked Parliament for an independent investigation into what he says is a small group of doctors being used by the Accident Compensation Corporation to reject claims on grounds of pre-injury "degenerative" conditions.
The call was made public yesterday as ACC Minister Nick Smith defended his order for a clamp on what he said was a blowout in elective surgery costs as accident victims sought to use their injuries as a way of having underlying conditions treated at the corporation's expense.
Philip Schmidt, a fulltime accident lawyer, wrote to Dr Smith and six parliamentary parties in July, alleging that "a small group of specialists" was giving medical opinions to the corporation "at a very high frequency".
"The sheer volume of work they are doing must leave little time for clinical practice," he said.
"A lack of independent clinical practice or a significant dependence on the income generated by report writing is not consistent with producing objective, clinically valid reports."
He called for investigations into the small group of favourite doctors and the review process for people declined ACC coverage, which is handled by an ACC-owned subsidiary, Dispute Resolution Services.
Calls and emails from people refused ACC cover for injury treatment and income compensation on the grounds that they had pre-existing "degenerative" conditions continued to pour into the Herald yesterday.
Orthopaedic Association president Gary Hooper said on Tuesday that ACC was "trying to say everyone over 40 has degeneration".
People aged over 40 pay about $2.1 billion of ACC's $4.6 billion annual income through levies on their income, car registration and petrol and through general taxation.
A former ACC reviewer for Dispute Resolution Services who is also now an Auckland lawyer, Simon Buckingham, also yesterday questioned ACC's appeal process.
"In the case of Dispute Resolution Services, if ACC are paying their wages, how impartial can they truly be?" he asked.
He said that if any medical report contained the word "degeneration", "ACC will almost always automatically decline the claim on these grounds".
"The position in law is that it must be proved on balance of probability that the injury is wholly or substantially caused by pre-existing conditions not covered," he said.
"What is happening now is that ACC are declining on the mere whiff of degeneration, which is illegal."
Speaking from Cancun in Mexico yesterday, Dr Smith told the Herald there had been a blowout in ACC's elective surgery costs, from $128 million in 2005 to $240 million last year.
"As as consequence, ACC is being more careful that it's not becoming a de facto provider of elective surgery that's really required for health reasons rather than being caused by accidents.
"I've given ACC very clear instructions that where elective surgery is required as a consequence of accidents, it needs to fairly meet those legislative obligations but equally so to be careful that ACC doesn't become the default health provider."
But Dr Smith conceded he was not entirely satisfied with the present system because of the number of complaints he was receiving.
He recently met orthopaedic surgeons,who told him some improvement had been made in the work done by the medical panel that supports ACC.
"We've employed some additional specialists to make sure that our decisions are fair - I'm going to continue to monitor the situation."
But it was "absolutely inevitable" that with more than 40,000 elective surgery cases a year "there will be some patients and doctors who will be dissatisfied".
Meanwhile, former Associate ACC Minister Pansy Wong told Mr Schmidt in an October reply to his letter that the Government recognised that ACC's disputes process needed attention.
"Once decisions are made in relation to the Government's stocktake of ACC accounts, I will be leading a review of the dispute process," she said.
The Government is expected to announce decisions on the stocktake before Christmas, and the new associate minister, Hekia Parata, is likely to take up the review of the dispute process.
But Mrs Wong told Mr Schmidt that doctors used by ACC were "appropriately skilled and qualified".
She acknowledged that there had been an increase in review and appeal applications "because ACC is committed to following its legislative requirements more closely and ensuring that any entitlements a client seeks are in relation to a covered injury".
