New Zealand Case Law: Decisions & Judgments

Topic

Prior approval requirement

Legal area

Court

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.
12 Nov 1999

Draper v Accident Rehabilitation and Compensation Insurance Corporation

Citation

[1999] NZACC 321
Court

District Court

Despite hardship and unfairness in the facts, the clear wording of the Regulations and binding High Court authority in Walsh require prior approval before the Corporation can be liable for specialist procedure costs; the Court will not imply an exception where the statutory words are plain, so the appeal is dismissed.
8 Sept 1999

LGS v Accident Rehabilitation and Compensation Insurance Corporation

Citation

[1999] NZACC 254
Court

District Court

The appeal is dismissed because Regulations 5 and 11 require prior approval as a precondition to payment, no applicable exception applied to the appellant's facts (complications arose after unapproved treatment and were not discovered during approved treatment), and there is no statutory power to award ex gratia payments; Walsh is binding authority.
12 Apr 1999

Strang v Accident Rehabilitation and Compensation Insurance Corporation

Citation

[1999] NZACC 90
Court

District Court

Regulation 11 of the Specialists Costs Regulations mandates prior approval by the Corporation for payment of specified surgical procedure costs and admits no discretion to approve retrospectively; because the appellant did not obtain prior approval his claim for payment must be refused.
5 Feb 1999

Mangino v Accident Rehabilitation and Compensation Insurance Corporation

Citation

[1999] NZACC 22
Court

District Court

Regulation 11 unambiguously requires prior approval for specified specialist procedures and, as confirmed by ARCIC v Walsh, no emergency exception or discretion exists; therefore the Corporation was correct to decline payment where no prior approval was obtained and the appeal must be dismissed.
11 Sept 1998

Fournier v Accident Rehabilitation and Compensation Insurance Corporation

Citation

[1998] NZACC 199
Court

District Court

The judge accepted the respondent's submission and followed ARCIC v Walsh, holding that Regulation 11(1) is to be given a strict construction and does not provide scope for an emergency exception or implied words to avoid the prior approval requirement; accordingly leave to appeal to the High Court was declined.
17 Dec 1997

LAF v Accident Rehabilitation and Compensation Insurance Corporation

Citation

[1997] NZACC 265
Court

District Court

Regulation 11(1) unambiguously requires prior approval from the Corporation before payment for the specified specialist procedure; courts may not read exceptions into that clear regulatory requirement, therefore the respondent is barred from paying the appellant's hospital costs incurred without prior approval.
10 Nov 1997

Pratt v Accident Rehabilitation and Compensation Insurance Corporation

Citation

[1997] NZACC 226
Court

District Court

Dismissal based on (1) no evidential link that the suspected tumour was accident-related so s.27 did not authorize payment and (2) even if accident-related payment was barred because mandatory prior approval under the Specialists Costs Regulations (reg 5(a)) was not obtained, and precedents confirm no discretion to override that requirement.
9 Sept 1997

Messner v Accident Rehabilitation and Compensation Insurance Corporation

Citation

[1997] NZACC 180
Court

District Court

Claims for treatment, rehabilitation and attendant care arising after 1 July 1992 were not payable because no entitlement under the 1982 Act was shown to be preserved by ss135,136 or 149, the 1992 Act and its regulations did not authorise overseas treatment for injuries sustained in New Zealand, and required prior approvals were not obtained; accordingly the Corporation had no power to pay and the appeal was dismissed.
6 Jun 1997

SPP v Accident Rehabilitation and Compensation Insurance Corporation

Citation

[1997] NZACC 109
Court

District Court

Regulation 5(a) plainly requires the Corporation to be satisfied before the procedure is performed and does not permit retrospective approval; because the appellant did not obtain prior approval and the Corporation had rejected the claim at the time of procedures, the appeal fails and payment cannot be ordered.