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A woman whose car was spun across three lanes in an accident on the Southern Motorway has been refused accident compensation for her back injury on the grounds that her spinal problem is "degenerative".
Yahaloma ("Diamond") Hochman, 48, has been taking morphine every day since January to cope with pain from the accident two months earlier. She walks with difficulty, cannot lift objects and cannot sit still for long.
She says she had no back pain before the accident.
"I was a very healthy, strong woman - I used to dance, walk, do everything," she said.
But the Accident Compensation Corporation (ACC) has refused to pay for spinal surgery, saying she had "advanced disc degeneration" which was "aggravated by the road traffic accident and not caused by [it]".
Orthopaedic Association president Dr Gary Hooper said the corporation was taking a similar hard line with many older accident victims.
"ACC is trying to say everyone over 40 has degeneration," he said.
"Of course everyone's tissue is ageing. But my understanding of the act is that ACC should cover people if they have sustained an injury on an area of the musculoskeletal system that has not been a problem prior to that."
Mrs Hochman's physiotherapist, Melissa Shapcott, said there was no doubt Mrs Hochman's back pain was caused by her accident.
"She had no problems at all with any activities prior to the accident, so you would assume that most of the damage was due to the accident."
Mrs Hochman was driving in the left-hand lane on the motorway between her Otahuhu home and Mt Wellington when the back right corner of her car was struck by a hit-and-run driver.
"It was 10am and we were all driving at 100 km/h," she said.
"I didn't see the person because it happened so quickly. I was driving and suddenly I was spinning through all the lanes of the motorway to the third lane very close to the wall.
"I remember three more cars hit me during the spinning, so in total four cars. I just held to the wheel very, very hard - that's why I couldn't open my fingers for a few days. All the back of my car just disappeared and the parts were all around the motorway.
"I thought, 'Oh my gosh, I'm dying, I'm dying.' But I ended up on the left side of the motorway."
A woman helped her out of the car and laid her down on the grass verge. Amazingly, she had no visible injuries and turned down the offer of an ambulance, calling her landlady instead to take her home.
But she felt severe pain in her knees, shoulders and hands and went to a family doctor at East Tamaki Healthcare.
An x-ray in December found degeneration but no fractures. But she was still in pain.
"The first four months was hell ... it was hard for me to breathe because of the pain," she said.
She was referred to one orthopaedic surgeon for her knee and another for her back pain.
ACC accepted cover for the knee and paid for knee surgery in February.
But it refused to cover the recommended spinal surgery because the x-ray and a subsequent scan found degeneration but not fractures.
Mrs Hochman has been waiting since then to have the surgery in the public health system, but the operation has been delayed twice and is now expected to be next year.
"Maybe I have degeneration of the disc, but that is not the cause of my pain," she said.
Dr Hooper said it was easier to trace pain in knees and shoulders to tissue damage, but it was harder to win arguments with ACC about back pain.
"Pain secondary to a back problem is often undiagnosable," he said. "Although someone may present with radiological evidence of a disc problem, that doesn't mean that's where the pain is coming from."
But if there had been no problem before an accident, a back injury should be treated the same as an 80-year-old breaking a hip in a fall.
"We know most of those hip fractures are in people with degenerative tissue, but because there is a clear-cut fracture ACC covers them," he said.
"I don't see any difference between that and you tearing a cartilage in your knee and needing an operation."
ACC's general manager of claims management, Denise Cosgrove, said ACC could not pay for surgery for "pre-existing conditions".
"Between 2005 and 2009, the cost of elective surgery for ACC grew from $128 million to $240 million," she said.
"Following detailed examination of surgical requests, ACC found that many are for conditions that people had before their injuries.
"There is long-established legal precedent that funding surgery for these conditions is not the responsibility of ACC.
"ACC isn't saying people such as Ms Hochman do not need surgery. That is a clinical issue between patients and their specialists.
"Instead, ACC is saying that it does not have responsibility for funding non-injury-related surgery.
"People with these types of conditions can seek and receive assistance from the public health system."
