New Zealand Case Law: Decisions & Judgments

Topic

Coverage for elective surgery

Legal area

Court

14 Oct 2014

Hutt v Accident Compensation Corporation

Citation

[2014] NZACC 259
Court

District Court

Judge accepted the appellant's sworn account of an anterior shoulder dislocation and, on the balance of probabilities and having evaluated competing medical opinions and evidence of only minor pre-existing degeneration, concluded the rotator cuff tear was caused by the 2 September 2012 accident and was not wholly or substantially due to gradual process or ageing, entitling the appellant to cover including elective surgery costs.
7 Oct 2014

Bines v Accident Compensation Corporation

Citation

[2014] NZACC 251
Court

District Court

On the balance of probabilities the claimant's current condition by July 2013 was wholly or substantially caused by a pre‑existing impingement syndrome rendered symptomatic after the fall; the temporary post‑accident bursitis resolved and any rotator cuff weakening resulting from reduced use was too remote or not a significant contributor to found ACC liability, so the Corporation's declinature is upheld.
22 Apr 2013

Eng v Accident Compensation Corporation

Citation

[2013] NZACC 125
Court

District Court

The Court preferred the treating surgeon's evidence that the DRUJ ligament tear was caused by traumatic force in the 29 April 2011 accident and, on the balance of probabilities, held that the portion of the surgery treating the DRUJ injury was for a covered personal injury and must be paid by ACC; components addressing pre-existing TFCC pathology are not payable.
31 Jul 2012

Taaffe v Accident Compensation Corporation

Citation

[2012] NZACC 253
Court

District Court

The appellant failed to establish on the balance of probabilities that the tendon tears requiring surgery were caused by the covered accident rather than by progression or steroid-related change of a pre-existing degenerative tendonosis; therefore ACC correctly declined funding.
13 Jul 2012

Robinson v Accident Compensation Corporation

Citation

[2012] NZACC 228
Court

District Court

Appellant failed to prove that a physical knee injury sustained on 1 January 1994 caused the left knee osteoarthritis requiring replacement; no specific significant traumatic knee injury was identified in contemporaneous records and expert evidence favored degenerative aetiology, so ACC was correct to decline cover.
27 Jan 2011

Warmington v Accident Compensation Corporation

Citation

[2011] NZACC 17
Court

District Court

The Clinical Advisory Panel's specialist medical evidence established the applicant’s bursitis and rotator cuff tendinopathy were degenerative pre-existing conditions rendered symptomatic by the strain but not caused by it; absent medical evidence to the contrary the applicant failed to prove on the balance of probabilities that the surgery would treat a compensable injury, so ACC’s declinature and the Reviewer’s confirmation were lawful and must be upheld.

New Zealand Case Law

Hutt v Accident Compensation Corporation

Bines v Accident Compensation Corporation

Eng v Accident Compensation Corporation

Taaffe v Accident Compensation Corporation

Robinson v Accident Compensation Corporation

Warmington v Accident Compensation Corporation