Medical conditions
We’ve talked in the past about how important it is to let ACC know when there is a health condition affecting an injured employees recovery. We are almost daily seeing an upsurge in the number of claims where recovery is hampered by health.
Over the years we’ve dealt with a number of these issues - in most cases, we already know the health issue exists but occasionally the injury will expose a health issue. In one case, an employee presented with a standard sprain. After the standard 3 allied health treatments, there was no improvement in symptoms as expected, so said employee was sent for imaging to see what other hidden issues there were. In the meantime, the employee was unable to work due to pain so was on weekly compensation.
The imaging revealed a health condition that required the employee to be off work for a lot longer while receiving treatment. ACC, being unaware of the health condition, continued to attribute the weekly compensation days to the original sprain.
As weekly compensation days cannot be challenged directly under the legislation due to it being an entitlement, the only way for us to manage this was to raise a dispute with ACC. After consideration, ACC overturned the entire claim and the weekly compensation days. This removed over 100 weekly compensation days and approximately $25,000 in costs from the employers Experience Rating report.
This case is a win win for both the employee and the employer. The employee now has a clear understanding of what their medical challenges are. For the employer, they have provided a lot of pastoral care whilst also preventing a substantial claim impacting their Experience Rating… over a three year period.
Lesson: always ask questions and push for action if the employee is not recovering as expected.
