New Zealand Case Law: Decisions & Judgments

Topic

Funding for treatment

Legal area

Court

26 Nov 2018

MG v Accident Compensation Corporation (Funding for Treatment)

Citation

[2018] NZACC 185
Court

District Court

On the balance of probabilities the medical evidence (CAP and physiotherapy review) established the appellant's thickened bursa and impingement resulted from a pre-existing, gradual impingement process related to acromial morphology and not the single-event accident; ACC therefore correctly declined funding for further physiotherapy. Interim name suppression was granted to permit specific evidential material but full suppression was not justified on the material before the Court.
25 May 2016

Henderson v Accident Compensation Corporation

Citation

[2016] NZACC 150
Court

District Court

On the balance of probabilities the parrot beak tear was caused by the 29 June 2013 accident because the mechanism and timing, the absence of prior knee problems, the treating surgeon's persuasive opinion, and MRI findings assessed in context made causation probable rather than attributable to degeneration; therefore ACC's decision to decline funding was quashed.
27 Feb 2015

Monaghan v Accident Compensation Corporation

Citation

[2015] NZACC 44
Court

District Court

On the balance of probabilities the District Court accepted the treating surgeon's reasoning and concluded the 29 February 2012 accident caused the majority of the rotator cuff tear; accordingly ACC's decisions declining to fund surgery were set aside as they failed to establish that the condition was not causally linked to a covered accident.
23 Feb 2015

Marsh v Accident Compensation Corporation

Citation

[2015] NZACC 39
Court

District Court

The court preferred the examined treating orthopaedic surgeon's opinion that the bench press incident caused bilateral rotator cuff sprains which produced bursal thickening and subsequent subacromial impingement; ACC's contrary reliance on generalized propositions and non‑examining advice (including factual errors) did not establish that an underlying gradual disease was the whole or substantial cause of the condition requiring treatment, therefore the treatment claim was covered and ACC's refusal was unjustified.
30 Oct 2014

Webster v Accident Compensation Corporation

Citation

[2014] NZACC 282
Court

District Court

On the balance of probabilities the full thickness supraspinatus tear was caused by the 25 November 2009 accident; the treating surgeon's (Dalgleish) opinion was compelling and addressed mechanism, timing and imaging; therefore ACC's decision and the review decision denying that causal link were wrong and must be quashed and set aside.
30 Jan 2014

Perry v Accident Compensation Corporation

Citation

[2014] NZACC 22
Court

District Court

On the balance of probabilities the available evidence—including imaging showing degenerative change, the appellant's rheumatoid arthritis, independent medical adviser opinions, and the intraoperative findings that rebutted the ultrasound tear diagnosis—demonstrated the shoulder pathology was the result of a gradual degenerative process (and related conditions) rather than the 15 December 2006 accident; therefore the respondent was correct to decline funding and the appeal is dismissed under the Accident Compensation Act 2001 statutory framework.
29 Nov 2012

Harrer v Accident Compensation Corporation

Citation

[2012] NZACC 391
Court

District Court

Weight given to the specialist evidence of Dr Laubscher that physical interventions (physiotherapy/chiropractic) produced only short-term benefit and that multidisciplinary pain management was the appropriate option, combined with absence of formal referral/prior approval and lack of evidence of sustained improvement, meant the treatments were not established as necessary and appropriate under Schedule 1; therefore ACC's decisions to refuse funding/reimbursement were upheld and the appeal dismissed.

New Zealand Case Law

MG v Accident Compensation Corporation (Funding for Treatment)

Henderson v Accident Compensation Corporation

Monaghan v Accident Compensation Corporation

Marsh v Accident Compensation Corporation

Webster v Accident Compensation Corporation

Perry v Accident Compensation Corporation

Harrer v Accident Compensation Corporation