6 Sept 2013
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.
4 Jul 2013
The court preferred the treating prosthodontist's evidence (Dr Cautley) that, given the severity of acid erosion, failed/ineffective conservative measures, the patient's inability to afford extensive restorations, and limited chewing needs, full extraction and provision of full dentures is necessary and appropriate to restore health to the maximum extent practicable; therefore ACC must fund the regulated contribution for that treatment and the reviewer's decision is quashed.
31 Oct 2012
The appeal was dismissed because the medical evidence did not establish that the lifting incident caused a significant discrete rotator cuff injury separate from underlying degenerative pathology; the treating surgeon provided only a temporal link without explanatory reasoning, while the ACC medical advisor gave specific reasons that the pathology was consistent with age-related degeneration and the event merely provoked symptoms, bringing the claim within the s26 exclusion.
27 Jul 2012
The total knee replacement was required for degenerative medial compartment osteoarthritis that predated the 2006 accident; ACC correctly declined to fund the elective surgery because the operative condition was not caused by the 2006 accident and the claimed 1993 causation was not part of the lodged claim nor sufficiently evidenced or investigated.
27 Jul 2012
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.
19 Jul 2011
On the balance of probabilities the available contemporaneous imaging and expert panel opinion demonstrate pre-existing degenerative rotator cuff disease and render it more likely than not that the need for the 2010 surgery was not primarily caused by the 29 October 2002 accident; ACC's decision to decline funding was therefore likely correct, subject to a requested further report from the operating surgeon.
18 May 2011
On the balance of probabilities the uncontested specialist medical evidence established adhesive capsulitis was idiopathic or related to pre-existing degeneration and not caused substantially by the June 2008 incident; therefore the condition is not covered under the Act and the appeal fails.
27 Jan 2011
The uncontested specialist medical evidence established only a temporal association and no biological or causal link between the covered minor head injury and the appellant's erectile dysfunction; therefore treatment for erectile dysfunction is not a consequence of the covered injury and is not payable under Schedule 1 Clause 1, so the respondent's decision to decline funding was correct.
13 Dec 2010
Because the massage and naturopathy providers were not registered health professionals within the meaning of s.6, their services did not qualify as 'treatment' payable under Clause 2 of Schedule 1 of the Accident Compensation Act 2001; therefore ACC's decision to decline reimbursement was correct and must be upheld.
3 Nov 2010
The Court found on the evidence that although degenerative change existed at C6/7 prior to the fall, those changes were asymptomatic and the trauma of the fall caused further narrowing and C7 radiculopathy (nerve root entrapment); because the radiculopathy and need for surgery were caused by the accident, the surgery was a treatment entitlement under the Act and ACC's decision to decline funding was quashed.