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Why ACC make me want to scream

Regular readers will know that my wife suffered a serious (but not life-threatening) accident some 18 months ago.

Slipping on a food wrapper while going about her job as a relief teacher caused her to fall and break both bones (radius and ulna) in both arms. The fractures were severe and required an operation taking several hours to repair.

While on the operating table, she suffered a collapsed lung and a thrombosis (clot) in the other lung -- leaving her body's ability to absorb oxygen significantly compromised.

Shortly after her discharge from the hospital and during subsequent follow-up treatment in the weeks that followed, it became apparent that she had developed an involuntary movement of her arms and shoulders. This quickly progressed until her speech became affected and now her memory and cognitive functions are also reduced.

Our experience with ACC to this point had been less than positive. They had failed to process our claim properly which meant that on release from hospital, none of the promised support (including income-related compensation and home-help) was forthcoming.

It took several weeks of regular phone calls and complaints before my wife's claim was fully processed and ACC was seen to be performing the services it is supposed to under the contract which is formed when people pay their ACC levies.

Once it became clear that my wife's mental impairment was becoming debilitating and clearly needed some form of prompt treatment, we filed a new claim with ACC -- for a physical treatment injury.

This was declined. The rationale being that there was no absolute proof that she had incurred a physical brain injury as a result of the anoxia her brain suffered during and immediately after the operation.

When her condition worsened even further, my wife was admitted to Waikato Hospital's neurology ward. While there, numerous tests were conducted in an attempt to find the cause of her deteriorating brain function and involuntary movements. The doctors were divided in their opinions. Some suggesting that (despite the hypoxia she had suffered) her condition was a psychological response to the trauma of the accident -- but another strongly disagreeing with that diagnosis.

MRI scans had been taken but they were "inconclusive", showing some unexplained abnormalities that could equally have been artifacts of the MIR process.

We were no further ahead -- without a firm diagnosis and without any form of treatment.

So, we paid a small fortune out of our own pockets to recruit the services of the country's leading neuropsychiatrist to try and come up with a diagnosis and programme of treatment.

He decided that he also could not come up with a firm diagnosis -- it could be a physical injury, it could be psychological, it could be a bit of both. He recommended a new MRI at a higher resolution to try and ascertain whether the "anomalies" seen on the previous MRI were injury or an artifact of the scanning process.

Meanwhile,we'd filed an appeal against ACC's refusal to accept the brain-injury claim.

I should point out that it was now more than a year since my wife's injury and she still had no firm diagnosis or any form of treatment for anything other than the original broken arms.

The review authority ordered ACC to pay for a new MRI to determine whether the injury was physical or mental. We were advised to re-file our claim as a "mental injury as a result of a treatment". We were told that it was clear she had sustained an injury of some kind and that it was either a physical (brain) injury or a mental (psychological) injury. Either way, she had definitely suffered an injury as a result of treatment and therefore was covered by ACC.

My wife had two further MRIs (funded by ACC) which were equally as inconclusive.

We refiled as advised and expected that the new claim would be accepted since -- if it wasn't a physical injury it *must* be a mental injury -- right? At last, we thought we had a positive result.

Well guess what?

The new claim has been denied.

Let's summarise for a moment...

* ACC acknowledge my wife has sustained an injury as a result of treatment and therefore that injury is covered under the act.

* However, they refuse to accept a claim for physical injury as a result of treatment because they say it could be a mental injury -- claim denied.

* And now they refuse to accept a claim for mental injury as a result of treatment because they say it could be a physical injury -- claim denied.

Unless we can get a conclusive diagnosis that the cause of the treatment injury is undeniably physical or undeniably mental then they can continue to refuse either claim on the basis that it could be the other. This is surely a blatant act of the Corporation doing whatever it takes (ie: mis-use a technicality) to dodge its obligations without any consideration for the rights of, or the best outcome for the client.

Let me say again -- they do not dispute that my wife has suffered an injury that should be covered by ACC. They are simply engaging the use of a technicality to avoid any liability for coverage.

Will someone please step in and end this absolute lunacy so that my wife can get the treatment she so badly needs. I mean -- it's now been over 18 months since her accident and she has not had a single bit of treatment with no prospect of such on the horizon.

The reality is that it doesn't really matter *what* her injury is classified as. Speaking to the "experts", it's apparent that, regardless of the cause, the treatment my wife so badly needs will be based on addressing and mitigating the symptoms -- which involves physical therapy and psychiatric assistance to halt and (hopefully) reverse the progress of those symptoms.

Before anyone suggests it, I should point out that we went to our local MP -- nothing came of that. She simply referred us back to ACC.

So then we went to Nick Smith, the Minister for ACC. He referred us to Pansy Wong, the associate Minister for ACC at the time, who (between trips to China with her husband on the taxpayers' dollar) referred us back to ACC.

It is clear that the directive within the ranks of government MPs is "refer any constituent complaints back to ACC and let them dodge the bullets, that's what they're paid to do".

I should add at this stage that the time and money ACC has spent trying to avoid meeting their obligations on these claims must be enormous. What's more, because it has now been over a year and a half since the accident, the prognosis for any treatment is poor. I fear that my wife, once a vibrant, articulate, intelligent woman who held down a good job and contributed to the nation's coffers and ACC's levy pool every fortnight, is now destined never to work again and to suffer a dramatically reduced quality of life -- all because a bunch of penny-pinching bureaucrats have been directed to "save money".

To really show just how unprofessional ACC really is, the case-manager who declined our latest claim admitted that she had made her decision based on reports that she (having had no medical training at all) did not fully understand. When I asked how that can be -- she said that it was the "procedure".

What are our options?

Now we must appeal the latest ruling and go through the entire, time-consuming, costly, incredible stressful process again. If the last appeal is anything to go by, it will be at least four months before we see that process completed.

The shear frustration of this whole situation highlights beyond any doubt that ACC is fatally flawed. Neither delivering the service that was contracted, nor operating in a prompt, efficient manner so as to ensure that levy-payers are getting value for money. What's worse, ACC are ignoring their mission statement

Oh yes, the case managers all speak very sweetly and if I had a dollar for every apology I've received from them when ACC have dropped the ball, slipped up, failed to meet their obligations or otherwise made our life hell -- I'd be so rich we wouldn't need their help.

I challenge any of MPs to live the life my wife and I have had to endure over the past 18 months and still tell me that ACC is working.

I urge them to consider that you can't write human collateral off the ledger of an insurer like ACC without causing huge pain and suffering.

I also accuse the government, through ACC of deceit, fraud and breach of contract -- by demanding (with menaces) that people like my wife pay their ACC levies then defaulting on the delivery of the services those levies are supposed to provide, even after admitting her injury qualifies for coverage.

When ACC fail to deliver -- that's just too bad -- nobody to blame, no sanctions, no repercussions. However, if we failed to pay our levies -- we'd get hauled before the courts and prosecuted to the full extent of the law. Is that really fair?

To prove my point in respect to ACC's failure to perform... let's take some excerpts from the ACC's own "Statement of Intent 2009-2012"

"Rehabilitation is one of ACC's core functions. The Act states that where injuries occur, the primary focus of the organisation should be on rehabilitation with the goal of achieving an appropriate quality of life. This obliges ACC to provide entitlements that restore a client's health, independence and participation in work and the community"

Has my wife suffered an accidental injury? Yes! Has she been offered *any* rehabilitation through ACC so as to restore her health, independence and participation in work and the community? No!

So is ACC failing to meet its contractual obligations? Yes they are!

"As stated in the Act, the purpose of this Scheme is to 'enhance the public good and reinforce the social contract represented by the first accident compensation scheme by providing for a fair and sustainable scheme for managing personal injury that has, as its overriding goals, minimising both the overall incidence of injury in the community, and the impact of injury on the community"

Has ACC's attitude to handling my wife's claim been "fair"? No! Have they honoured their social contract in this instance? No!

I'm sorry but I now reach a point of deep despair in respect to this issue.

My wife's injury has affected not just her but also myself. There are two victims of ACC's arrogance, and dereliction of their contractual obligations in this case -- my wife and myself.

I know that we are but two of thousands who have been cast-adrift by ACC, an organisation that is clearly working on the principle that if you keep saying "no" then, regardless of the merits of someone's claim, they'll eventually give up and go away or just die.

Just as the word "accountability" has been struck from the parliamentary dictionary, "pragmatism" seems to have been expunged from the vocabulary of all those involved in ACC.

If my wife's original claim had been accepted, she might well have already been back at work, paying more tax, contributing once more to the ACC's coffers and performing a valuable role as a teacher of our youth. Instead, everybody pays. We get a quality of life that is nothing like what we'd imagined as we approach our late 50's. No doubt, in one way or another, my wife becomes an ongoing burden on the taxpayers' purse due to her untreated condition. And I mourn for the vibrant, intelligent, articulate partner that I once had and who could well have been returned to me if a few beancounters weren't so intent on saving a buck and any cost.

I know nothing much will come of this column -- when dealing with a faceless bureaucracy there can be no victory, there will be nobody held to account and no change will happen where it is most needed.

As my wife repeatedly asks, in the hesitant and awkwardly inflected cadence that her injury has created "all I did was break my arms, why won't anyone help me?"

How can I respond to that?

Because of her injury she has been re-reading the same page of the same book for over a year now. Her life is in stasis and ACC don't give a damn.

I thought torture was illegal in this country - it seems that so long it's the state inflicting the pain and anguish, it's not.

Thanks for reading.

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