Haitana v Accident Compensation Corporation

IN THE DISTRICT COURT HELD AT WANGANUI Decision No. 251 /2001 IN THE MATTER of The Accident Insurance Act 1998 AND IN THE MATTER of an Appeal pursuant to Section 152 of the Act BETWEEN KEITH HAITANA AI 68/01 Appellant AND ACCIDENT COMPENSATION CORPORATION Respondent HEARD at WANGANUI on the 7th day of June 2001 APPEARANCES: Mr K Haitana in person Mr A Sherriff counsel for respondent RESERVED JUDGMENT OF JUDGE M J BEATTIE [1] The issue in this appeal is whether the respondent was correct, by its decision of 27 October 2000 to suspend entitlements to the appellant. [2] The facts which are relevant to the determination of this issue can be shortly stated as follows. [3] The appellant, now aged 64 years, suffered an injury to his right shoulder on 24 May 2000 when he hit the wall with his shoulder whilst playing squash. 68 01haitana.doc (gm) [4] The appellant consulted his GP, Dr Corbett, who diagnosed a sprain to his right upper arm/shoulder and a claim for cover was made in respect of that injury. The appellant was prescribed acupuncture and physio and a MRI report of 24 July 2000 noted that the muscles and tendons appeared normal and that there was no evidence of rotator cuff pathology or tears. However, there was an appearance of a subdeltoid bursitis. [5] The appellant was referred to Dr Wigley, a Consultant Rheumatologist, and Dr Wigley determined that in addition to the subdeltoid bursitis the appellant was also displaying the condition of polymyalgia rheumatica. [6] On receipt of this report the respondent sought the opinion of the appellant's GP as to whether the polymyalgia rheumatica was connected to the injury suffered in the accident and Dr Corbett responded that it was not but that the appellant's symptoms of the right shoulder were attributable to the accident. [7] The circumstances of the appellant's medical conditions were referred to Mr M Shatwell, Consultant Orthopaedic Surgeon, who reviewed the appellant's file and found that it was reasonable to assume that the contusional sprain that the appellant had suffered on the squash court would have settled within six to eight weeks but that the current symptoms were those of polymyalgia rheumatica and as such had arisen quite independent of any personal injury by accident. [8] It is to be noted that the treatment prescribed by Dr Wigley proved successful in treating the polymyalgia and by December 2000 the appellant was fit to return to work full time. [9] The review decision of 24 January 2001 confirmed the respondent's primary decision that entitlements to the appellant should be suspended and the appellant has now appealed against that decision to this Court. [10] In the written submissions made to the Court the appellant indicated that, whilst he accepted the respondent's decision, his concern was that the circumstances and fact of the injury to his shoulder on the squash court should be noted as being separate and distinct from the condition of polymyalgia rheumatica which subsequently arose and which was not compensable under the Act. His reason for this was so that in the event that his shoulder injury should again cause problems and 68 01haitana.doc (gm) 2 require treatment or give rise to other entitlements, that condition would not be lost sight of and somehow submerged within the condition of polymyalgia rheumatica. [11] Mr Sherriff for the respondent submitted that the evidence was quite clear that there were two separate and distinct conditions and that the medical evidence was that the injury for which the appellant had been given cover had resolved and therefore there was no basis for continuing entitlements. DECISION [12] It seems that there is not any dispute by the appellant that he did coincidentally suffer from two separate conditions, one shortly after the other, and that one arose out of the striking of his shoulder against the wall on the squash court and the other arose from causes unrelated to accident. [13] In circumstances such as that, it is for the appellant to establish that there continues to be an entitlement for the personal injury by accident for which he was granted cover as opposed to the injury or condition which is not compensable. Having regard to the medical evidence it is clear that the polymyalgia rheumatica became the dominant condition for a time until it too was successfully treated by various steroid injections, and the subdeltoid bursitis, which was the culmination of the injury for which the appellant had been given cover, had also resolved as well but had resolved prior to the resolving of the polymyalgia rheumatica. [14] In those circumstances, it was correct for the respondent to advise the appellant that his entitlements must be suspended and this is the effect of its decision. [15] It should be noted that the respondent's decision was simply a suspension of entitlements pursuant to section 1 16 on the basis that the appellant was not satisfied from the information in its possession that the appellant was entitled to continue to receive statutory entitlements. The decision is that of suspension and it is not a cancellation of entitlements or cancellation of cover. The appellant still retains the right to again apply for any statutory entitlements in respect of that personal injury for which he was granted cover as and when medical evidence determines that such entitlements are required. 68 01 haitana.doc (gm) 3 [16] The respondent's file does clearly establish the distinction between the personal injury for which he was granted cover and the non compensable disease of polymyalgia rheurmatica and the appellant should not be concerned that his compensable injury might not be identified if some future claim for entitlement were to be made. [17] I note that the appellant produced a note from his GP, Dr Corbett, in which he clearly identified the two separate conditions and for which the appellant received separate treatment and this note also forms part of the record of this appeal. [18] Accordingly then, I find that there is no basis for determining that the respondent's decision was in any way not correct but at the same time the appellant can be assured that his compensable claim remains "registered" on the file. [19] This appeal is dismissed. DATED at WELLINGTON this G day of September 2001 M J Beattie District Court Judge 68 01haitana.doc (gm) 4