In February this year Derek and I decided that he would apply for a Treatment Injury claim against Accident Compensation Corporation (ACC) for the DIC/CAPS which caused the Adrenal Insufficiency.
Definition of Treatment injury
(1) Treatment injury means personal injury that is— (a) suffered by a person— (i) seeking treatment from 1 or more registered health professionals; or (ii) receiving treatment from, or at the direction of, 1 or more registered health professionals; or (iii) referred to in subsection (7); and (b) caused by treatment; and (c) not a necessary part, or ordinary consequence, of the treatment, taking into account all the circumstances of the treatment, including— (i) the person's underlying health condition at the time of the treatment; and (ii) the clinical knowledge at the time of the treatment.
We were very surprised but very pleased when they accepted, without argument, that he had suffered a treatment injury, and they would cover the costs of his time off work, any treatments for his now permanent condition of adrenal insufficiency, an anything else related to his multiple organ failure.
He had taken sick leave from 28 Sept (the day before surgery, but day of admission to hospital), with the intention of returning to work from home, on 8 October.
On 2 October Derek visited the Dr for the first time due to being unwell after surgery (a very important date).
After the Treatment Injury was accepted, we were told that Derek could get reimbursement for the time he had to take of work between October and January. This meant that all the leave Derek had had to take so he could lay in a hospital bed dying, or sit at home recovering, would be given back to him by his boss as ACC would reimburse Derek, and Derek could reimburse work.
The process is that ACC agree the dates to be paid, they calculate how much to pay, based on information from your employer, then they pay you, and you pay your employer back in some way (it is up to you and your employer how this is done).
The reinstatement of your wages should not disadvantage you or your employer, but ACC are not interested in the details.
After much toing and frowing, ACC decided that Derek should have been off work for 4 weeks after surgery, and therefore he was incapacitated from surgery, and so ACC would not reimburse him for those 4 weeks, but would reimburse his wages after that period. This was regardless of the fact we had given very clear evidence that Derek’s intention was to work.
When you receive reimbursement of wages from ACC, you do not get the first week you are off work, but you get every week after that.
According to our calculation ACC should pay reimbursement from 2 October (legal date set for treatment injury as it was the first date we sought treatment), with a 1 week non payment period, that made first day of payment 10 October.
ACC’s idea was Surgery on 29 Sept, plus a 4 week recovery from that surgery made the date of incapacity from treatment injury the 26 October. Therefore, no payment until 26 October. They did allow the 1 week non reimbursement to be during the period from 2 – 10 October.
We argued this point several times, but in the end our Case Manager, and Her manager, made a decision. We were told very clearly that Derek would have his wages reimbursed from 26 Oct. IF we didn’t agree with the decision, we could apply for a review. If the person conducting the review agreed with the initial decision, and we were still unhappy, we could go to court. We asked for them to produce the case law that supported their decision. Derek’s Case Manager’s Manager actually told Derek on the phone that his would be a good “Test Case” for reimbursement.
Basically we were told they didn’t have to prove they were right, we had to prove they were wrong.
We deiced that this is what we would do, once we received their letter detailing why they had set the date as 26 October.
We then waited for the payment. Day after day, we checked our bank account to see if the money had come in. Derek’s boss was waiting for his reimbursement. We planned to take a break, believing that Derek would have leave reinstated once the reimbursement was sorted out.
3 weeks later and still no payment. Derek made phone calls to find out what was happening.
Finally he received a phone call from his case manager. She was trying to sound like she was happy to be giving him the good news. His reimbursement had been calculated and approved. And the really good news…………….
Somebody, somewhere (not in the local office) had basically told Derek’s case manager and her manager, to pull their head’s in. They were both wrong, and Derek’s reimbursement would be from 10 October (the date WE believed was correct). His case manager had been over ruled in a major way.
She didn’t sound happy to have been told she was wrong but tried to make it sound as if she was pleased for us. She may have been. Ultimately we don’t care. Somebody at ACC had seen sense, and we had won our argument, without having to fight.
It is a small win, but a matter of principle. So, if you are on sick/annual leave, or working from home (whether a normal situation, or a special setup) you are entitled to weekly compensation for time off work.
If any one reading this is fighting over their Incapacity date because they were injured on sick/annual leave, make sure you fight for your rights. ACC seem to work on the idea that, if they fight long enough, you will be too tired to argue, and you will accept what ever they say.
You don’t have to accept it. You just have to have someone in your corner that can take up the fight when you are too tired.
Accident Compensation Corporation say they are there for you, and most of the people we have dealt with at ACC have been wonderful. But the Lower Hutt’s Long Term Claims branch appears to be there to drag the chain, and sometimes appear less professional, seeming to spend their time working on reducing your entitlement with little regard for the ACC act. When asked what section of the Act they were using and how it was being applied we were simply told “it was their decision, end of story.
This aspect is the worst from that division. We have a very long list of problems caused by that department, from reading information from other people’s files to you, to stating dates, and then getting those dates wrong, to making decisions that go completely against their own policy.
For someone who does not have Stress Hormones ACC are making Derek sicker and costing ACC more money as he ends up off work due to his Adrenal Insufficiency and they are legally obliged to pay his sick pay.