“Denied for ‘Degenerative’? Why Age Is Just a Number in Injury Claims”
By Chloe Harland
Why Was My Injury Claim Denied?
We hear this question a lot: “Why has my injury been declined by ACC on the grounds that it was caused by ‘degeneration’ rather than my accident?” Many believe they only need to prove two things: a) they suffered an accident and b) they require treatment. However, that’s rarely enough. Even if the accident description from your GP seems clear, ACC might not dispute the accident or the need for treatment. So, what’s the real issue?
The Key Issue: Proof of Causation
Once your claim is declined, the burden of proof falls on you. A simple connection in time and place to an accident doesn’t necessarily prove that the accident caused your injury.
Example: Jess’s Story
Jess, an avid tennis player, falls during a game and immediately feels pain. Assuming it’s a sprain, she tries home treatment. Weeks later, still in pain, she consults a specialist. An MRI reveals a partially torn meniscus, tendinosis, and osteoarthritis. The specialist applies for ACC cover, but Jess’s claim is denied, attributed to degeneration rather than the accident.
What Does This Mean?
Jess’s case shows that a history of chronic conditions can complicate claims. ACC may argue that her knee issues were due to pre-existing conditions, not the fall. It’s common for underlying issues to become symptomatic after an accident, but ACC law distinguishes between aggravating an existing condition and causing a new one.
What You Need to Prove
To overturn a denial, you must prove that the accident was the ‘whole or substantial’ cause of the injury. This involves demonstrating the degree of chronic (pre-existing) versus acute (new) pathology.
How to Build Your Case
- Medical Evidence: You need more than just a timeline of events. Obtain detailed medical reports, which can only be requested by a lawyer or advocate.
- Expert Representation: A skilled lawyer or advocate will align medical evidence with ACC legislation to make your case. They know the nuances of the law and can effectively argue your point.
Final Thoughts
Nearly everyone has some degree of degeneration, especially as they age. ACC can’t deny a claim solely based on this. The critical factor is proving that the injury was primarily caused by the accident. With only one chance to review an ACC decision before potentially appealing to the District Court, getting expert help is crucial. Remember, you don’t know what you don’t know—so get someone who does to assist you.
