New Zealand Case Law: Decisions & Judgments | LexChat

New Zealand Case Law

Entitlement to treatment funding

  • 22 Jan 2019

    Wytenburg v Accident Compensation Corporation (Entitlements)

    Citation
    [2019] NZACC 2
    Court
    District Court

    On the balance of probabilities the evidence establishes that the appellant's medial tibialis posterior dysfunction and planovalgus deformity represent a gradual degenerative process predating 2009 with MRI and clinical signs noted in 2006 and 2009; any contribution from the 2009 lateral inversion injury is at best acceleration of a pre-existing condition and therefore excluded under s26, so the required surgery is not causally linked to the covered accident and the appeal must be dismissed.

    • Causation
    • Entitlement to treatment funding
    • Aggravation of pre-existing condition
    • Application for suppression

  • 27 Jul 2016

    Rehn v Accident Compensation Corporation

    Citation
    [2016] NZACC 194
    Court
    District Court

    The appellant failed to prove on the balance of probabilities that her need for right shoulder surgery was caused by the 19 October 2013 accident; the Court preferred the CAP medical opinion that the condition was degenerative tendinopathy related to a pre‑existing process, so ACC's decision to decline funding was upheld.

    • Entitlement to treatment funding
    • Causation
    • Pre-existing condition
    • Weight of medical evidence
    • Surgical treatment coverage

  • 30 Sept 2014

    Magee v Accident Compensation Corporation

    Citation
    [2014] NZACC 237
    Court
    District Court

    On the balance of probabilities the accident of 3 February 2010 was a significant factor in generating the rotator cuff tear and thereby the need for surgery; the treating orthopaedic surgeon's opinion that the fall caused the tear is compelling and outweighs the view that degeneration alone caused the need for surgery, so the Corporation's decline is set aside.

    • Causation
    • Entitlement to treatment funding
    • Medical evidence assessment

  • 1 Nov 2013

    King v Accident Compensation Corporation

    Citation
    [2013] NZACC 373
    Court
    District Court

    On the balance of probabilities the appellant sustained a full thickness supraspinatus tendon tear in the 5 August 2012 incident, producing immediate significant pain, and therefore the injury is a specific covered event requiring surgery; the respondent's refusal was incorrect and must be quashed.

    • Causation
    • Entitlement to treatment funding
    • Standard of proof
    • Evaluation of medical evidence
    • Judicial review of administrative decision

  • 17 Sept 2013

    Collins v Accident Compensation Corporation

    Citation
    [2013] NZACC 302
    Court
    District Court

    The appellant failed to prove on the balance of probabilities that the condition requiring surgery was caused by the covered accident; medical evidence and the lengthy delay showed the surgery treated degenerative osteoarthritis rendered symptomatic, so the respondent correctly declined funding and the appeal is dismissed.

    • Causation
    • Entitlement to treatment funding
    • Pre-existing condition vs covered injury
    • Delay in seeking treatment

  • 28 Sept 2012

    Spriggs v Accident Compensation Corporation

    Citation
    [2012] NZACC 318
    Court
    District Court

    On the evidence (patient history of being pain-free after 2004 surgery, immediate severe pain after the February 2008 fall, MRI and operative findings of a supraspinatus tear, and expert opinion of treating surgeon) the Court found the supraspinatus full thickness tear was caused by the February 2008 accident; accordingly ACC's decision declining funding was quashed and replaced by an entitlement to funding for the surgery.

    • Entitlement to treatment funding
    • Causation
    • Pre-existing gradual process vs specific event
    • Judicial review of administrative decision

  • 4 Sept 2012

    Welsh v Accident Compensation Corporation

    Citation
    [2012] NZACC 296
    Court
    District Court

    The appellant discharged the onus on the balance of probabilities: the treating specialist's reasoned opinion that the lateral talar dome osteochondral lesion was traumatic and would not have been asymptomatic was preferred to the respondent's CAP opinion which lacked sufficient explanation for why cystic change and chondral thinning could not have developed within the post-accident timeframe; ACC's decline was quashed and ACC must fund the surgery.

    • Entitlement to treatment funding
    • Causation of injury
    • Elective surgery approval
    • Evaluation of expert medical evidence

  • 11 Dec 2009

    Rothery v Accident Compensation Corporation

    Citation
    [2009] NZACC 220
    Court
    District Court

    The appellant failed to prove that the L3/4 spinal stenosis was caused by the November 2007 accident; medical evidence established the L3/4 condition was degenerative and not causally linked to a specific accident, therefore the respondent correctly declined to fund decompression at L3/4 and the appeal is dismissed.

    • Entitlement to treatment funding
    • Causation
    • Medical expert evidence assessment
    • Extension of time to file appeal