Dialogue: ACC confident it has its rehab task by the tail

RICHARD NINNESS* says claims of mismanagement and harassment by ACC are contradicted by statistics which suggest the system is fair.

For 26 years ACC has played a critical role in society and has had a colourful past. We are trying to improve services for people who need ACC, and make sure the people using ACC do need it.

Most claimants' experience of ACC is barely noticeable, amounting to little more than the completion of a claim form during a visit to their GP and a course of treatment for injury. For others with more serious injuries, the experience is much longer term.

In recent years we have been addressing the rising numbers of long-term claimants. These people are important, mainly because we want to alleviate their long-term pain and suffering where we can.

It is also worth remembering that the actuarial cost of sustaining long-term claimants was estimated to rise to between $9 billion and $10 billion this year. In fact the estimated cost is now down to $6.4 billion.

Our main strategy has been to slow the growth in the number of long-term claimants (the so-called ACC tail). With better and faster treatment, the number of people entering the tail each year has reduced by 35 per cent from nearly 17,000 three years ago to 11,500 last year. The number of people leaving the tail last year was no different from the number five years ago.

There are three groups of long-term claimants: those whose injuries are severe and who will always be with ACC because of their legitimate need for ongoing services; those who need ACC services now because of a serious injury but who will recover and become independent; and those who we believe could leave the scheme with help or who no longer need to be on the scheme.

We have been trying to assist those whose injury doesn't really justify their presence on the scheme. No rehabilitation, delayed medical care, fear of returning to work, benefit dependency, lack of jobs, pain or other medical conditions are real barriers to returning to work or independence.

Yet these barriers can often be overcome for the long-term benefit both of the people concerned and the financial health of the scheme.

A key part of managing the tail has been to upgrade rehabilitation services and medical support. The main requirement ACC places on itself is to ensure that people have received sufficient rehabilitation and vocational training assistance from ACC.

The treatment and vocational training needs of claimants are established with independent professionals at the start of the rehabilitation process and monitored throughout the programme. At the completion of the rehabilitation programme, claimants should either return to full independence or return to continued reliance on ACC to an appropriate level.

There is occasionally a difference in view between ACC and a claimant over whether rehabilitation is complete. Resolution of this difference is achieved by an independent process carried out in two stages: an initial occupational assessment by a qualified independent occupational assessor, followed by medical assessment by an independent physician.

ACC relies on the advice of medical professionals, and although it pays for these services, they are thoroughly trained professionals responsible to their professional boards for the competence of their independent opinions.

If it is found that the claimant cannot return to work, compensation is continued. If the assessment is that the claimant is fit for work, ACC continues weekly compensation for three months while the claimant seeks work. If the claimant cannot find work (and the majority do), he or she is transferred to Work and Income for help, such as unemployment, sickness or invalid benefits.

The system seeks to be fair and contains real checks and balances. All decisions can be reviewed or appeals taken to an independent authority and all claimants are notified of this. Over the past three years, fewer than one in 500 cases went to review. Of those, ACC's decision was upheld three times out of four.

Rehabilitation assessment or work capacity assessment (as it is more frequently known) is a tool, but its impact must not be overstated. Since its introduction in 1997, only 10 per cent of all exits from the tail - 5000 people - have been the result of work capacity tests.

The vast majority of the 52,000 people who left the tail in the past three years simply got better with their motivation and our help.

Reassessment of cover is another controversial area. When ACC reviews claimants' needs it often starts with a check of the claimant's medical condition. Occasionally, this review reveals that ACC has been providing cover for a disability related to a perceived injury which, with time, is more properly considered a medical condition outside the scope of the ACC scheme.

By law, ACC cover should not be provided for these cases and claimants leaves the scheme.

They may move to Work and Income, where they will continue to receive help as sickness beneficiaries. The difference in the level of financing (ACC's scheme typically pays more) sometimes causes dislocation in living standards.

ACC is addressing this issue and will be working extensively with these claimants to smooth the transition.

On balance, ACC has a challenging job but I am confident we are doing well and very much better than in the past.

* Richard Ninness is a spokesman for ACC.

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