Assessor works to find the truth behind ACC claims

GEOFF CUMMING, following up his ACC series, meets a man paid by the corporation to put long-term injury claimants to the test.

Bob Sellars reckons he can tell people with genuine injuries from those he calls the Hollywood actors.

His company, FCE Systems, does "functional capacity evaluations," which compare an injured person's physical efforts against "normal" function.

ACC sends him claimants with short and long-term complaints for evaluation. They hobble into his gym to be put through their paces. Squats, lifts, presses, flexes - the range of exercises is designed to show just how much the injury is affecting the victim physically.

The American-developed FCE programme also tries to pinpoint psychological and social factors that may be affecting recovery.

The corporation bought into the FCE programme as part of its clampdown on long-term claimants - those whose pain persists long after the accepted recovery time.

Since securing a nationwide contract in 1998, Mr Sellars' company has tested about 2500 ACC claimants. He says most exaggerate their symptoms - consciously or unconsciously.

"From a physical point of view, the vast majority are capable of working. Just because you've got a sprained ankle doesn't mean you can't sit in front of a word processor."

But sections of the medical profession are highly sceptical about FCE. Pain specialist Dr John Hancock says the tests are a "grossly ridiculous money-making venture" without proper scientific grounding.

He is not alone. When it comes to the causes and effects of chronic pain, particularly lower back pain and occupational overuse syndrome (OOS), medical knowledge is lacking and the profession is split.

"It's helpful for insurers so they use these people," says Dr Hancock. "[The FCE system] has an air of respectability. They have all this paraphernalia but it's absolute pseudo-science."

He says the corporation has latched on to a group of health professionals who believe that chronic pain is more psychological than physical. The corporation will pay out only on injuries that stem from a specific cause - so assessments that find a complaint is not, or no longer, related to an "event" injury can save it money.

Thousands of long-term claimants cut off by ACC, particularly OOS sufferers, maintain that they remain unfit for work because of their original injury.

Scores have complained to the Herald about being cut off on the basis of ACC medical and physical assessments - even though they have specialist opinions supporting their claim.

Mr Sellars, a physiotherapist, concedes that chronic pain and the workings of the nervous system remain mysteries for modern science. But he has faith in his evaluation programme.

The effects of an injury on physical function can be measured, he says. FCE, one of several similar programmes, measures performance against "normal" function and allows cross-test comparisons.

The evaluation takes three to four hours and includes questionnaires to gauge claimants' physical and psychological perceptions of their injuries.

"If it all correlates we start to believe the patient. If it doesn't, we start to believe that psychological or social factors may play a part."

Mr Sellars says most people whose injuries linger well beyond the "normal" recovery period have developed some form of chronic pain syndrome.

"They believe they are severely disabled but there is little or no medical or physical explanation of why this should be so," he says.

The brain may become conditioned to associating movement or action with pain, or wider psycho-social beliefs come into play.

"With the vast majority we find it's not so much a physical disability they've got but the threat of going off ACC."

He says that most of the long-term claimants he sees lack "transferable skills" and live in areas where there are no jobs to go back to.

"The chances of them getting a job are pretty well zero. The vast majority fear they are going to end up on a [Work and Income NZ] benefit."

Several claimants responding to the Herald's series on ACC have complained that, far from helping their rehabilitation, physical FCE tests aggravated their condition and delayed recovery.

Claimants also say such medical assessments often contradict diagnoses by their own specialist or GP.

Mr Sellars says patients can be selective in their recall. "A lot go through a process of what we call catastrophisation. They believe only the worst of what they hear from the surgeon. It becomes a self-fulfilling prophecy."

But specialists in the opposing camp, including Dr Hancock, say the psycho-social theory is far too simplistic.

ACC says few long-term claimants have legitimate grievances when their compensation ceases. Most injured people simply get better.

The story so far


* Thousands of accident victims with long-term injuries have lost their compensation in a three-year clampdown by ACC.

* Many maintain they are unfit for work but that opinions of their surgeons and GPs are overruled by ACC assessors.

* The trend to rediagnose chronic injuries as degenerative or generalised pain, not covered by ACC, has been criticised by judges and lawyers.

* Workers fear being cut off on the basis of notional jobs that bear no comparison with their pre-injury skills and earnings.

* More than 150 claimants have contacted the Herald alleging harassment and mismanagement by ACC.

* ACC says some long-term claimants develop a victim mentality.