Delays caused by ACC haggling over "degeneration" may have cost claimant David Hastings in lost shoulder function.
Specialist shoulder surgeon Khalid Mohammed told Mr Hastings, a retired clergyman, the surgery needed to be done without delay to achieve a full repair.
But ACC refused to pay for the surgery, and it took more than five months and a reviewer's orders to obtain the money.
Now aged 69, Mr Hastings said yesterday that his shoulder was feeling much better than before the surgery in June, but it was "not perfect".
He was cleaning a swimming pool last December 31 when he slipped and fell, tearing the rotator cuff tendon in his shoulder.
When Mr Hastings challenged ACC's decision, the reviewer, John Greene, preferred Mr Khalid's evidence to that of ACC clinical advisory panel member Ray Fong, an orthopaedic surgeon from Lower Hutt.
Mr Fong's opinion was: "David is suffering from L shoulder subacromial impingement syndrome - an intrinsic degenerative condition rendered symptomatic."
Mr Mohammed disagreed. He laid out, to the reviewer's satisfaction, the factors he considered showed a causal link between the poolside accident and the need for surgery.
And he dismissed the idea that the rupture was wholly or substantially due to age-related or degenerative changes, though acknowledging such changes could exist in older people.
Mr Greene ordered ACC to pay for the surgery, pay Mr Hastings' review costs of $685, and pay costs of $915 for Mr Mohammed's report.
Mr Hastings is among hundreds of upset ACC claimants who have contacted the Herald. Many have complained the corporation has used evidence of age-related degeneration to decline funding for surgery.
ACC's general manager of claims management, Denise Cosgrove, said last night:"We approve the overwhelming majority of surgery requests. However, sometimes we decline claims and if our clients are unhappy with that decision we encourage them to go to review.
Ms Cosgrove said if they were still not happy, they could "exercise their right to go through the district court process."
"Sometimes the review and court cases go in ACC's favour and sometimes they go in the client's favour. This is how a fair system works and ACC abides by the review or court decisions.
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