New Zealand Case Law: Decisions & Judgments

Topic

Funding for elective surgery

Legal area

Court

11 Apr 2016

Holland v Accident Compensation Corporation

Citation

[2016] NZACC 91
Court

District Court

The appeal is dismissed because the appellant failed to prove on the balance of probabilities that the 11 May 2014 accident caused the L4/5 disc prolapse requiring surgery; the contemporaneous imaging and clinical notes, together with independent expert and Panel opinions, indicated longstanding degenerative disc disease and spondylolisthesis predating the accident, so ACC correctly declined funding.
7 Oct 2014

Wagener v Accident Compensation Corporation

Citation

[2014] NZACC 250
Court

District Court

On the balance of probabilities the Judge found that by early 2010 the appellant's ongoing shoulder problems were substantially caused by subacromial impingement and age‑related deterioration leading to tears; the 2 August 2008 injury was not the whole or substantial cause, therefore ACC's decisions denying weekly compensation and surgery funding were correct and are upheld.
27 Jul 2012

Lattimore v Accident Compensation Corporation

Citation

[2012] NZACC 252
Court

District Court

The appeal was dismissed because the Court lacked jurisdiction to consider the substantive May 4, 2010 decision until the appellant obtained the intermediary determinations under s135(3) confirming extenuating circumstances for the late filing of reviews; those determinations had not been sought or obtained, so the Reviewer correctly declined jurisdiction.
16 May 2012

Coop v Accident Compensation Corporation

Citation

[2012] NZACC 171
Court

District Court

After weighing the written medical opinions and available imaging together with intraoperative findings, the Court concluded on balance that the condition requiring surgery was probably caused wholly or substantially by a pre-existing degenerative process (rotator cuff arthropathy/glenohumeral osteoarthritis) rather than by the covered accidents; therefore funding exclusion under s26(2) applied and the appeal was dismissed.
21 Mar 2012

Taramai v Accident Compensation Corporation

Citation

[2012] NZACC 92
Court

District Court

Because the MRI and medical evidence established advanced osteoarthritis and did not demonstrate that the intra-articular loose bodies or pathology were caused by the covered knee sprain, the appellant failed to prove on the balance of probabilities that the proposed surgery was to treat a condition causatively linked to a covered injury; therefore the decision declining funding was correctly upheld.
21 Oct 2011

Hall v Accident Compensation Corporation

Citation

[2011] NZACC 314
Court

District Court

On the balance of probabilities the court accepted the treating surgeon's credible opinion that the 10 May 2007 fall produced a sudden injurious change (acute L4/5 disc protrusion with instability) rather than a condition caused wholly or substantially by a pre‑existing degenerative process; accordingly the ACC review decision and the Corporation's declinature were quashed and funding required.
27 Jan 2011

McKee v Accident Compensation Corporation

Citation

[2011] NZACC 18
Court

District Court

On the balance of probabilities the Court found the appellant's Type II SLAP lesion was causally linked to the covered 1 March 2003 shoulder injury given (a) continuous symptoms since the injury, (b) contemporaneous physiotherapy concern that a SLAP may have been missed after 2007 surgery, (c) the treating surgeon's later concession that the lesion was likely missed at arthroscopy, and (d) supportive expert opinion; accordingly ACC's decision declining funding was quashed and replaced with a decision to fund the requested surgery.
11 Nov 2010

Aberhart v Accident Compensation Corporation

Citation

[2010] NZACC 201
Court

District Court

On the balance of probabilities the District Court accepted the Clinical Advisory Panel and medical literature over the treating surgeon’s view because the CAP’s opinion fit the appellant’s documented history of prior inversion injuries and established pathophysiology; therefore the peroneus brevis longitudinal tear was more likely degenerative/repetitive in origin and not caused by the 31 October 2007 accident, so ACC correctly declined funding and the appeal fails.
15 Dec 2008

Shanks v Accident Compensation Corporation

Citation

[2008] NZACC 293
Court

District Court

The proposed L3/4 decompression was treatment for a pre-existing degenerative spinal stenosis that was longstanding and not caused by the 27 April 2007 accident; symptomatic exacerbation of a non-covered condition does not create entitlement to ACC-funded surgery, so the respondent correctly declined funding and the appeal is dismissed.