The ACC system is being clogged up with surgery claims that have no hope of succeeding because of private insurance company requirements, ACC Minister Nick Smith says, as he dismissed the idea of an independent review into claims.
Last week ACC bosses were quizzed during a parliamentary committee hearing about why more claims were being declined, following a rash of reports about people claiming they are unfairly being turned down for surgery.
ACC chief executive Jan White said one reason for the increase in declines was that ACC had hired more assessors, and that an internal review about decision-making was under way.
However, the Labour and Green parties said they were not satisfied with the internal process and called for an independent review of the ACC's handling of elective surgery claims.
Dr Smith this morning dismissed the idea of an independent review.
"I've been keeping a close eye on those review decisions and if I see, for instance, ACC losing, the reviewers and the courts finding that ACC is unfairly making decisions about people's elective surgery entitlements, then that will be the sort of trigger that I might consider," he said.
"At the moment ACC is well and truly winning the vast majority of those cases . . . so I don't see any justification for an independent review around ACC's management of elective surgery."
Dr Smith also noted that a number of claims with no hope of succeeding were tying up the ACC system so people could meet private health insurers requirements.
"A number of the private insurance companies have it as a precondition for funding elective surgery, that they first must be declined by ACC, that has been their policy, I understand, for the last couple of years," Dr Smith said.
"I am getting concern both from orthopaedic surgeons and from ACC staff that that is clogging up the system for elective surgery cases. We should not be surprised that, with insurance companies having those sorts of policies, that we're getting a 10-20 percent rejection of those that claim elective surgery under ACC."
Dr Smith said one way to address the problem would be for surgeons in such cases to indicate that the claim was being lodged for insurance purposes.
"That would then free up the resources to be able to get on and process those elective surgery claims more quickly."
