It’s one of the most disheartening things that can happen in an ACC claim. ACC accepts cover for your injury, and you have sought entitlements, and then ACC revokes and declines that cover. Being told your cover has been revoked, and that no further entitlements will be provided, is not the end of the road. These decisions can be reviewed like any other.
ACC has the power to revoke cover where it considers that the decision to grant cover was made in error. An example may be where ACC provides cover for a meniscal tear in your knee, or a disc prolapse in your back and then, after obtaining further evidence decides this condition was not caused by the accident. On that basis it revokes and declines cover which means that you will no longer receive entitlements under the claim – even though your specialist says the injury is caused by accident.
What’s really being decided
Almost always, the question is one of causation. Was the accident a material cause of the injury that ACC decided to cover, or is it caused by something else? Without cover you cannot usually receive entitlements, potentially effectively bringing an end to your claim and support from ACC. ACC can revisit its’ decisions, and it will often rely on a paper-based review of your file, or a single opinion, to conclude its’ decision to grant cover was made in error. That conclusion is almost always arguable.
Where a review makes the difference
A central issue in these types of cases is usually the medical evidence. Whilst not always necessary, new evidence, especially from your treating specialist who knows your case, supporting the causal link between your injury and the accident is always helpful. Thorough reading of ACC’s full file to see exactly what its decision was based on, enables us to establish whether the evidence really supports revoking cover, and whether further evidence is required. Reviewers can award up to $4,150 (inclusive of GST) towards the cost of obtaining a further medical report.
The takeaway
Cover that’s been granted and then revoked is not settled — it’s a decision, and decisions can be wrong. If cover has been expressly granted then the law puts an onus on ACC to show that it made the decision to grant cover in error, which can be a high bar to reach. Additionally, if your treating specialist still considers there is a causal link between your injury and the accident, that’s exactly the kind of case worth reviewing.
This is an illustrative scenario for general guidance only. It is not a description of a specific client’s case, legislative provisions can change, and every claim turns on its own facts.