When the Southern Cross Member Advocacy team successfully challenge an ACC claim, it’s not just our member who wins – their employer can too. It’s another good reason why it pays to look after your team with a Southern Cross health insurance work scheme.
It’s a no-cost service that advocates to have ACC review claims for members, which we believe have been incorrectly declined. These claims can relate to a personal injury caused by an accident, treatment injury or a work-related gradual process.
Over tfhe past 12 months, the team has:
Employers benefit from a successful challenge too, because:
A successful ACC claim may also include entitlements not covered by a member’s health insurance, such as:
It’s good to be aware of ACC’s return to work programmes which can help individuals recover from an injury and get back to work sooner. These programmes typically involve an Occupational Therapist making recommendations on activities, equipment, changes to a workplace or tasks, or identify areas to ease the person back into their role.
To better understand how the team can help, let’s look at a real situation. Arthur’s* case is a typical one the team deal with every day.
Arthur slipped in a feed-out wagon and fell onto his shoulder, requiring a rotator cuff repair. Because Arthur was part of a farming corporate group, his claim went to a private ACC claims management organisation. They stated that because Arthur was not acutely incapacitated at the time of the accident, the tear in his rotator cuff was not traumatic. They were also of the view that, as Arthur is a ‘stoic’ individual who carried on working and managing his pain without surgical intervention, it suggested the tear was not accident-related.
Arthur approached Southern Cross to get approval for his surgery. The Southern Cross Member Advocacy team saw that his declined ACC claim was worth challenging, so helped Arthur through the process.
ACC revoked the decision and accepted the claim, which resulted in: