New Zealand Case Law: Decisions & Judgments

Topic

Pre-existing condition

Legal area

Court

27 Jun 2019

Tukutama v Accident Compensation Corporation (Entitlement to Surgery)

Citation

[2019] NZACC 71
Court

District Court

On the balance of probabilities the Court accepted the Clinical Advisory Panel and independent orthopaedic assessment that the pathology for which surgery was sought was longstanding and/or pre-existing; the July 2016 accident at best aggravated pre-existing disease but did not cause the conditions requiring surgery, therefore ACC liability for the requested surgical treatment was not established and the appeal must be dismissed.
6 May 2019

Lin v Accident Compensation Corporation (Entitled to Surgery)

Citation

[2019] NZACC 43
Court

District Court

The judge found, on balance of probabilities, that the appellant failed to establish the necessary causal link between the covered ankle sprain and the condition requiring surgery; the Court preferred the Clinical Advisory Panel's view that the accessory navicular was a developmental condition rendered symptomatic by chronic/repetitive stress rather than by a single traumatic event, and dismissed the appeal.
22 Feb 2019

Bertram v Accident Compensation Corporation (Entitlement to Surgery)

Citation

[2019] NZACC 16
Court

District Court

The Judge found on the balance of probabilities that the need for the 2017 L3/4 surgery was predominantly and substantially caused by a gradual age‑related degenerative process present before the 2011 accident and not by the 2013 fusion; the fusion was not a dominant or material cause of the adjacent segment disease, and therefore ACC was not liable to fund the surgery.
31 Oct 2018

Williams v Accident Compensation Corporation (Funding for Surgery)

Citation

[2018] NZACC 169
Court

District Court

Weighing the medical evidence, the Court concluded the TFC pathology is chronic and degenerative and pre-dates the 2016 accident; the accident rendered that pre-existing pathology symptomatic but did not cause the pathology requiring surgery, so the need for surgery is not covered and ACC's decline is upheld.
26 Sept 2018

Burton v Accident Compensation Corporation (Entitlement to Surgery)

Citation

[2018] NZACC 153
Court

District Court

On the balance of evidence the court accepted the treating surgeon's opinion that the accident caused an acute supraspinatus tear and materially aggravated bursitis despite underlying degenerative AC joint pathology; accordingly ACC's refusal was set aside and ACC must contribute to the costs of surgery to the extent it treated the injury-related condition identified in the ARTP of 13 December 2016.
17 May 2018

Milner v Accident Compensation Corporation (Funding for Surgery)

Citation

[2018] NZACC 75
Court

District Court

On the evidence the appellant failed to prove on the balance of probabilities that the multi‑level lumbar pathology requiring surgery was caused by the 2014 accident or was a covered consequence of earlier ACC injuries; independent expert opinion and imaging established congenital/developmental and long‑standing degenerative causes for the stenosis and the surgery treated degeneration, so ACC's decline and the reviewer’s decision were correct and must be upheld.
4 Nov 2016

Cornwall v Accident Compensation Corporation

Citation

[2016] NZACC 295
Court

District Court

Having considered additional evidence and expert reports, and applying Mehrtens factors and the Ambros inference, the Court preferred the treating surgeon Mr Love's coherent clinical opinion and found on the balance of probabilities that the December 2011 accident most probably caused the appellant's labral tear; the reviewer’s declinature was quashed and ACC must fund the proposed surgery.
19 Oct 2016

Pahi v Accident Compensation Corporation

Citation

[2016] NZACC 284
Court

District Court

Weighing the divergent expert opinions under the Ambros approach, the Court found there was sufficient material on the balance of probabilities — including a strong temporal link and specialists' acknowledgement of a possible connection — to infer that the 31 May 2012 workplace event caused the loose body to become dislodged/symptomatic; accordingly the Aon decision and the review were quashed and the appellant was entitled to ACC cover for the 2012 accident.
29 Jul 2016

Fulton v Accident Compensation Corporation

Citation

[2016] NZACC 200
Court

District Court

The court accepted the Clinical Advisory Panel's analysis that the appellant's Charcot pathology was a progressive disease process related to longstanding diabetes and that the 5 August 2011 event at most rendered that disease symptomatic rather than being its cause; therefore the need for the contested surgery was not caused by a covered injury and ACC's refusal to fund was correct.
27 Jul 2016

Rehn v Accident Compensation Corporation

Citation

[2016] NZACC 194
Court

District Court

The appellant failed to prove on the balance of probabilities that her need for right shoulder surgery was caused by the 19 October 2013 accident; the Court preferred the CAP medical opinion that the condition was degenerative tendinopathy related to a pre‑existing process, so ACC's decision to decline funding was upheld.