Ministry of Justice

Appeal of the Corporation’s decision to decline cover for a treatment injury. s 32 Accident Compensation Act 2001. Whether the surgery performed on Appellant’s left hand constituted a treatment injury. Held: Corporation’s decision to decline appellant’s claim was correct. Surgery performed was appropriate for the underlying condition and did not deviate from an acceptable standard of care. Appeal dismissed.

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 understandable circumstances. 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.  

Leave to appeal to High Court – s 162(1) of the Accident Compensation Act 2001. Whether the decision to revoke deemed cover and decline cover for a treatment injury related to an untreated sacral pressure wound was correct. No question of law was raised; the appeal was based on disagreement with factual findings which is not a valid ground for appeal under section 162. Leave to appeal to High Court was dismissed.

Cover and Suspension - ss 20, 25, 26, 27 and 11(7)(1) Accident Compensation Act 2001. Appeal against decision declining cover for SSD and PCS. Appeal against decision suspending entitlements for head injury. Evidence did not support claim for cover for SSD and PCS. Decision to suspend entitlements arising from head injury was incorrect. Evidence to support ongoing symptoms causally related to head injury. Entitlements reinstated. Outcome: appeal allowed in substantial part.

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 – 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 mental injury as a treatment injury – ss 26 and 32 Accident Compensation Act 2001. Whether Corporation correctly declined Appellant’s claim on basis that it did not meet the criteria for a treatment injury. Available factual and medical evidence did not establish Appellant suffered a mental injury because of a physical injury causally linked to treatment by a registered health professional. Corporation correctly declined Appellant’s claim. 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 – Part 3 Schedule 1 Accident Compensation Act 2001. Whether the 20% whole person impairment (WPI) assessment was correct. Appellant failed to establish on a balance of probabilities, the assessment was incorrect. There was no clear, credible, cogent expert evidence to establish a flaw in the assessment or a failure to take relevant considerations into account. The 20% WPI assessment was correct. Appeal dismissed.

Appeal from a review decision regarding the Corporation’s decision declining the appellant’s request for weekly compensation. Claim for weekly compensation – s 105. Whether the appellant’s current symptoms and incapacity are causally linked to the covered head injury thereby entitling her to weekly compensation. Held: the weight of expert medical evidence did not support a material causal connection between the injury and the appellant’s symptoms. Outcome: 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.