New Zealand Case Law: Decisions & Judgments

Topic

Revocation of cover

Legal area

Court

17 Jul 2019

Tau v Accident Compensation Corporation (Cover and Entitlements)

Citation

[2019] NZACC 85
Court

District Court

On the evidence the 1991 right hip injury was misdiagnosed — radiology and multiple expert opinions establish an accessory ossicle not an acute fracture — therefore revocation under s65 was valid; for the 2001 accident, expert evidence (examining ophthalmologist and document review) established on the balance of probabilities that trauma contributed materially to right eye corneal scarring and visual loss despite pre-existing keratoconus, so cover for visual loss is warranted; the 2015 lumbar sprain is spent and suspension of entitlements for that injury is lawful under s117 but the medical r…
26 Jun 2019

Ali v Accident Compensation Corporation (Deemed Decision)

Citation

[2019] NZACC 67
Court

District Court

The Court upheld the reviewer: AMP lawfully revoked the deemed cover because the medical evidence established Charcot arthropathy related to poorly controlled diabetes was the substantial cause of the foot fractures (s26(2) exclusion), and no deemed review decision arose under s146 because a hearing date had been set within the statutory period; therefore the revocation and suspension of entitlements were justified.
2 May 2019

Crosswell v Accident Compensation Corporation (Revocation of Cover)

Citation

[2019] NZACC 37
Court

District Court

The appellant failed to prove on the balance of probabilities that she sustained an acute sprain (an accident) on 3 May 2016; the reliable medical evidence established a distal tibial stress fracture caused by repetitive loading (a gradual process), therefore the Corporation properly revoked cover under s65 and the reviewer's decision was not unreasonable or legally erroneous.
11 Jul 2018

Edwin v Accident Compensation Corporation (Cover Issues)

Citation

[2018] NZACC 110
Court

District Court

The Court held that to obtain cover under s26(1)(c) the mental injury must be caused by a physical injury; evidence did not establish that the applicant's PTSD was caused by a physical injury (smoke inhalation) from the fire, so ACC's decision to decline cover and revoke the earlier grant was correct; appeal dismissed.
10 May 2018

Rankin v Accident Compensation Corporation (Leave to Appeal)

Citation

[2018] NZACC 70
Court

District Court

The application for leave failed to show a novel question of law because the High Court has held that revision of a deemed decision under s65(2) does not require the Corporation to establish the deemed decision was made in error, removing the basis for leave.
9 Feb 2018

Carson v Accident Compensation Corporation (Revocation of Cover)

Citation

[2018] NZACC 34
Court

District Court

The court found the deemed grant of cover for the January 2010 shoulder claim was made in error because contemporaneous records and multiple expert opinions established a pre‑existing degenerative rotator cuff tear with no reliable evidence of a discrete traumatic event in January 2010, permitting lawful revocation under s65; similarly the court found the June 2012 fall did not materially extend the tear such that a new compensable injury arose and the respondent correctly declined to add cover (s26 exclusion), so both appeals were dismissed.
6 Dec 2017

Paku v Accident Compensation Corporation (Revocation of Cover)

Citation

[2017] NZACC 143
Court

District Court

Judge concluded on the balance of probabilities there was insufficient evidence to support cover for post-concussion syndrome and therefore the Corporation's revocation of PCS was correct; however the Corporation did not have a sufficient evidential basis to be 'not satisfied' that the appellant was no longer entitled to entitlements, so the suspension of entitlements was set aside.
15 Aug 2017

Moore v Accident Compensation Corporation (Leave to Appeal)

Citation

[2017] NZACC 93
Court

District Court

Leave to appeal was dismissed because the contested issues were factual determinations properly made by the District Court after weighing competing and uncertain medical evidence; no question of law capable of serious argument arose in any of the three matters, so leave under s 162 was not granted.
2 May 2017

Gupwell v Accident Compensation Corporation

Citation

[2017] NZACC 47
Court

District Court

Res judicata did not bar ACC from issuing the 28 July 2015 decisions because the 2012 reviewer’s suspension was not a final determination foreclosing further investigation, ACC had statutory authority under ss65 and 117 to revisit decisions when new evidence or a change in cover arose, and the 2015 decisions were founded on materially different medical evidence and a revision of cover that justified revocation and suspension on the balance of probabilities.
28 Feb 2017

Brown v Accident Compensation Corporation

Citation

[2017] NZACC 15
Court

District Court

The Court held ACC's suspension decision (6 September 2013) was unlawful because ACC did not have a sufficient evidential basis and failed to conduct an adequate causal inquiry before suspending entitlements; furthermore, on the balance of probabilities the labral tear was caused by the 20 July 2013 accident (jump into trench) and therefore ACC's refusal to fund surgery was set aside and cover extended to include the labral tear.