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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.
Personal Injury, s 26; Work Related Gradual Process Injury, s 30; Suspension of Entitlements, s 117 – Accident Compensation Act 2001. Whether Appellant’s back pathology was coverable either as a personal injury by accident or a work-related gradual process injury (WRGPI). Weight of medical opinion supported Appellant’s symptoms being caused by multi-level degenerative disc disease, not the accident. Section 30 criteria for WRGPI not fulfilled. Corporation’s decisions declining cover and suspending entitlements correct. Outcome: appeal dismissed.
Claims for costs on appeal. Outcome: Respondent ordered to pay Appellant $350, $250 in costs and disbursements of $100.
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.
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.
Claims process – s 135 Accident Compensation Act 2001. Whether Reviewer correctly dismissed Appellant’s review, on the basis of a lack of jurisdiction in view of the defective nature of the review application. Appellant did not identify decision or decisions in respect of which her purported application for review was made. Reviewer correctly dismissed review. 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.
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.
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.
Claims process - s 146 Accident Compensation Act 2001. Appeal against decision to decline funding for 26 items requested by the Appellant. Reviewer correctly declined jurisdiction to determine application for review, in light of later deemed review decision. 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.
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 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.
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.
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.
Claims process; deemed cover – ss 48, 58, 145, 149 Accident Compensation Act 2001. Whether there was a Review Decision/right of appeal/whether claim for cover/whether deemed cover decision. Appeal against Review Decision determining that Corporation’s decision declining appellant’s claim was reviewable and substantive merits of review would be heard and determined on future date; and determining Appellant did not have deemed cover. No right of appeal from Reviewer’s decision. No error established in the Review Decision. 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.
Claims process: applications for recall of judgment and reinstatement of appeal. Whether Court’s Minute dismissing the Appellant’s appeal due to Appellant’s failures to prosecute the appeal should be recalled and the appeal reinstated. Justice did not require recall of the Minute. Grounds provided by Appellant to support reinstatement of her appeal were far outweighed by the lost opportunities to hear the Appellant’s appeal, the overall procedural history of the appeal, the requirements of the ACC Practice Guidelines, the lack if any identified merits in the appeal, and the interests of the Corporation and the public. Outcome: applications for recall of the Minute and for reinstatement of the 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.
Leave to appeal to the High Court – s 162 Accident Compensation Act 2001. Grounds for leave to appeal raised by Applicant did not raise questions of law capable of bona fide and serious argument which would justify a further appeal to the High Court. Outcome: application 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.
Suspension of entitlements - s 117 of the Accident Compensation Act 2001. Wether the Corporation's decision to suspend appellant's entitlement was correct, based on the determination that his condition was no longer the result of his covered injuries. Held: Corporation had sufficient basis to suspend appellant's entitlements, as medical evidence supported that his incapacity was due to degenerative changes. Covered injuries from the 2021 accident had resolved and appellant's ongoing symptoms were not related to those injuries. Outcome: Appeal dismissed.
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.
Interest - s 114 Accident Compensation Act 2001. Appellant appeals against decision regarding entitlement to interest on backdated weekly compensation payments. No live issue remained in respect of interest entitlement. No evidence provided to substantiate costs for phone, printing, internet, or travel costs. No basis on which they can be awarded. Outcome: appeal dismissed.
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.