Understanding Treatment Injury: An Advocate’s Perspective

Understanding Treatment Injury: An Advocate’s Perspective

By Chloe Harland

What is a Treatment Injury?

A treatment injury is an injury caused by medical treatment from a registered health professional. For a claim to be accepted by ACC, it must meet three main criteria:

1. An Injury Occurred: The injury must involve physical harm or damage. For example, a claim based on dizziness alone, without any physical evidence, may not qualify.
2. Causation by Treatment: The injury must be directly caused by the treatment. It’s assessed based on the balance of probability, not mere possibility. For instance, if a patient experiences numbness after a nerve is cut during necessary surgery, this could be covered.
3. Not an Ordinary Consequence: The injury should not be a normal part of the treatment, considering medical knowledge and the patient’s health. For example, a hernia developing post-surgery might be covered for a generally healthy patient but not for someone with complicating health conditions like diabetes.

Common Reasons for Declined Claims

1. Insufficient Evidence: A lack of physical evidence often leads to claim rejection. For instance, claims for symptoms like dizziness without a detectable injury are likely to be denied.
2. Ordinary Consequences: Injuries considered ordinary outcomes based on the patient’s condition are not covered. For example, post-surgery infections in patients with pre-existing health issues might be seen as expected complications.
3. Consent Issues: If a patient didn’t follow the treatment plan or withheld consent, resulting in injury, their claim might be denied. For example, if a patient refuses to complete prescribed medication and their condition worsens, the claim could be rejected.

Moving Forward

As an advocate, I’m here to ensure your voice is heard and your case is carefully considered. If your treatment injury claim has been declined, don’t lose hope. Understanding the criteria and presenting a well-supported case with an advocate’s help can significantly improve your chances of a fair outcome. For further guidance or assistance with your claim, feel free to reach out. Together, we can navigate the complexities of ACC’s treatment injury claims and work towards achieving a just resolution.