New Zealand Case Law: Decisions & Judgments

Topic

Surgery funding

Legal area

Court

16 May 2019

Beets v Accident Compensation Corporation (Suspension of Entitlements)

Citation

[2019] NZACC 53
Court

District Court

On the balance of probabilities the medical and imaging evidence established extensive pre-existing bilateral rotator cuff and biceps pathology that pre-dated the 4 June 2016 accident and there was insufficient causal nexus between the 2016 event and the surgical pathology; accordingly ACC had a sufficient basis under s117 and the exclusions in s26 to suspend weekly compensation and decline surgery for the 2016 claim; the appeal is dismissed.
2 May 2019

Evans v Accident Compensation Corporation (Suspension of Entitlements)

Citation

[2019] NZACC 36
Court

District Court

The court accepted the specialist occupational physician's detailed examination and reasoning (Dr Strack) and the body of medical evidence showing cervical spondylotic change and non-organic features; on the balance of probabilities the claimant's current condition and need for treatment were attributable to degenerative disease and related factors rather than the covered accidents, and ACC therefore had a sufficient basis to be not satisfied that entitlements should continue under s117; appeal dismissed.
11 Dec 2018

AT v Accident Compensation Corporation (Entitlements)

Citation

[2018] NZACC 193
Court

District Court

On the available medical evidence, including specialist reports and urodynamics, the Court concluded the appellant's urinary retention is an ongoing consequence of the covered bladder injury such that the injury is not spent; accordingly the appellant is entitled to ACC entitlements including weekly compensation, with payments backdated to the date of the TURP surgery.
17 May 2018

Wigg v Accident Compensation Corporation (Funding for Surgery)

Citation

[2018] NZACC 76
Court

District Court

Medical evidence including imaging and specialist advice established pre-existing degenerative pathology (pars defects and facet arthropathy) that became symptomatic after the event but was not caused by the single lifting event; therefore no causal link existed between the covered accident and the surgical treatment sought and ACC's decision declining funding was correct and must be upheld.
25 Aug 2017

Shirkey v Accident Compensation Corporation (Entitlement to Surgery)

Citation

[2017] NZACC 106
Court

District Court

The Court preferred the Clinical Advisory Panel and radiological evidence that the L4/5 pathology reflected multi-level degenerative disease pre-existing the 25 January 2015 incident; the incident at most rendered underlying pathology symptomatic and did not cause the disc protrusion for which surgery was performed, therefore the surgery was not for a covered injury and ACC was not liable; appeal dismissed.
30 Jun 2017

George (Entitlement to Surgery s 67 and Schedule1)

Citation

[2017] NZACC 73
Court

District Court

On the facts and contemporaneous medical evidence the Corporation's decisions were reasonable: further pain management in November 2015 was not necessary or appropriate given extensive prior unsuccessful programmes and claimant non‑engagement and the decision to decline elective surgery in August 2015 was justified by the balance of specialist opinions that surgery was unlikely to be beneficial and posed significant risk given central sensitisation and mental health comorbidities; the appeal is dismissed though the fact surgery later occurred in the public system does not automatically render…
31 Aug 2015

Farrell v Accident Compensation Corporation

Citation

[2015] NZACC 261
Court

District Court

The appeal was dismissed because the appellant failed to produce sufficient contemporaneous or persuasive medical evidence to establish that the Grade 4 chondral defects and need for knee replacement were probably caused by the 7 July 2011 motor vehicle accident; the Clinical Advisory Panel's view that the defects reflect progressive degenerative disease was preferred.
28 Apr 2014

Thickpenny v Accident Compensation Corporation

Citation

[2014] NZACC 96
Court

District Court

Judge accepted the neurologist's (Dr Simcock) specialist opinion that the 14 March 2008 accident precipitated irritation of the left C7 nerve root constituting a discrete injury which continued to contribute significantly to incapacity, and that the subsequent cervical surgery treated that accident-related injury; accordingly the reviewer’s decision upholding Care Advantage determinations was quashed and entitlements and surgery funding must be restored.
29 Nov 2013

Murphy v Accident Compensation Corporation

Citation

[2013] NZACC 398
Court

District Court

On the evidence, including contemporaneous physiotherapy notes, a credible witness affidavit and persuasive specialist opinion (Swan supported by Chin), the Court was satisfied on the balance of probabilities that a workplace accident occurred and that it caused a traumatic extension of a pre-existing rotator cuff tear and associated biceps tendon dislocation for which surgery was necessary; therefore s26(2) and (4) exclusions do not apply and the review decision denying funding was quashed.
11 Oct 2013

Cosgriff v Accident Compensation Corporation

Citation

[2013] NZACC 329
Court

District Court

On the balance of probabilities the judge preferred the treating specialist's case-specific reasoning and found the rotator cuff tear was caused by the 16 September 2012 fall rather than a gradual degenerative process; the review decision was therefore quashed and ACC cover (including surgery) granted.