Medical Specialists Sensitive Claims

Dealing with Specialists

 

There are several types of Specialists and Medical Practitioners who are likely to be involved with your claim at some stage. These are the people who will provide the information that will determine if you have entitlements. It is up to you as the claimant to make sure that the information obtained about you is correct, relevant and put in the hands of the right people. It is not advisable to leave this process in control of the staff at the SCU.

The ACC controls the insurance process to the extent the legislation allows. However the ACC does not control the clinical process. The clinical process is in fact controlled by the GP and the treating specialists and clinicians. It is absolutely essential that the ACC is prevented from interfering with the clinical process. We will know examine who is who and how your information should be handled to protect your clinical process.

Sexual Abuse Counsellor / Psychotherapist 

The Counsellor is not a practitioner or Psychologist therefore their professional opinion is not given as much weight by the DRSL or the Courts as they do Practitioners. However that does not mean that their opinion and the information they provide is not important. The information that the Counsellor provides the GP will be taken seriously when the GP makes a determination. Also the information collected and provided by a Counsellor provides useful insights that may very well determine the outcome of an appeal.  Counsellors are also good in that they can help you deal with the pain and fear you are going through.

General Practitioner

A General Practitioner or GP is a medical doctor who can provide treatment and prescribe medications. The GP is the practitioner who lodges the claim on your behalf and signs off on any on-going incapacity. The GP is very important and not to be underestimated in the scheme of things. The GP is generally very busy and their time must be treated as very precious. There is no time to waste on how much the ACC sucks here. The GP can refer you to specialists and query assessors in the event clarification is required. The ACC dismisses the GP but the GP is a powerful defender of the clinical process.

Clinical Psychologist

A Clinical Psychologist is a high ranking specialist who is a Doctor but not qualified to prescribe medications. Therefore the Clinical Psychologist is not a practitioner. Yet the Clinical Psychologist is taken very seriously in the process and their opinions and reasoning are considered at length by Psychiatrists and the Courts.

Psychiatrist

A Psychiatrist is high ranking specialist and a Doctor of medicine who can prescribe medication. The Psychiatrist is a practitioner. This places the Psychiatrist at the top of the food chain when it comes to assessments. The opinion of a Psychiatrist carries a lot of weight. However their opinion is not completely unassailable.

It is important to understand that the above disciplines play various roles in your claim.

Treatment Providers

A treatment provider can be a Counsellor, a GP, a Clinical Psychologist or a Psychiatrist. Treatment providers are the people who will try and assist you with your injury. Their opinions are given significant weight. However their opinion (with the exception of the Psychiatrist) loses weight when it comes to Occupational Medicine. If you are a weekly compensation recipient then that is an important consideration.

Branch Psychology Advisors

Branch Psychology Advisors are generally Clinical Psychologists who work for the Corporation. They provide what is called peer review. Branch Psychology Advisors advise the Corporation when it comes to applying medical process to the insurance process. Branch Psychology Advisor's also examine medical evidence to find avenues the ACC can use to dis-entitle claimants.  

Assessors

An Assessor for the purposes of determining whether you have entitlements will almost certainly be a Psychiatrist. This is because of the wording in Section 93 of the Accident Compensation Act 2001.

93          Medical assessor

(1) A medical assessment must be undertaken by a medical practitioner who is described in subsection (2) or subsection (3).

(2) A medical practitioner who provides general medical services must also—

  • (a) have an interest, and proven work experience, in disability management in the workplace or in occupational rehabilitation; and
  • (b) have at least 5 years' experience in general practice; and
  • (c) meet at least 1 of the following criteria:
    • (i) be a Fellow of the Royal New Zealand College of General Practitioners or hold an equivalent qualification:
    • (ii) be undertaking training towards becoming a Fellow of the Royal New Zealand College of General Practitioners or holding an equivalent qualification:
    • (iii) have undertaken relevant advanced training.

(3) A medical practitioner who does not provide general medical services must—

  • (a) have an interest, and proven work experience, in disability management in the workplace or in occupational rehabilitation; and
  • (b) be a member of a recognised college.

 

As we can see the only person who can actually perform an assessment is a practitioner who is also a specialist. Only a Psychiatrist fits this requirement when it comes to assessing Sensitive Claimants. However this only holds true for assessments conducted for answering the questions required by the legislation. There are other types of assessments such as a DATA assessment. A DATA assessment is an assessment normally carried out by a Clinical Psychologist to determine the effectiveness and possibly the direction of the treatment provided by a Sexual Abuse Counsellor.

The Politics of the Professions

There is a dynamic that you as the claimant need to be aware of. The ACC is expert at sowing discord and creating side shows to distract from the Corporations own agendas. Sexual Abuse Counsellors are often at odds with the Clinical Psychologists and the Psychiatrists that perform DATA assessments. The Counsellors are aware that their opinions are easily brushed aside by the higher qualified specialists and the use of DATA assessments is a source of friction.

The ACC provides a certain amount of treatment sessions and then they demand a DATA assessment. If the Clinical Psychologist decides that treatment is no longer required or that the Counsellor’s treatment is ineffective then the Corporation simply refuses to fund more treatment. A large percentage of Sensitive Claimants only claim for treatment as many are not employed when they first present to the GP with their sexual abuse issues.

If the Clinical Psychologist is in conflict with the Counsellor and the GP the ACC will give weight to the Clinical Psychologist. The claimant then has to fight for treatment. In the event the claimant is proving difficult for the Corporation an assessment with a Psychiatrist is arranged. The Psychiatrist is then presented with information from a Counsellor and a GP and the information from the Clinical Psychologist.

Keeping in mind it is likely the Corporation has handpicked both the Clinical Psychologist for the DATA assessment and the Psychiatrist for the assessment, the claimant is under serious threat. If the Psychiatrist goes with the opinion of the Clinical Psychologist (which is likely) then the claimant has to go to review with a GP and Counsellor against a Clinical Psychologist and a Psychiatrist. One cannot forget the Branch Psychology Advisors who will be influencing the process as much as they can behind the scenes.

The result of this is the Counsellors see the Clinical Psychologists as the enemy and this perception is often passed on to the claimant. However this is not the correct stance to take. You as the claimant need to be aware of this. It is not the Clinical Psychologists and Psychiatrists who are the enemy it is the ACC who is the enemy. It is the processes that the ACC put in place and the manner in which the Corporation uses the Clinical Psychologists that is the threat to the claimant.

In my own case ACC misused, ignored and maligned at least two Clinical Psychologists and no less than five Psychiatrists two of whom are ACC hardliners ironically. The ACC did so because these specialists and practitioners did not say what the ACC wanted them to say. I will be devoting a section to this matter so be sure to check it out.

ACC want Claimants and Counsellors to believe that the Psychiatric profession is behind ACC and stand in opposition to the Counsellors. This is typical divide and rule tactics and should be seen for what it is. What Claimants need is a unified medical profession yet ACC has cynically created a climate of uncertainty and division that only suits the Corporation. 

Steps to Maintaining a Safe Medical Process 

As this information demonstrates the claimant faces a difficult task trying to protect themselves from ACC ultra vires behaviour. There is a path through the minefield. Here are the steps you will need to take. 

Under no circumstances compromise the clinical integrity of your treatment providers. Moderate your tone when criticising ACC assessors.  The medical community is easily appalled at a lack of decorum. Seriously. 

Your GP is utterly essential. Your GP may genuinely believe after years of dealing with the Corporation that the GP has no power in the scheme of things but they do. You as a claimant need to realise this truth. The Corporation finds it much harder to fend off a GP letter than a claimants letter for one thing. More importantly the GP can refer the claimant to specialists and generally keep the clinical process on track. The more the GP stands back the more the Corporation will be able to weave it’s web. 

The Corporation likes to maintain it has carte blanche rights to choose an individual assessor. I differ from the Corporations view. I have written counter arguments to argue that the assessor choice is a matter for the GP and or treating providers. I have already won a Review with earlier versions of the arguments but they really need to be tested in the courts to make case law. The arguments have worked for me so far and the ACC has declined to push me on them at this point. If the ACC tries to fight those arguments email me at accschelp@actrix.co.nz and I will see what can be done. Any claimant can use the submission if they so choose but I make no guarantees of any kind. Make sure your GP gets to read the submission. 

https://sites.google.com/site/sensitiveclaimshelp/counters-to-acc-choosing-assessor


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