Editorial: ACC's image still tarnished despite review

Photo / Thinkstock

Six months ago, the Herald received extraordinary public feedback when it published a series of articles on the stricter enforcement of the Accident Compensation Corporation's policy of declining to pay for surgery for "pre-existing conditions".

More than 400 people complained about their ACC cases. It quickly became apparent that to save money, the corporation was seizing on age-related degeneration of claimants' bodies to unjustifiably reject their claims for surgery after an injury. As much was highlighted by the large number of surgery cases going to legal review, and a decline in the ACC's success rate.

The corporation's response was to insist that it was merely more strictly applying the legislation under which it worked. That was never convincing. Nor did it help that the Government refused to initiate an independent review of the ACC's handling of claims for elective surgery. As it was, all that eventuated was an internal review. Yet even its findings have been enough to make the ACC concede that it had been rejecting too many claimants and must improve its processes.

While welcome enough, this was too late to prevent damage to the corporation. Because it had sought in the first instance to deny there was a problem, the ACC's credibility has been tarnished. In future, its response when similar issues of patient cover are raised is bound to be treated with greater scepticism. In a similar vein, the tenor of the review, and the ACC's response to it, offer pointers to whether lessons have genuinely been learned, or whether the culture and attitude of the organisation will remain largely unchanged.

Here the scoreboard is somewhat mixed. The scope and value of the internal review was much enhanced by the inclusion of a survey of 500 clients, as well as discussions with surgeons. These revealed a belief that the ACC was not getting the balance right in its decision-making, as well as criticism of the lack of transparency and independence of the corporation's medical advisers. Figures in the review that showed a sharply increased rate of its decisions refusing to pay for surgery being overturned offered further confirmation that the ACC was being too hard-nosed.

It is, therefore, somewhat worrying that the review seeks, in part, to deflect some of the criticism. There are, for example, references to the public's poor level of understanding of the legislative basis for the ACC's elective surgery decision-making. That is little more than passing the buck. What people have picked up on is the reasonableness of the ACC's decisions. Any doubts about these can only be reinforced if many of them are being subsequently overturned.

In that respect, there is an air of unreality about the reaction to the internal review of Denise Cosgrove, the ACC's general manager of claims management. She told the Herald that it did not say the corporation's decisions were wrong. Maybe not, but legal reviews have found plenty of those decisions to be fallible. She also talked about the internal review highlighting "that our decision-making processes could be more robust". Whatever that means.

Hopefully, it indicates the ACC will involve claimants' surgeons more in its decision-making and apply extra expertise where needed, especially before a decision to decline is made. And, hopefully, it will explain its rationale for decisions far more clearly to patients.

No one wants the balance of its decision-making to tip so dramatically that totally unworthy claims for surgery get the green light. But this episode should have been a chastening experience - and one from which the ACC must learn.