ACC wrong to restrict certificates, lawyer says

Moves to impose stringent restrictions on the issuing of ACC "fully unfit" medical certificates are wrong in law and could damage relationships between injured patients and their doctors, Dunedin lawyer Peter Sara says.

Mr Sara and ACC claimant support group Acclaim Otago are voicing concern about the medical certificate issue, given the text of "decision" letters recently sent to several ACC claimants, and a section on the ACC internet site, offering guidance to medical professionals over ACC's "Better at Work" approach.

The Otago Daily Times has obtained a copy of one of the letters, dated September 16, and titled "Fully Unfit (FUF) medical certificates", and apparently sent to a claimant in the central North Island.

ACC was "no longer accepting" FUF certificates from clients, the letter announced.

Such certificates would be accepted only if at least one of four "exceptional circumstances" applied: that a person needed to be "in a place of care", or "confined to home or bed"; there was a "risk of contagion or a need for quarantine"; or a "protective environment" was needed.

Clients should "in all other cases" be certified "fit for selected work", or "back to work full time"and "fully unfit" certificates otherwise submitted to ACC would not be actioned.

A copy of the letter was tabled at meeting of the ACC Consumer Outlook Group (COG) - a liaison body involving senior ACC administrators and claimants - in Wellington late last month.

Acclaim Otago president and COG member Denise Powell said the Acclaim group was "extremely concerned" about ACC's attempts to "influence a GP's opinion and medical certification", and that the advice was "misleading", and not what the law provided.

The same four "exceptional circumstances" cited in the September letter are also given in the internet advice to doctors.

ACC spokesman Laurie Edwards said that international evidence showed "people rehabilitate faster and more fully if they can keep working, even if in a limited fashion, while they rehabilitate".

ACC had no policy of dictating how a GP should certify patients, but worked very closely with GPs on the benefits of workplace recovery - essentially by presenting evidence of its benefits.

Such sound principles were behind both the letter and the website content, but it was clear that both "do not fully and accurately reflect ACC policy".

There would always be some people who were genuinely "fully unfit" and ACC continued to accept medical certificates to that effect.

The few clients who were sent the letters had received follow-up calls to clarify the situation and the ACC internet site content was being reviewed, he said.

Mr Sara said that sending such a letter to ACC claimants was "totally inappropriate", given that issuing medical certificates was "purely the province of the registered medical practitioner", and over which the client had no control.

The references to medical certificates were also "completely wrong in law", he added.

Under section 103 of ACC's governing legislation, the requirement was simply whether patients were able to engage in their pre-injury employment, not whether they were fit to undertake some other work, he said.

The patient's rights could be damaged by incorrect advice being given to doctors, and this ACC approach could also "undermine in an insidious way the relationship of trust and confidence" between GPs and their patients, Mr Sara said.

COG administrator Ku Seymour has sent a letter, dated October 6, to COG representatives, stating that the September 16 letter had been sent out by one case manager who had drafted without it being reviewed by her team leader.

"Obviously it is incorrect, and all 13 clients who received the letter have been or are in the process of being contacted and advised to ignore the letter," Mr Seymour said.

"The letters have been discussed with the staff member concerned to ensure she understands why the letters were flawed not only in law, but also, why the tone used was inappropriate when communicating with our clients."

- john.gibb@odt.co.nz

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