ACC doctors

September 8th, 2012 at 9:46 am by David Farrar

Phil Kitchin reports at Stuff:

is spending millions of dollars flying doctors around New Zealand to assess long-term clients who have already been assessed by other doctors.

The policy has been slammed by John Miller – one of the country’s top lawyers specialising in ACC legislation – who said the so-called “independence” of some assessors was a sham.

ACC lawyers, advocates and claimant groups know those doctors as “hatchet men and women”, Mr Miller said.

I’m not to keen on the airfares, but I do think there is a place for independent assessors, and in fact if you ask many GPs, they will say they find it useful to have them also.

The reality is that it can be very difficult to ascertain how genuine some injuries such as back pain is. And the local GP can come under huge pressure from patients whom they see on a regular basis to give them the benefit of the doubt. They will often say they doubt the symptoms but can’t prove it.

The independent assessors don’t have to maintain a long-term relationship with the person, so  don’t get pressured so much into giving the benefit of the doubt so to speak.

Now I am sure there are some independent assessors who are too harsh, and there is a danger they get into a mindset of refusing all claims. But I would be very wary about anyone who advocates with doing away with the entire system of independent assessors.

What I would be interested in is data on each assessor (not named) and how often they disagree with the original assessment. That data would show you if some are being too zealous.

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19 Responses to “ACC doctors”

  1. slijmbal (1,133 comments) says:

    the problem is probably somewhat bigger in how to apply common standards in what is essentially a judgement call in many circumstances – some doctors are renowned for being soft touches for all sorts of ailments – stress leave, acc claims etc.

    Talking to an employment lawyer and she said is was common knowledge who to send your client to if you wanted for them to get stress leave when there was a PG.

    It is also likely that there are stricter doctors, which all adds a random element.

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  2. thomasbeagle (78 comments) says:

    “The independent assessors don’t have to maintain a long-term relationship with the person, so don’t get pressured so much into giving the benefit of the doubt so to speak.”

    Yes, and that’s exactly the point. The “independent assessors” have to maintain a long-term relationship with the ACC or their job will evaporate. They know the answers ACC wants and, even if they were trying their very best to be fair, that’s going to shade their diagnoses. (And of course the real suspicion is that they’re hired to get people off ACC, screw the medical evidence.)

    BTW, full marks to whoever thought up the term “independent assessors” for a group of people who are paid by the ACC.

    [DPF: For me then the solution is not to do away with independent assessors, but to limit the amount of work each one does for ACC, so none of them are dependent on ACC]

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  3. Nostalgia-NZ (4,682 comments) says:

    Smells of ‘hatchet’ men already. Figures would be necessary of course. The costs also look exploitive, that part seems an unnecessary cost straight away. ACC hasn’t earned a good reputation with the way it treats clients and breaches confidentiality, lies about interviews and so forth – people have a genuine right to be sceptical based on ACC’s own performance, particularly where they purport to be keeping others to standards they can achieve themselves. They’re an overburdened financially crippling fat cow of self-servers gone mad. I vote they walk the plank.

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  4. Fisiani (849 comments) says:

    Family doctors see their registered patients and charge them for a consultation. If the patient does not like the outcome of the consultation then they can choose to see another doctor. If a family doctor does not please their patient the doctor loses future income. There is thus a pressure on family doctors to please their patients.
    Independent doctors are paid by ACC. They have a pressure to please ACC.
    The current situation is that there are thousands of people chronically on ACC payments who have been declared ‘unfit for any work’ by family doctors This is often manifestly wrong.
    Some people claim to be unfit for any work because they
    a) have some chronic pain
    b) are in a wheelchair
    c) have anxiety
    d) have depression
    e0) have had a troubled past.

    None of these reasons makes someone automatically unfit for work.
    There are people currently working who even have all 5 of the above elements in their life.

    It is not good for your mental health or self esteem to spend a long time on ACC if you do not need to.

    This initiative by ACC should be cautiously applauded but closely monitored.
    I would suggest that the independent assessors reports be anonymous if possible. This would negate any bias to produce an unfair report. If there was a dispute a second anonymous assessment , without any reference to any other report could be binding.

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  5. F E Smith (3,273 comments) says:

    I just want to confirm what Thomas Beagle said. The assessors are not independent at all.

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  6. Michael (880 comments) says:

    About 20 years ago I had a claim for assistance from ACC, they sent me to an independent assessor who poked and prodded me for about an hour before deciding I had a permanent disability. Not sure why this represents a headline now?

    Agree with Fisiani that being in a wheelchair doesn’t prevent you from working – there is a woman at my office who manages just fine. (In fact better than fine, she can even use the escalator with her wheelchair!)

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  7. krazykiwi (9,188 comments) says:

    [DPF: For me then the solution is not to do away with independent assessors, but to limit the amount of work each one does for ACC, so none of them are dependent on ACC]

    I know… we could retain some new independents to assess the absence of dependence on the part of indepdendent assessors :)

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  8. my 2 cents (1,091 comments) says:

    Maybe we should just scrap ACC and have private insurance with their independent assessors?

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  9. Pauleastbay (5,030 comments) says:

    Lets see some numbers before ” millions of dollars ” is banded about as gospel, this has become standard phraseology whenever spending is used to have a dig at the Government

    and

    [DPF: For me then the solution is not to do away with independent assessors, but to limit the amount of work each one does for ACC, so none of them are dependent on ACC]

    you are you to try and limit individuals earning, it takes time to build up a client base no matter who is paying the bill.

    Would you recommend pharmacists have to give up their govt contracts as well ?

    Imagine if rules were introduced David that stated you could only work for a client once every two years or once you’d earnt X amount off a certain client you had to pass him on to someone else.

    What utter bullshit

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  10. peterwn (2,932 comments) says:

    There are ways of dealing with ‘experts’. Many years ago in pre ACC days a woman was hit by a vehicle and there was a jury trial to assess negligence and fix damages – main issue was amount of damages.
    A O&G specialist had given an expert opinion that the pelvic injuries could cause childbirth problems later on.
    Insurance company doctor (insurance work being his main practice) said that in his opinion, it was unlikely to make a difference.
    Woman’s lawyer “How many deliveries have you personally conducted in the last 12 months?”
    Insurance doctor “None”.
    Jury was not impressed.

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  11. Pauleastbay (5,030 comments) says:

    “Million of dollars”

    1666 flights at $600 makes a million dollars – that is quite alot, and seeing as the quote is plural ” millions”

    And guessing say there might be 20 doctors on the service provider list, thats 83 flights each.

    I believe there may be some exaggeration in this article, imagine, exaggeration in the NZ media.

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  12. MH (558 comments) says:

    A long term patient must be assessed not just to ensure the integrity of the system but to encourage some form of recovery programme exists. Not convinced it needs a GP to do this as the patient has probably been subject to examination for some time. Rehab and physio people prob more useful in getting someone back to the grind.

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  13. duggledog (1,102 comments) says:

    Dear Santa
    Please allow me to be able to opt out of the ridiculously expensive ACC system and organise my own insurance. That goes for schools and hospitals too. And retirement. With a commensurate reduction in my taxes

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  14. BigFish (131 comments) says:

    If we’re going to have a choice of private insurers, then I want the heck regulated out of them. Last thing I want to see is accidents treated like Chch earthquke claims.

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  15. Bob R (1,250 comments) says:

    ***The independent assessors don’t have to maintain a long-term relationship with the person, so don’t get pressured so much into giving the benefit of the doubt so to speak.***

    Exactly right. Do you think a GP in a small town is going to be keen on saying some guy with Mongrel Mob connections is overstating his back strain?

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  16. PaulL (5,774 comments) says:

    As with all insurance, the people who take due care and who try to minimize their losses subsidise the rest. Or, to put it another way, those who don’t get injured, an those who get injured and get on with life, subsidise those who see ACC as an opportunity to bludge. These assesors seem like the only defence against that. So I say they’re a good thing.

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  17. Thomas the Unbeliever (141 comments) says:

    “… The independent assessors don’t have to maintain a long-term relationship with the person, so don’t get pressured so much into giving the benefit of the doubt so to speak. ….”

    The problem is that many of these so-called independent assessors ‘maintain a long-term relationship’ with ACC. In some instances, that relationship is a significant proportion of their income. I know of some assessors earning more than $200k a year from ACC. Sadly, these are the ones who their own colleagues acknowledge are not objective or balanced in their approach.

    Some disclosure of the highest earning assessors may assist. If the top Legal Aid lawyers can be named, then why not name the top recipients of ACC assessment contracts. I think the public might be a little shocked at the tight group of assessors – and the amount they are being paid by ACC.

    True independence requires greater transparency.

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  18. annie (533 comments) says:

    Couple of points:

    1. fisiani: “..If a family doctor does not please their patient the doctor loses future income. There is thus a pressure on family doctors to please their patients…” . This may to some extent be true, but you must also remember that a doctor’s relationship with their patient is based on duty to that patient, and to that patient alone. So in cases where there is significant doubt, the patient’s usual doctor must come down on the patient’s side.

    2. Thomas: “The problem is that many of these so-called independent assessors ‘maintain a long-term relationship’ with ACC.” Indeed. The quality of the assessors is also a concern in many cases – ACC has in the past had a reputation as a bit of a haven for at least some doctors who weren’t necessarily held in high regard.

    3. Many of the assessors routinely make assessments outside their area of expertise, sometimes totally in the face of reason, evidence and good sense. ACC case managers’ view tends to be that their assessors are some sort of experts, which in many cases is simply not true. Cunning GPs will try to get the patient reassessed by an appropriate specialist they know to be competent, but this isn’t always possible, especially outside the major metropolitan areas.

    One can only hope that the current cleanup of ACCs procedures and processes extends to include their clinical functions.

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  19. derriaghy (1 comment) says:

    I would love to have independent assessors available to all NZers. Reality is it just doesn’t always happen as it should. My husband was prescribed a statin 10 years ago, a few weeks later had renal failure and a stroke. He’s been left permanently injured. All was accepted by ACC until 2009 when the Recover Independence Service got involved and enter Dr Peter Jansen. He offered many opinions and hypothesis. Husband was sent to 15 assessors in 2 years. A harrowing experience. ACC weren’t happy with the results and opinions as they were all in favour of my husband. SO they kept going. Eventually the flew in a neurologist from Wellington to Auckland. Husband underwent 2 assessments with this new doctor. No surprise the new fellow came back with a report making comments on bladder control, psychiatry, muscoskeletal, renal and ACC loved it. We challenged the report. New doctor wrote 39 pages… we have again to challenge. We have complained to Health and Disability, Medical Council, Office of Complaints at ACC and lobbied MP’s to try and end the corrupt ACC regime but ACC are just a train wreck waiting to happen. A doctor wrote to ACC about our complaint when he changed his diagnosis after 10 years – stating he saw my husband as a private patient and not an ACC claimant. Unfortunately many people in NZ who have been injured a long time ago, are the passengers on the train and we are all suffering the consequences. So yes please, lets have truly independent and honest assessors.

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