New Zealand Case Law: Decisions & Judgments

Topic

Pre‑existing condition exclusion

Legal area

Court

16 Oct 2018

Reesby v Accident Compensation Corporation (Entitlement to Surgery)

Citation

[2018] NZACC 162
Court

District Court

On the balance of probabilities the appellant failed to establish that the medial meniscal and patello-femoral chondral pathologies were caused by the 6 April 2015 accident; the CAP's analysis, supporting evidence of pre-existing symptoms, delay in claim, equivocal imaging and continued activity outweighed the treating surgeon's tentative opinion, therefore ACC's refusal to fund surgery was correct and the review decision is upheld.
7 Sept 2018

Fabish v Accident Compensation Corporation (Suspension of Entitlements)

Citation

[2018] NZACC 143
Court

District Court

The appeal was dismissed because the reviewer and Court were satisfied on the balance of probabilities that the appellant's ongoing back condition was better explained by pre-existing and age related degenerative pathology and competing medical evidence, so the Corporation was justified in suspending entitlements under s117.
23 May 2018

Peni v Accident Compensation Corporation (Entitlement to Surgery)

Citation

[2018] NZACC 77
Court

District Court

On the medical evidence, particularly the Clinical Advisory Panel opinion, the tibialis posterior insufficiency is a progressive degenerative condition rendered symptomatic by the covered sprain but not caused by a single traumatic event; therefore ACC correctly declined to fund the surgery and the review decision was rightly upheld.
21 Dec 2016

Thompson v Accident Compensation Corporation

Citation

[2016] NZACC 340
Court

District Court

On the balance of probabilities, having considered the temporal connection, the perioperative delirium and the weight of specialist opinion, the Court concluded the cognitive impairment was caused by an embolic/ischaemic phenomenon attributable to the cardiac surgery and was not substantially or wholly due to underlying small vessel disease; therefore the injury qualified as a treatment injury under s32 and cover must be granted.
6 Sept 2013

Aldridge v Accident Compensation Corporation

Citation

[2013] NZACC 289
Court

District Court

The acute inflammatory change caused by the covered ankle sprain produced symptomatic posterior impingement; excision of the long posterior talar process and debridement were treatment of that covered injury because the anatomical variant was an extraneous irritant preventing healing, so the surgery was a compensable consequence of the accident.
27 Jul 2012

Accident Compensation Corporation v Mehrtens

Citation

[2012] NZACC 250
Court

District Court

The Reviewer’s factual finding that a forced hyperextension occurred was not displaced; on the balance of medical opinion the treating surgeon's view that the accident was a substantial contributor to the scapholunate ligament rupture and hence a substantial contributor to the need for surgery was more persuasive; accordingly ACC must fund the surgery and the review decision refusing funding is quashed.
7 May 2003

Pitkethley v Accident Compensation Corporation

Citation

[2003] NZACC 79
Court

District Court

The court held that monthly Internet account payments were not an 'aid or appliance' or a key aspect of social rehabilitation payable by the insurer because the claimant had alternative means (fax/writing), had already installed equipment, and the ongoing service cost was not a direct result of the covered injury; and that the cochlear implant was excluded because the need for treatment arose wholly or substantially from the claimant's well documented pre-existing progressive otosclerosis, not solely from the medical misadventure.
2 Mar 2001

Adair v Accident Compensation Corporation

Citation

[2001] NZACC 38
Court

District Court

On the balance of probabilities the medical evidence as a whole established that the appellant's ongoing condition is attributable to gradual degenerative change rather than the 1991 compensable injury; the appellant failed to prove the 1991 injury was the predominant cause of ongoing disability, so suspension of entitlements was correctly made under s29 and upheld on review.
1 Jul 1999

Joslin v Accident Rehabilitation and Compensation Insurance Corporation

Citation

[1999] NZACC 167
Court

District Court

On the balance of probabilities the medical evidence established that the appellant's present incapacity is substantially attributable to pre‑existing progressive degenerative changes in the lumbar spine rather than the 9 July 1993 accident, therefore the respondent was correct to cancel weekly compensation under s.10(2)(a).