16 Jul 2019
On the balance of probabilities the appellant proved that the tibialis posterior tendon tear was caused by the 13 May 2017 trampoline accident; the injury was not caused wholly or substantially by a gradual process, therefore ACC's decision to decline funding was wrong and must be reversed.
10 Jul 2019
On the balance of probabilities the L3/4 disc changes were chronic degenerative and unlikely caused by the 8 November 2010 accident, and there is no compelling causal link between the covered L4/5 injury (including post‑surgical changes) and the need for the proposed two‑level fusion; accordingly ACC properly declined funding and the appeal is dismissed.
2 May 2019
On the balance of probabilities the medical evidence of a longstanding degenerative subacromial impingement (including OS acromiale) rendering the supraspinatus tendon abnormal outweighed the treating surgeon's opinion of acute causation; the mechanism described was more consistent with rendering a pre-existing degenerative tear symptomatic rather than causing a new tear. Temporal coincidence alone did not establish causation under s25, so the injury requiring surgery is a gradual process injury not covered by ACC and the appeal is dismissed.
22 Feb 2019
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.
30 Aug 2018
The Court preferred the Clinical Advisory Panel's analysis over the treating surgeon: the mechanism described was insufficient to cause a traumatic medial talar dome lesion, there was no evidence of expected lateral ligament rupture, and imaging showed pre-existing changes (early osteophytes and cystic change) consistent with a longer standing process; accordingly ACC correctly declined funding under s26(2) and the reviewer's decision was upheld.
28 Aug 2018
Judge preferred the Corporation's medical advisor (Dr Snyman) over the treating specialist; there is no reliable medical or imaging evidence that the 1985 forestry accident or other accepted claims caused a lumbar injury or facet joint pathology and the appellant failed to establish causation on the balance of probabilities, therefore ACC correctly declined funding and the appeal is dismissed.
3 May 2018
No medical evidence established implants were appropriate and the treating dentist's assessment indicated the appellant did not meet the qualifying criteria; factual findings showed teeth had been previously heavily restored such that regulation 10(4) required ACC to fund 75% only; therefore the reviewer's dismissal of the appeals was correct and must be upheld.
20 Feb 2018
Dr Thompson's opinion was conclusory and relied principally on temporality without adequate medical reasoning to link the L5/S1 pathology to the 23 August 2015 accident; the Clinical Advisory Panel's explanation that the imaging demonstrates multi-level degenerative disease not attributable to a one-off event was more compelling; therefore on the balance of probabilities the L5/S1 condition was not caused by the accident and is excluded from cover, so funding for the injection was correctly declined.
30 Mar 2017
On the balance of probabilities the proven lateral meniscal tear was caused by the 25 October 2013 gym accident; the Court preferred the treating surgeon's opinion (Mr Brownlee) as providing a logical basis linking the injury event, temporality, MRI findings and absence of lateral degenerative change, therefore ACC's decision declining funding was quashed and cover for surgery is warranted.
15 Mar 2017
The appellant failed to prove on the balance of probabilities that teeth 16 and 24 or a TMJ injury were caused by the 17 January 2008 assault because treating clinicians were equivocal and the independent specialist (Dr Leichter) concluded there was no evidence of accident-related damage; consequently ACC's decision to decline extended cover is upheld.