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According to the Accident Compensation Corporation, its costs for elective surgery grew from $128 million to $240 million between 2005 and last year.
That is an alarming jump and, unsurprisingly, it prompted a detailed examination of surgical requests. Many of these, says ACC, were found to be for conditions
that claimants had before their injuries.
The upshot has been the stricter enforcement of its policy of declining to pay for surgery for "pre-existing conditions". It seems, however, that, as with many a blunt instrument, this may be being carried too far.
The corporation's approach was highlighted this week by a Herald report on a 48-year-old woman who, after an accident on the Southern Motorway, was refused accident compensation for a back injury on the grounds that her spinal problem was "degenerative".
ACC says her condition was "aggravated by the road traffic accident and not caused by [it]". The woman says she had no pain before the accident.
Plainly, ACC's funding of non-injury-related surgery was applied too loosely in the past. This led to a degree of misuse in a manner similar to that for free physiotherapy visits, which were ended last year. But there now appears to be a strong case to suggest the judgment calls being made on pre-existing conditions by some surgeons used by ACC are too harsh.
Doctors and specialists have not been slow to voice their qualms. A particularly damning verdict was delivered by the president of the Orthopaedic Association, Dr Gary Hooper. "ACC," he said, "is trying to say everyone over 40 has degeneration."
In one respect, that is self-evident. Everyone's tissue ages. However, it is surely drawing a long bow to suggest that should be a critical part of the equation in cases where claimants had no pain before their accidents.
As Dr Hooper points out, most hip fractures occur in people with degenerative tissue but, because there is a clear-cut fracture, they are covered.
In effect, ACC's change of approach has opened a Pandora's box. In the resulting bewilderment, the victims are those forced to endure long waits for surgery in the public health system. And those unaware of their right to challenge ACC decisions, or unable to pay a lawyer to do so.
There is another reason for concern. The strict application of this policy began without any public notification. There was no announcement from ACC about why this approach was necessary, by how much it wanted to cut the cost of elective surgery, and how precisely the policy would be applied. The first information has come in response to the report on the motorway accident claimant.
Everybody is aware that ACC is being reined in, and that this is necessary. Over much of the past decade, there has been a laxness about its activities, perhaps promoted by the previous Government, which wanted to expand the coverage and increase the take-up rate.
Wider entitlements were the order of the day. Stricter control of ACC costs is an obvious course for the Clark Government's successor, plagued as it is by a difficult economic environment.
In support of its policy, the corporation points to "long-established legal precedent that funding surgery for these [pre-existing] conditions is not the responsibility of ACC". That, however, does not excuse the distinctly harder line that is being taken with many older accident victims. A jump in the proportion of rejected surgery claims from 12 per cent in 2008 to 20 per cent last year confirms the impact of this approach.
The law may or may not be being misinterpreted. Either way, ACC is being unnecessarily and unduly severe. If it continues with this policy, shouldn't all those with "degenerative" issues pay a lower ACC levy in recognition of the extent of their cover?
