More Surgical Mesh Injuries Denied ACC Cover

Jo Spod has lost his jobs and contemplated suicide after excruciating pain from a surgical mesh complication after a hernia repair procedure. "No-one disputes that Mr Spod is in pain, but ACC cannot cover pain without an identified physical injury and the external opinions provided to ACC could not identify any injury causing his pain." said an ACC spokesperson.

This article from NZ Herald states that in the last year alone, the decline rate of mesh injury claims jumped from 17 per cent to 28 per cent – with 43 of 152 claims turned down. 

Cerebral palsy teen loses appeal to have treatment covered by ACC

A teenage boy with cerebral palsy has lost a decade-long court case against ACC to cover the cost of his treatment. Jeremy was deprived of oxygen to the brain during his premature birth by emergency caesarean section and as a consequence has suffered from cerebral palsy all his life. This from the article by Mike Watson, on Stuff:

"The High Court was correct to find that a failure to treat cannot occur in circumstances where there are no indications for a different treatment course.

"In Mr Adlam's circumstances there was no suggestion prior to the emergency caesarean section that there should have been medical intervention of any kind."

As a result there was no entitlement to cover treatment under the Act and the appeal was dismissed.

In essence, they are saying that this wasn't an 'accident' and therefore does not qualify. Although the limitations of ACC may appear horribly cruel, unless the scheme covered everything, there will always be borderline cases being tackled in the courts. Click here to read more.

Basic stats on the lack of preparation

Most people don't prepare - take a look at these, my favourite income protection stats: 
  • In the last five years about 18% of households have had a period of between 3 and 6 months when someone was unable to work
  • Most people thought they might get ACC, but, they were more than twice as likely (2.2 times more likely) to to be as a result of a serious illness than a serious accident. As many as one in five people think that ACC covers illness - it doesn't.
  • Two thirds thought they might be entitled to the jobseeker benefit, but about half of them were unaware that their partner's income would affect their eligibility
So with benefits not being very helpful, what about savings? 
  • 54% of people would be unable to maintain their spending rate just four weeks after their sick leave and annual leave had run out. 47% said they would be unable to pay their rent or their mortgage. 
  • Apparently the average household (in 2015) needed $683 each week to cope with loss of income due to illness.
According to a study done by Horizon Research for the New Zealand Financial Services Council in 2015. 

Southern Cross and ACC scrap over Liability

Southern Cross set up a team of specialists ten years ago because they believed that ACC was wrongly turning down legitimate claims by policyholders, leaving the Southern Cross to pay the cost of treating them. 'The insurer said it scrutinised around 200 cases a month where policyholders had had claims declined, usually older people whose injuries ACC concluded were wholly or substantially caused not by their accidents, but by underlying medical conditions. Usually age-related degenerative conditions.' Click here to read more from Rob Stock. The emphasis was added by me, that is a very large number of claims - something like 24,000 claims since the team was set up by Southern Cross. 

You should read the whole article. There is a wealth of claims data on the number of claims that were subject to some sort of dispute, the number of decisions changed, and the amount of money that is at stake. $4.95 million in payments made by ACC to Southern Cross in the year to June 2016. More than that, is the extent of the process Southern Cross engages in. 

Farm Bikes: Injuries and Deaths Rising - UPDATED

Stuff has this article on deaths and injuries from farm bikes. Headed, provocatively, "A New Zealand Death" written by Charlie Mitchell. It is worth a read. The reason why it caught my attention - apart from a natural interest in the morbid arising from working in life insurance - was that a friend's son has recently suffered terrible injuries in just such an accident. He has a broken arm and badly broken leg. The photos looked a lot like the ones in this article.

I will not jump to the conclusion that these deaths are preventable by a law change, or that quad bikes are inherently unsafe. 33 deaths were recorded from these causes in a period of about 10 years. Although many more injuries are likely to have occurred - the article hazards a guess at 20 times as many. It is worth contemplating how many equivalent injuries and deaths would occur by letting a child use an ordinary motorbike, or ride a horse, for that matter. Risks are real and they are also the stuff of life. I have let my kids do similarly dangerous things - parents cannot keep children's lives entirely risk free without taking something else away from their lives.

But it is also worth wondering how many could be prevented by requiring a roll cage be fitted to the four wheel versions of these vehicles. I hope someone is pondering the questions, because the list at the end of the article is heartbreaking. 

Declined for Surgery by both ACC and the Health Board

What happens when both ACC and the District Health Board believe the other should be responsible for paying for your surgery?

You get no treatment until they sort it out, apparently. Which is ridiculous for us who do not have to suffer the consequences directly, it is far worse for the woman who is a victim of this situation, Amy Whiting.

Especially when you bear in mind that these are two separate funding agencies, but immediately above and below them the treatment value chain come together: ultimately the money is public, whichever funding agency you choose, and probably it would be the same surgeon in the same operating theatre that would do the job, irrespective of the payer. Although some very specific and painful costs are borne by Ms Whiting there are some general costs borne by us all: Ms Whiting should be getting on with her life, becoming a teacher, and being self-supporting. Instead, because of a failure to fund treatment, she must depend on a benefit. That is a cost to the rest of us. 

Click here to read Amy Whiting's story. 


Killer Furniture

What are the risks posed by the furniture around you? Seriously: falls from beds, chairs, ladders, and steps are rising because of an ageing population. Before you click on the link ask yourself this question: which type of fall accounts for more deaths? I bet you won't get it right. Link. This data comes from the United States, but I doubt that the trend would be much different here. 

ACC Am I Covered?

A link to ACC's page "Am I Covered?" an essential resource which it is worth being reminded of from time to time. Even if you do not provide advice on ACC coverage it is worthwhile knowing the boundaries of ACC coverage and being able to quickly communicate those to clients or those around you: whether you are a financial adviser or you are further back the value chain working on product design. Link.