The following is an all too common story of dealing with ACC (the Accident Compensation Corporation) – having income protection or at the very least mortgage protection insurance in place can often help in terms of better outcomes.
ACC is spending millions each year spying on claimants it suspects are committing fraud. Cate Broughton reports.
ACC spent $5.1 million in the last year on investigating suspected fraud, including internal and contracted staff, surveillance, and lawyers for prosecutions, but claims it saved taxpayers about $7.3m in weekly compensation payments for fake claims.
One of those ACC has spied on is self-employed Christchurch landscaper Ivan Stryder, who has been embroiled in a bitter dispute with ACC since he injured his back at work in April 2014.
The 44-year-old, who featured in a Stuff series about ACC in July, suffered a severely bulged disc in his lower back and the subsequent surgery in April 2016 failed to relieve severe pain.
Four months after the surgery, an ACC-funded independent medical assessor said Stryder could resume full-time “light to moderate” work duties, but should limit “heavy lifting, pushing, pulling or carrying on a more frequent basis for the medium term”.
Stryder objected to this, and two further ACC-funded medical assessments, citing his ongoing pain and reports from his own sports doctors.
Documents supplied to Stryder by ACC last month revealed his case manager requested surveillance in August 2016, based on suspicions Stryder may try to stay on weekly compensation long term without medical justification.
The Privacy Act permits ACC investigations as long as they are conducted for lawful, relevant purposes, including the protection of public revenue, and are done in a lawful, and not overly intrusive way.
Stryder was watched for up to six hours on three days from August 18, 2016.The “operative” was to get video footage of Stryder lifting something heavy, and record his work hours over a day.
On August 18, a man who resembled Stryder was tracked for “a number of hours” during the surveillance, but later “discounted from the inquiry”. Another day Stryder was seen bending down to lift a red bag. He was not seen doing heavy lifting, but “was seen to walk, or even run freely”.
The investigator concluded that the hours Stryder was seen working “more or less” matched the hours he was medically certified for. The inquiry was closed after finding little evidence of fraud, though the investigator noted there was a “possibility that future investigation will be required”.
An ACC spokesman said the agency “decided not to pursue the matter further”.
Stryder said he was annoyed when he found out about the surveillance because he had done nothing wrong. ACC said concerns that Stryder was fraudulently receiving weekly compensation justified the need for video surveillance.
“Even after proof of failed back surgery their doctors are still saying I am fit for 40 hours’ work a week doing landscaping, labouring and heavy physical work and they will not listen to my treating doctor, my GP,” Stryder said.
In total, ACC spent $3200 on video surveillance and about $19,500 on lawyers to represent ACC at reviews of decisions on Stryder’s entitlements. It spent another $1500 for security at a review he had with dispute resolution service FairWay Resolution Ltd.
Stryder believed he was still being watched, but ACC denied that.
“I don’t doubt it, they are just trying to exit me any way they can,” he said.
An ACC spokesman said the agency spent $5.1m on its integrity services unit, which investigated 698 cases, in the 2017-18 year. Of those, 427 involved fraud, waste or abuse and 58 were assessed as fraud.
Just over $105,000 was spent on private investigation services for the same period.
Of the 58 cases assessed as fraud, 53 involved fraudulently gained weekly compensation, and social and vocational services. Five cases involved fraudulently gained treatment payments by treatment providers.
ACC prosecuted six people, five of whom pleaded guilty and one case was withdrawn. Other consequences for fraud included formal warning, debt penalties, and ceased or reduced entitlement.
The value of current and ongoing weekly compensation gained from fraud in the last financial year – $7.3m – was calculated using claim history to model expected client claim durations and costs, ACC said.
Lawyer Peter Sara, who represents Stryder, disputed the $7.3m figure.
“That kind of figure is made up … it’s not a hard figure, it’s speculative.”
Sara said ACC needed to learn how to better deal with people like Stryder.
“Like a number of people who have had unhappy dealings with ACC, they get mad as hell and that can lead to … nothing less than warfare.”
ACC defended the figure, saying the value of its integrity unit “intervention” was calculated based on claim history modelling.
In the financial year to June, ACC made 802,099 payments totalling $131m for medical assessments.
ACC used lawyers for about 10 per cent of review hearings due to “legal complexity, the precedence value of the issue, indications the client intends to progress the matter to court, and the workload of our people”.
Sara said hiring lawyers for reviews only inflamed the situation and put claimants in an unfair position.
“Once you’ve got a lawyer involved, every case has to have a lawyer.
“At some point somebody with intelligence needs to stand back and say this is crazy. This is insane, we’re spending all this money and the guy is mad as hell – what do we need to do to fix this?”
As for Stryder, his war with ACC continues. To date, he has had 16 reviews of ACC decisions and applied to appeal three review decisions in the district court. He has been barred from communications with ACC case managers and trespassed from dispute resolution service Fairway Resolution Limited premises.
The financial stress, severe back pain, insomnia and challenging of ACC caused his marriage to break down and he suffered from anxiety and depression, he said.
“I hate it when ACC don’t believe you. I’m going to have to keep battling with them; I believe it’s totally criminal behaviour.”
ACC BY THE NUMBERS*:
1.98 million new claims received
79,648 new weekly compensation claims received
$69m – spending on injury prevention
$1.7 billion – spending on treatment and emergency travel
$740m – spending on care and support
$1.4b – spending on financial compensation and vocational rehabilitation
$740m – spending on operating costs
$40b – size of ACC’s investment portfolio to cover future claims
$3.5b – amount ACC earned in interest on its investment
99,500 – number of claims declined annually (disputed by some lawyers and advocates who say the figure could be as high as 300,000)
7616 – number of applications for reviews of ACC claim decisions*
$12.2m – spending on review services to FairWay Resolution**
(Source: ACC Annual Report 2018 and ACC Media Adviser)
* For the financial year to June 2018
** For the financial year to June 2017.
By Cate Broughton