I am updating a post I made recently about a small win against ACC over the 4 weeks that Derek’s case manager was saying they did not need to pay his wages because he was incapacitated by surgery.
We received a phone call to say the stand-down had been cancelled, and that he would be paid. We now have documents from ACC which state clearly WHY it was changed.
It is a matter of Law. Do Not let them refuse the cover just because. The following is from the Policy Department regarding incapacity from injury.
ACC cannot set a stand-down period greater than 1 week from Date of First Incapacity (see Section 97) and ACC cannot set a stand-down period at any time on the basis that we have in this case. I.e., ACC cannot say “but for the injury you would have been off work because of your surgery for 1 month, so we won’t pay you for that month”.
The whole picture changes once an injury that is covered by ACC causes or contributes to the incapacity. As soon as a covered injury becomes a substantial contributor to the incapacity, then weekly compensation is payable (provided that the other statutory criteria for eligibility are satisfied), regardless of the presence of the non-covered condition and that conditions contribution to incapacity (unless that condition is the whole cause of the incapacity).
Basically, if you suffer an injury of any type that incapacitates you, even if you are on sick leave at the time, ACC MUST pay you.
If anyone reading this is in this situation, feel free to copy the quoted part of this post to use.
When we were in a face to face meeting with the case manager, we again questioned her decision. She agreed to go and ask another case manager. She came back and said she had received conflicting advice (she didn’t say she was told she was wrong) and would have to ask her Technical Claims Manager for further advice.
She then wrote notes of our meeting in which she states:
I met with client F2F. He was not happy that ACC are trying to find out how long he would have taken to recover from his surgery and take this into consideration in the stand-down period. This was approved by BMA and TM. However I have spoken to another CM and appears I received incorrect adivse, referring this to TCM.
Even when told she was wrong, she continued on the path. Question, and re-question every decision your Case Manager makes. If it is not in your favour, it may be wrong.
The Case Manager told us that the Technical Claims Manager (TCM) agreed with her even after being told they were wrong. The TCM was ALSO wrong, but refused to admit it. His attitude was, I have made a decision, if you don’t agree with it, seek a review and bugger you. We will be putting a formal complaint in about his attitude.
The parts in italics are direct quotes from the paper work received from ACC. It is a matter of record that she was told she was wrong but refused to change her mind.