New Zealand Case Law: Decisions & Judgments

Topic

Surgical funding

Legal area

Court

8 Nov 2018

Hay v Accident Compensation Corporation (Funding for Surgery)

Citation

[2018] NZACC 176
Court

District Court

The District Court upheld the Reviewer's decision because the preponderant medical evidence (Clinical Advisory Panel and reviewer analysis) established that the shoulder pathology was more likely the result of a chronic, multifactorial impingement and intrinsic tendon disease (with uncertain contribution from steroid injections) rather than being caused by the 2001 or 2014 low‑energy squash accidents; therefore the surgery did not address a covered personal injury and funding was correctly declined.
7 Sept 2018

Bradshaw v Accident Compensation Corporation (Entitlement to Surgery)

Citation

[2018] NZACC 144
Court

District Court

On the balance of probabilities the clinical timeline, contemporaneous notes, imaging sequence (intact tendons on ultrasound 28 March 2013 and degenerative tears on MRI 5 June 2013), expert opinions (Scragg, Beaumont, Clinical Advisory Panel) and operative findings demonstrated the rotator cuff and biceps pathology was far more likely due to a degenerative process or progression after March 2013 rather than causally caused by the 13 February 2013 workplace event; therefore ACC was correct to withhold entitlements for the later tears and the appeal is dismissed.
2 Feb 2018

Haylett v Accident Compensation Corporation (Cover)

Citation

[2018] NZACC 20
Court

District Court

Contemporaneous medical records from the date of the accident consistently record injury limited to the left thumb with normal wrist examination and no objective nerve signs until many months later; there is insufficient evidence to establish on the balance of probabilities that the 13 July 2015 accident caused the appellant's wrist/forearm/nerve conditions, therefore additional cover, weekly compensation and surgical funding are not payable.
2 Feb 2018

Turner v Accident Compensation Corporation (Entitlement to Surgery)

Citation

[2018] NZACC 22
Court

District Court

The medical evidence did not establish on a balance of probabilities that the disc prolapses requiring surgery were caused by, or a gradual process consequential on, any covered neck injury (including the 1992 accident); the treating surgeon's opinions were inconsistent and speculative while the Branch Medical Advisors' opinions that the condition was degenerative were preferred, therefore ACC's decision to decline funding was correct.
19 Dec 2017

Brown v Accident Compensation Corporation (Entitlement to Surgery/Cover)

Citation

[2017] NZACC 151
Court

District Court

The Court dismissed both appeals because there was no contemporaneous medical evidence establishing that an injury occurred on 18 January 2013 so that event did not attract cover, and the need for surgery was attributable to pre-existing degenerative disc disease (with an L5/S1 extrusion present on the 2008 MRI) rather than the 2012 covered event, so surgical funding was correctly declined by the Corporation.
7 Sept 2017

Lundy v Accident Compensation Corporation (Entitlement to Weekly Compensation)

Citation

[2017] NZACC 101
Court

District Court

The Branch Medical Advisor's specialist opinion, which concluded the frozen shoulder began between 6 May and 12 June 2015 and was most likely idiopathic rather than caused by the earlier covered accidents, was a competent and persuasive basis for ACC's decisions. There was an identifiable break in the appellant's pain presentation and no specialist evidence to overturn the BMA's timing-based causation conclusion; therefore the frozen shoulder was not caused by a covered injury and the ACC decisions declining weekly compensation were correct.
25 Aug 2017

Martin v Accident Compensation Corporation (Cover)

Citation

[2017] NZACC 100
Court

District Court

A 'sportsman's hernia' as described is a pain condition and, absent demonstrable physical pathology or evidence of an acute injury caused by the 26 February 2013 incident, there is no injury within the meaning of the Act; contemporaneous records and expert opinion do not support that the incident caused such an injury, so ACC cover and associated surgical funding are unavailable.
16 Jun 2017

Jones v Accident Compensation Corporation (Entitlement to Surgery)

Citation

[2017] NZACC 65
Court

District Court

Although a temporal connection existed between the reported twinge and the onset of symptoms, the objective imaging and the reasoned conclusions of the Clinical Advisory Panel that the L3/4 pathology reflected pre-existing degenerative change (and that the described mechanism lacked sufficient force to cause an acute traumatic prolapse) were more persuasive; causation to the covered accident was not established and entitlement to surgical funding was therefore denied.
27 Jan 2017

Johnson v Accident Compensation Corporation

Citation

[2017] NZACC 4
Court

District Court

On the evidence the Court accepted, by a narrow margin, the operating surgeon's causation opinion that the February 2008 cricket accident caused the pathology addressed by the C7/T1 surgery; the ACC decision declining funding was therefore incorrect and was quashed and set aside, entitling the appellant to funding for the surgery.
21 Sept 2016

Bhasin v Accident Compensation Corporation

Citation

[2016] NZACC 267
Court

District Court

On the balance of probabilities the heaving of the heavy bag on 15 January 2013 caused an overloading of the right supraspinatus leading to the tear requiring surgery; the mechanism, temporal connection and clinical findings outweigh CAP's view of gradual pathology.