Ministry of Justice

Late filing of an appeal to the District Court – s 151, Accident Compensation Act 2001. Whether appellant's late filing of appeal against Corporation’s decision to decline cover for PTSD should be accepted. Appellant's delay arose out of error due to significant mental and physical injuries. Corporation did not oppose application and no significant prejudice or hardship to others. Interests of justice required exercise of discretion to sustain Appellant's application for leave to file appeal out of time. Outcome: application granted.

Claims for costs on appeal. Outcome: Respondent ordered to pay Appellant $2,064.00, being costs of $1,550.00 and disbursements of $514.00. Appeal allowed.

Cost of Treatment; Schedule Clause 1 – Accident Compensation Act 2001 and Regulation 13 Accident Compensation (Liability to pay or contribute to cost of Treatment) Regulations 2003. Whether Corporation required to fully fund cost of GP appointments for purposes of providing a medical certificate to determine incapacity as required by the Corporation and/or the purpose of providing treatment. Corporation correctly applied Clause 1 of Schedule 1 and Regulation 13 in declining Appellant’s claim for full GP cost payment. Outcome: appeal dismissed.

Appeal from the decision of a Reviewer. Ss 20, 25, 26 Accident Compensation Act 2001. Whether the Corporation correctly declined cover for the injuries and entitlements claimed by appellant, including weekly compensation and treatment costs. Held: Corporation correctly declined cover for lumbago with sciatica, right rupture of tendon, and L5/S1 facet joint osteoarthritis- medical evidence did not establish a causal link to the accident. Reversed Corporation’s decision to decline weekly compensation for right gluteal strain. Granted appeal in relation to Corporation’s decline of cover for sprain injury of the facet joint and directed further funding for treatment costs. Appeal partly granted.

Late filing of an appeal to the District Court – s 151, Accident Compensation Act 2001. Delay in filing Notice of Appeal in complete form was nearly six months, which was not insignificant. However, responsibility for delay lay not with appellant but with his counsel. No history of non-cooperation or delay be Appellant himself. Corporation did not oppose leave being granted. Interests of justice required exercise of Court’s discretion to sustain application for leave to file appeal out of time. Outcome: application granted.

Appeal of the decision of a reviewer declining Appellant’s claim for cover for treatment injury. s 32 Accident Compensation Act 2001. Whether the delay in treating Appellant’s ulcer and circulatory problems led to the above-knee amputation. Held: Corporation correctly declined Appellant's claim for cover for treatment injury. medical evidence indicated appellant’s health issues were the primary causes of his condition and earlier intervention would not have prevented the need for amputation. No departure from the standard of care in treatment provided to appellant. Appeal dismissed.

Late filing of an appeal to the District Court - s 151 Accident Compensation Act 2001. Whether interests of justice required the exercise of discretion to sustain his application for leave to file his appeal out of time. Interests of justice established for appeal. Delay arose out of circumstances partly out of the Appellant's control. Outcome: appeal granted.

Late filing of an appeal to the District Court - s 151 Accident Compensation Act 2001. Whether interests of justice required the exercise of discretion to sustain his application for leave to file his appeal out of time. Interests of justice not established for appeal. Length of delay was significant. Adequate reasons not provided for delay. Grounds of appeal not strongly arguable. Outcome: appeal dismissed.  

Claims for costs on appeal. Outcome: Respondent ordered to pay Appellant $350, $250 in costs and disbursements of $100. 

Claims process – s 135 Accident Compensation Act 2001. Whether Corporation correctly declined to accept Appellant’s 20 review applications which had been filed out of time, explaining that it was unable to accept that the Appellant’s mental injuries affected her ability to file review applications in time. Corporation was entitled to be not satisfied there were extenuating circumstances that affected the Appellant’s ability to meet the time limits for her review applications. Outcome: appeal dismissed.

Claim for personal injury – ss 20, 25, 26 Accident Compensation Act 2001. Whether Corporation correctly declined cover and surgery and suspended existing entitlements on basis Appellant’s covered right shoulder sprain had resolved. Whether Appellant’s accident caused a physical injury that caused or contributed to his post-accident incapacity. Held: Corporation’s decision was incorrect. Sufficient factual and medical evidence to draw robust inference that Appellant’s injury was causally linked to his accident rather than wholly or substantially caused by a degenerative condition. Appellant entitled to cover and entitlements including surgery funding. Outcome: appeal allowed, review decision set aside.

Claims process, interpretation of decision – ss 6, 134 Accident Compensation Act 2001. Whether Reviewer correctly dismissed Appellant’s two review applications. Corporation’s decision to combine two claims under single claim number was administrative in nature and reasonable. Allegation of unreasonable delay not upheld because Corporation made a decision on cover within the required deadlines, and question of delay is not subject to review and was now moot. Decision of Reviewer upheld. Outcome: appeal dismissed.

Impairment assessment – Schedule 1(4) of Accident Insurance Act 1998, and Schedule 1(3) of Accident Compensation Act 2001. Whether Corporation’s decisions regarding Appellant’s whole person impairment (WPI) for independence allowance and lump sum purposes were correct. Whether Appellant had demonstrated a material flaw in the WPI assessment such that the assessment could not be relied upon. On available evidence, Corporation’s decisions were correct. Appellant had not demonstrated a material flaw in the WPI assessments. Outcome: appeal dismissed.