KEY POINTS:
An ACC system that dictates a set number of physiotherapy visits for different injuries should be thrown out, says the New Zealand Law Society.
In a hard-hitting submission to a ministerial inquiry into how physiotherapists are paid by ACC, lawyers also recommend that the Endorsed Provider Network, which they believe has created two tiers of physiotherapists, be abolished.
"The current systems employed by ACC ... have shifted the emphasis from the claimant's rights to proper treatment in the interests of rehabilitation, to management of treatment and cost containment," says the submission, put together by a committee of accident compensation law experts.
Submissions are being heard before QC David Goddard in Wellington this week. The lawyers are not planning to speak at the hearings, but released their submission to the Herald.
The ministerial inquiry came because senior physiotherapists, including those who treat world-class athletes, complained about the way ACC was treating them.
The physiotherapists claim ACC is investigating some of them for fraud for refusing to join the EPN, which they claim puts financial goals before patients. They say the ACC has full control over those who join the scheme, which pays a higher fee per treatment than the previous one under which therapists could charge the patient part of the fees.
They also hit at the injury-profile system where an injury is graded and a certain number of treatments allocated per injury no matter how serious the injury. Extra sessions are allowed but one has to fight for them.
The Law Society submission backs the physiotherapists on all points. The submission says ACC regulations have no regard for sex, age, the physical condition of the patient, the nature of injury, whether there are multiple injuries or complex injuries or other conditions which might have a bearing on the clinical requirements.
Neither did the regulations have any regard for the skill required by the physiotherapist providing treatment.
"The regulations are clearly directed at cost containment and not at the patients' injury-related clinical needs," say the lawyers.
They also said the EPN system had created a division within the physiotherapy profession which could act as a deterrent to rehabilitation.
"A physiotherapist who has elected to join the EPN, and therefore cannot charge the claimant a co-payment, is forced to comply with ACC directives regarding the number and/or type of treatments permitted.
"The EPN should be abolished and payment for all physiotherapy services put on the same basis."
The lawyers say that court cases over the past few years have shown ACC is quick to allege fraud against claimants and physiotherapists.
And where physiotherapists made claims for treatments which ACC considered outside the "norm" it was assumed the claim was being made fraudulently, they said.
Don Rennie, the convenor of the Law Society's ACC committee, told the Herald: "It's the claimants that are not getting their entitlements, they're being managed out of the system basically."
