The ACC files: Adam Darby

Adam Darby is recuperating from shoulder surgery after winning a long battle with ACC. Photo / Dean Purcell

Injury: Wrenched shoulder

Rejected: Degeneration

Adam Darby is recuperating from shoulder surgery this week after a reviewer overturned ACC's refusal to provide cover for the operation.

The Accident Compensation Corporation had said the Auckland design engineer had arthritis.

Mr Darby suffered acute pain in his right shoulder after he wrenched it removing trees from his garden two years ago when he was aged 39.

It came right after a fortnight so he didn't seek medical attention, but then flared up worse than at first when he took part in an office arm-wrestling competition.

ACC paid for more than a year's physiotherapy and he received cortisone injections, all of which helped, but the pain returned.

He saw orthopaedic surgeon Adam Dalgleish who, after trying more cortisone and having an MRI scan taken, recommended an operation to remove bone and tissue to make more room for the damaged tendons between the bones and to stop irritation.

The scan was taken 14 months after the gardening accident.

Mr Darby had no problems with the joint before the accident and he had played tennis and golf and went fly-fishing.

ACC refused to pay for the surgery. One of its medical advisers, general surgeon Mike Sexton, said, based on the MRI scan, that the joint had signs of osteoarthritis and a causal relationship had not been established between the gardening incident and the need for surgery.

The Accident Compensation Act allows ACC to refuse cover for surgery if an injury is "wholly or substantially" caused by age-related degeneration, disease or a gradual process.

When Mr Darby challenged ACC in the review case prepared by Nelson-based advocate David Wadsworth, a comparative x-ray of his left shoulder was taken. It did not show any evidence of degenerative disease.

This led his GP, Dr Barry Claridge, to conclude that the possibility of any generalised degenerative joint disease could be excluded.

Mr Dalgleish said Mr Darby's right shoulder had developed a post-traumatic condition.

]The delay from the injury to the MRI was time enough for the joint to have developed degenerative changes.

The reviewer, S. R. Houliston, said he was satisfied on the balance of probabilities that the gardening accident caused the injury for which he required surgery.

He quashed ACC's decision and ordered that it was liable to cover the operation and pay medical and legal costs of $626.

Mr Darby said yesterday that it was frustrating ACC had put him to so much unnecessary trouble for a case that was clear-cut.

"They had the opinion sitting there of the orthopaedic surgeon and the physiotherapist, yet they, without even looking at me, decided that those people were wrong and their opinion counted more."