29 Aug 2014
The appellant failed to prove on the balance of probabilities that the meniscal tear was caused by the 15 July 2011 accident; medical evidence and imaging showed pre-existing chondrocalcinosis and degenerative joint change as the major contributor to the need for surgery, so ACC cover is not payable.
31 Jul 2014
The appeal was dismissed because the temporal link was weak, the fall was low impact with delayed presentation, imaging and operative findings demonstrated degenerative changes and no clear traumatic lesion, and the treating surgeon's opinion was equivocal; on balance ACC's advisors' view that the condition was degenerative was preferred, so causation by accident was not established.
29 Mar 2012
The appellant failed to prove on the balance of probabilities that the surgical condition (tendon tears and bursal damage treated in February 2009) was caused by the covered July 2005 injury rather than by progression of a pre-existing degenerative condition; therefore ACC's decision to decline funding was correct.
15 Sept 2011
Because both implant and bridge were generally accepted treatments but the implant offered materially greater longevity (>15 years versus ~5 years for the bridge), the implant was held to be the treatment that would restore the claimant's health to the maximum extent practicable and therefore was necessary and appropriate under Clause 2 of Schedule 1; ACC liable to fund the implant.
13 Jul 2011
The appellant is not entitled to weekly compensation because she was not an earner at the time of the personal injury and therefore cannot meet the s103(2) incapacity test and Schedule 1 eligibility requirements; ACC correctly declined to fund a TENS machine because available medical evidence and expert opinion did not establish that provision of the device was necessary and appropriate as a direct consequence of the covered injury.
30 Oct 2009
On the balance of probabilities the appellant suffered an acute labral tear or an extension of a pre-existing tear in the 11 May 2007 accident and that tear was the primary cause of his symptoms and the substantial reason for the surgical dislocation; therefore the surgery treated a medical condition arising from a covered personal injury and ACC must meet the costs.
15 Sept 2004
The appeal is dismissed because the appellant failed to prove on the balance of probabilities a causal nexus between the Baker's cyst and an accidental injury; the absence of a torn meniscus and the treating surgeon's uncertainty meant ACC properly declined to fund the MRI.
14 Apr 1997
The Court held the appellant was entitled to reimbursement because the particular treatment she required — frequent intravenous narcotic management administered with 24‑hour availability and under the Pain Clinic's guidance — constituted the relevant 'treatment' and was effectively only available from Dr Searle; thus regulation 6(4) permitted reimbursement for travel to him as the nearest place able to provide that treatment in substance, distinguishing Warren and aligning with Hei.