Hugh Donald has had years of issues dealing with ACC, which acknowledged they treated him "despicably" and offered him a lump sum payment. Donald wants an independent mediator to hear his case and justice - not to be bought off quietly.

Before the election Labour said ACC was "mean-minded" and promised to make it fairer and more transparent for claimants. But will they deliver for thousands of claimants denied cover? CATE BROUGHTON reports.

A former Tiwai smelter worker who received an apology from ACC for "despicable" treatment over three decades says ACC needs a major shake-up.

DAVID UNWIN/STUFF ACC Minister Iain Lees-Galloway said he is happy with progress already underway to improve ACC processes for claimants who challenge decisions.

Christchurch man Hugh Donald, 68, lost 30 per cent of the capacity of his lungs when they were poisoned by toxic fumes at the site in the late 1970s.

He developed life-threatening asthma and spent years battling with ACC over getting his entitlements.

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*ACC causing 'unacceptable harm' to many rejected, legitimate claimants each year

Ross Giblin Dunedin barrister Warren Forster says an independent personal injury commissioner is needed to make ACC accountable.

Donald had been given two separate payments of $10,000 and an apology from ACC, but said he wanted an independent review of his case.

Talking about ACC still makes the father and grandfather emotional.

DAVID WALKER/FAIRFAX NZ Hugh Donald, 63, said poor treatment by ACC caused him to throw pig poo around the Dunedin ACC office. ACC acknowledged they treated him "despicably" and offered him a lump sum payment. Donald wants an independent mediator to hear his case and justice - not to be bought off quietly.

His advice for ACC Minister Iain Lees-Galloway? Don't rely on ACC for your advice, talk to claimants too.

"Give me a call and I'll tell you about ACC."

Dunedin barrister and researcher Warren Forster has spent the last decade researching ACC and defending claimants like Donald unfairly locked out of the system.

He's convinced the government's personal injury insurer has gone awry and needs supervision, discipline and attention.

This week he was awarded the country's highest legal research award by the New Zealand Law Foundation and will spend the $125,000 investigating how to scrap the system and start afresh.

Forster first hit the headlines when he released a damning report based on six years of research with the help of ACC advocacy group Acclaim Otago.

The report found huge barriers to justice for ACC claimants turned down for cover for treatment and/or weekly compensation payments.

Former ACC Minister Nikki Kaye commissioned Miriam Dean QC to review the findings.

Dean found most of the claims valid and issued 20 recommendations for reform in May 2016.

The most significant of these were to improve collection and analysis of claims data, address lack of access to medical evidence for claimants, and consider funding a nationwide advocacy service.

The Government released a plan for their implementation, and assigned ACC as lead agency for most of the work.

But Forster is critical of the Government response.

"What we pointed out to the previous government is you can't let the fox design the hen house – you can't give them all to ACC to implement."

In May this year Forster released a report backed by the Law Foundation which found ACC's data was unreliable and grossly underestimated how many injured and disabled people were left to cope without weekly payments, treatment and support.

ACC put the figure at 90,000 but Forster said the method for data collection used had not captured tens of thousands of claimants cut off from support and it was likely to be up to 300,000.

He asked to meet with ACC Minister Michael Woodhouse to discuss the report findings but the Minister did not respond.

Forster said he has made the new minister, Iain Lees-Galloway, aware of the issue.

He renewed an earlier call for the Government to establish an independent commissioner for ACC, similar to the Health and Disability Commissioner, as a means of ensuring accountability.

A key plank of Labour's ACC election manifesto was to fully implement the Dean's recommendations and "make the ACC system fairer and more transparent for claimants".

"Under National, ACC has too often been mean-minded, and it has become more difficult for claimants to accesss cover or entitlements for which they are eligible. This is not acceptable," the manifesto stated.

Lees-Galloway told Stuff he had asked Ministry of Business, Innovation and Employment (MBIE) advisers to look in to Forster's claims.

MEDICAL EVIDENCE CRUCIAL

Doctor's reports, X-rays or MRI scans are crucial in ACC claim decisions and often determine whether a patient will be supported or cut adrift.

When claimants are cut off and want the decision reviewed, they often need to produce alternative and superior evidence to have a chance of success.

ACC lawyer John Miller said a dearth of medical specialists willing to provide an opinion for an ACC case was the biggest issue for his firm.

Many specialists did not want to get involved in ACC cases because they were too busy and considered the pay inadequate.

Before lawyers were involved, individual claimants coping with an injury were often unaware of the importance of medical evidence and, even when they were, had no idea how to obtain it or did not have the money to pay for it, Miller said.

"I can't see a practical solution to it – claimants getting access to independent medical advice – because it's such an unequal playing field and they are at such a disadvantage."

Advocates say some case managers, under pressure to "exit" a claimant within nine months, attempt to influence medical reports.

Forster said he had evidence ACC case managers had called doctors and asked them to change a report.

"If a doctor says you can't go back to work and [ACC] don't like it, they will call the GP and say change your mind. If they can't work, it's about time we throw them onto the dole."

Forster believed the practice happened "every minute, every day, every month".

Miller said he was aware of attempts to influence medical reports.

"I'm certainly aware of case managers bullying or querying doctors. That's what I mean, it's very difficult to get independent medical advice because they are often driven into the ground by ACC then saying 'well you said this and that . . . and we want more information'."

Some GPs new to New Zealand did not understand the complex ACC system and were more susceptible to conscious or unconscious manipulation.

Miller said most people did not appreciate the huge effect adverse decisions by ACC could have on people's lives.

"People are abysmally ignorant of ACC. You don't care about ACC until it happens to you. Like everything in life, accidents happen to other people."

UNFAIR DEAL FOR PATIENTS?

Dean recommended a working party with an independent chair be set up to find a solution.

A medical evidence working party including advocates, lawyers, and representatives of medical specialists, has met four times over the last year to discuss the thorny issue, chaired by ACC chief clinical adviser Peter Robinson.

ACC is due to report on the outcome of the meetings in the new year.

Robinson said he was asked to chair the meetings by ACC but independent facilitators were present.

Representatives of the medical community at the meetings objected to suggestions by advocates that their opinion could be "bought" by ACC, he said.

"There was some angst really that it was thought that somehow doctors would get 'captured' and therefore would side with the funder."

Robinson said ACC had the same problem as claimants over medical evidence.

"There's a small pool [of medical experts] and while they might not want to write a report for the injured person they might not want to a report for ACC either."

He said ACC expected all health providers to "maintain their professional ethics and integrity" in writing reports.

"We are absolutely adamant that the people who write reports for us do so as independent experts and not to follow some sort of a... we want you to find in favour of ACC."

Robinson acknowledged the advantages ACC had over claimants in navigating the process and accessing evidence.

Even if more GPs "stepped up" and supported their patients with ACC claim disputes, there was also the issue of cost.

"These reports are not cheap. So clearly ACC has a distinct advantage..."

Robinson said he was not aware of any case manager trying to unduly influence a medical provider's report during his three years in the role.

He expected case managers would discuss a patient's progress with their health provider and obtain whatever information they needed to progress the patient's rehabilitation and return to work but not to coerce them to change a report.

New Zealand Medical Association president Kate Baddock, who attended the working group meetings, said doctors were concerned patients were not getting a fair deal from ACC.

The meetings were "excellent" and ACC "very much wanted to make it work for the patient/claimant".

"What we talked about was having a pool of independent medical experts that could be drawn on by ACC or the claimant to have an opinion and then everyone would accept that opinion."

Baddock said she was hopeful ACC's final report would reflect the working group's shared view.

Lees-Galloway said he was aware of the issues raised by Forster and had asked MBIE officials to investigate further.

The new minister had no issues with either the leadership nor pace of change for Dean's recommendations.

"I've been advised that most of the recommendations of the Miriam Dean report have been implemented and I'll work with ACC to ensure that this work continues apace."

Work towards a national advocacy service to assist claimants was "particularly important to me", Lees-Galloway said.

"The smaller-scale advocacy services that currently exist do important work and a service with national reach will be a big step forward."

Acclaim Otago spokesperson Denise Powell said she wanted the Government to ensure ACC fulfilled its purpose under the ACC Act, to rehabilitate the injured person to the maximum practicable extent.

"Now that doesn't mean time limiting someone's claim simply because [ACC policy] says you should be fixed by now and you're not so therefore it's your problem because obviously you're malingering or you've got some psychological problem... it actually is about real rehabilitation and for that there needs to be quite a big culture shift."

WHAT IS ACC?

- The Accident Compensation Corporation (ACC) is a crown-owned entity providing accident insurance.

- It provides financial compensation, rehabilitation and support to people who have suffered a personal injury.

- The scheme offers entitlements to people making a claim (claimants) subject to various eligibility criteria.

- ACC services and payments are funded through levies paid by employees and businesses and government donations.

- ACC is also responsible for injury prevention programmes in workplaces and the community.

- In 2016 ACC accepted 1,933,629 new claims and increased its investment income to $3.3 billion.