Ministry of Justice

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.

Weekly Compensation – s 103(2) Accident Compensation Act 2001. Whether Corporation correctly determined date of commencement of incapacity for purposes of weekly compensation payment. Evidence did not support date of incapacity argued for by Appellant. Correct date had been determined and therefore weekly compensation paid on correct basis. 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.

Claim for treatment injury - ss 32-33 Accident Compensation Act 2001. Whether the Corporation correctly declined the appellant’s claim for cover for a treatment injury arising out of a delay in treatment for sensorineural hearing loss. Appellant failed to establish, on the balance of probabilities, that an alternative treatment that would have prevented the injury she suffered could and should have been given, having regard to the clinical indications at the time of the alleged failure/delay in treatment. The Corporation correctly declined cover for the appellant’s sensorineural hearing loss as a treatment injury. Review decision upheld. Appeal dismissed.

Impairment assessment – Schedule 3(1); rehabilitation and treatment – Schedule 1(1), Accident Compensation Act 2001. Whether Corporation’s decision declining to proceed with assessing Appellant’s entitlement to permanent injury compensation was correct. Point at issue had been overtaken by a new decision, therefore no longer a live issue to be determined by Court. Whether Reviewer had jurisdiction to consider application for review against alleged unreasonable delay in finalisation of an individual rehabilitation plan (IRP). No jurisdiction to seek review of a draft IRP in terms of unreasonable delay. Whether Corporation’s decision declining to fund weight loss drug was correct. Corporation correctly declined funding on basis there were too many potential medical risks associated with the medication. Reviewer’s decision upheld. Outcome: appeal dismissed.

Personal Injury - ss 25, 26 Accident Compensation Act 2001. Appeal against cover for injuries suffered giving birth. Found injury not caused by an accident but as a result of internal forces generated during birth process. Outcome: appeal dismissed.

Appeal challenging the Corporation's decision to decline cover and suspend entitlements - ss 20, 26, and 117(1) of the Accident Compensation Act 2001. Whether the evidence supported that the appellant suffered a personal injury. Held: The appellant suffered a personal injury (lumbar disc injury with radiculopathy). Consequently, the Corporation's decision to decline cover was incorrect, and the suspension decision falls away. Outcome: The appeal is dismissed. The appellant is entitled to reasonable costs and disbursements.

Preliminary Decision as to Jurisdiction - Accident Compensation Act 2001. Appellant had several discrete claims, past and current reviews, and appeals. Whether the Court has jurisdiction has jurisdiction to hear appeal. Found Court had jurisdiction to hear appeal. No reason for the Appellant to be limited in the appeal to arguments raised in the review or in her notice of appeal. Outcome: appeal allowed.

Personal injury/causation – s 26 Accident Compensation Act 2001. Whether Employer’s decisions revoking cover and suspending entitlements, and subsequent Review Decision declining Appellant’s application for review, were correct. Whether Appellant’s injury was caused by accident or by a pre-existing degenerative condition. On balance of probabilities Appellant’s accident caused the injury. Employer’s decisions revoking cover and declining entitlements for the injury and the subsequent Review Decision were incorrect. Outcome: appeal allowed. Orders made quashing Employer’s decisions and directing Employer to reinstate entitlements from date of suspension, including weekly compensation, the provision of aids and appliances and surgery.

Claims for costs on appeal. Outcome: Respondent ordered to pay Appellant $5,513.35, $2,234.70 in costs and disbursements of $3,278.65. 

Leave to Appeal to High Court – s 162 Accident Compensation Act 2001. Legal issue raised by Appellant was one of wider importance, and capable of bona fide and serious argument. Outcome: leave to appeal granted.

Appeal challenging the Corporation and Reviewer’s earlier decision. Sections 79 and 81 of the Accident Compensation Act 2001. Whether the Corporation’s decision to decline funding for air conditioning equipment and voice-activated computer software was correct. Held: Corporation’s decision to decline funding request was correct. Medical evidence did not support a causal link between injury and the need for requested equipment. Treatment provided to appellant was reasonable and appropriate, no departure from the standard of care. Appeal is dismissed.