Part 6: Claimant service performance

Accident Compensation Corporation: Case Management of Rehabilitation and Compensation.

Corporate Approach to Claimant Service

ACC’s strong internal focus on processes and efficiency does not have to be incompatible with a customer service ethic. Nevertheless, some claimants, both short-term and long-term, who expect a more personalised relationship, find ACC’s focus unsettling.

ACC told us that it endeavours to have a strong customer focus, and wants to resolve any complaints informally. It also said that more claimants than ever are satisfied with the service they have received from ACC, and it cites results from claimant satisfaction surveys as evidence.

Although ACC has this approach, its interaction with claimants is governed through the Code of ACC Claimants’ Rights that was implemented on 1 February 2003 (a requirement under the Act). The Code imposes a legislative framework on ACC in relation to the rights of claimants and the obligations on ACC.

Code of ACC Claimants’ Rights

Part 3 of the Act requires ACC to establish a Code of ACC Claimants’ Rights. The Code came into force on 1 February 2003. Specifically, section 40(1) states that the purpose of the Code is to meet the reasonable expectations of claimants (including the highest practicable standard of service and fairness) about how [ACC] should deal with them … Included in this section is a reference to conferring rights on claimants and imposing obligations on ACC as to how it will interact with claimants, along with the provision of a means of lodging and dealing with complaints about breaches of the Code by ACC.

The Code specifies eight rights of claimants. These are the right to: • be treated with dignity and respect;

  • be treated fairly, and to have their views considered;
  • have their culture, values, and beliefs respected;
  • have a support person or persons;
  • effective communication;
  • be fully informed;
  • have their privacy respected; and
  • complain.

Case managers have had formal training sessions about the Code, and how to comply with it. These sessions have emphasised case manager responsibilities to uphold the rights of claimants under the Code.

Some staff suggested to us that the Code simply expresses the customer service values to which ACC already aspires. However, we consider that the Code has given increased prominence to these values, and has helped to standardise and clearly articulate internal procedures, particularly for dealing with complaints. Moreover, ACC’s Complaints Office can now direct other parts of ACC to rectify any breaches of the Code.

Claimant Service

Case managers have most contact with claimants by telephone. Face-to-face interviews are normally used for the initial interview as well as preparing and completing Individual Rehabilitation Plans. Some claimants criticise ACC about the low amount of face-to-face contact, as they expect a more personalised and tailored service to discuss their injury and the effect on their families, and to explore future employment possibilities.

Based on our work in the branches we consider that ACC is generally providing a sufficient level of face-to-face contact with claimants.

Some claimants expressed concern that ACC does not fully inform them of what they are entitled to. Illustrated publications were available at ACC offices that explain most services, including a guide to recovery and how to resolve issues. Such publications are of a high quality and are easy to understand. However, the language of some of the template letters to claimants can be overly formal, and might appear impersonal and confusing to some claimants.

Of course, we cannot comment on the quality of the verbal advice provided by case managers in individual cases. However, we noted in paragraph 4.44 on page 64 that some claimants said that their case manager referred them to written information in brochures rather than discussing the preparation of their IRP with them.

Some claimants also talked of the number of case managers that they have dealt with during their time on the accident compensation scheme. Some told us that they had one case manager for the duration of their claim, while others had several. Case manager turnover is low (see paragraph 5.8 on page 80), and this should in future limit the number of case managers that claimants deal with during the life of their claim.

ACC considers that, as long as the level of service is not affected when a claim is transferred between case managers, it should not matter how many transfers occur during the life of a claim. However, some claimants told us of their frustration when their claim was transferred to a new case manager because they had formed a relationship with their previous case manager, and then had to repeat the process with a new one. This situation is another example of the gap between the personal service expected by claimants and the kind of service ACC thinks it should deliver.

ACC policy is that when a case manager transfers a claim to another case manager (whether because of a redistribution of work or because a case manager is leaving), the claimant should be sent a letter notifying them of the change and of their new case manager’s contact details. However, this policy is not always followed because we talked with claimants who said that they had not been notified of a change in case manager. In line with the Code of ACC Claimants’ Rights, ACC is obligated to effectively communicate with claimants to keep them fully informed.

Recommendation 9
We recommend that ACC ensure that claimants are notified when their claim is transferred to another case manager.

In conjunction with Work and Income, ACC has created a protocol (in line with a whole-of-government approach) covering the process for claimants transferring from the accident compensation scheme to an unemployment benefit. Such a transfer occurs when an ACC claimant has been assessed as vocationally independent, but has no employment to go to.

The protocol involves the ACC case manager introducing the claimant to their Work and Income case manager, thereby easing the transfer between organisations. The protocol was implemented in June 2003, and is optional for claimants. Branches are to report back to Head Office about claimant uptake of the protocol.

Our understanding from Work and Income is that few claimants so far have transferred to them using the protocol. Nevertheless, we view the protocol as useful for claimants transferring between ACC and Work and Income.

ACC formerly had a policy that case managers were to contact claimants four weeks after they left the accident compensation scheme to find out how they were getting on. ACC told us that it no longer has this policy because of the cost, and because there were few benefits to the claimant. In any case, such follow-up did not happen in all cases because of the low priority that some case managers gave to the task.

In our view, when a claimant leaves the accident compensation scheme for any reason there needs to be some form of follow-up by ACC to allow it to gauge the success, or otherwise, of the service it provided. As an example of how it already does this, ACC cited a satisfaction survey of former ACC claimants that asks them about their ACC experience. This survey would be a useful tool, but it should be commissioned more frequently for ACC to obtain information on the quality of claimant rehabilitation outcomes.

Recommendation 10
We recommend that ACC more frequently commission the survey of former ACC claimants to obtain data that can be used to improve the quality of claimant rehabilitation outcomes.

Another example of ACC follow-up is a research project, in conjunction with the Department of Labour and the Ministry of Social Development, that looks at whether former ACC claimants return to work or go on to receive a benefit after they have left the accident compensation scheme. There is value in this research, and it should be continued, especially in regard to claimants who have been declared vocationally independent by ACC but who subsequently qualify for a medical-related benefit (such as an invalids benefit).

Complaints, Reviews, and Appeals

ACC has clear and appropriate complaint procedures in place for receiving and responding to complaints made by dissatisfied claimants, in accordance with the detailed review and appeal rights outlined in the Act. The rights to complain, to seek a review, or to appeal, provide important checks and balances on case management in individual cases.

In general, the term “complaint” means a formally or informally expressed grievance, often relating to a matter of behaviour or process. The term “review” refers to a formal consideration of an objection to an ACC decision (such as a decision about cover or entitlements), with a request that the decision be changed. An “appeal” can be lodged with the District Court if either the claimant or ACC is unhappy with the review’s outcome. Complaints

Although ACC wants to resolve complaints as informally as possible, the claimant often determines the degree of a complaint’s formality. For instance, they can choose whether to raise their issue over the telephone, or in writing, and whether to do so with the:

  • responsible case manager;
  • team manager;
  • branch manager;
  • complaints office (at Head Office); or
  • Minister for ACC.

Significantly, the Act provides that a claimant can apply for a review of a decision that ACC’s Complaints Office has made about a complaint under the Code. This is a useful further check on ACC’s actions.

In addition to seeking remedy from ACC, some claimants complain to external agencies, such as the Ombudsmen, the Health and Disability Commissioner, or the Privacy Commissioner. We did not audit how those agencies deal with complaints from ACC claimants.

The number of complaints received by ACC’s Complaints Office has increased since the introduction of the Code. This increase may be because more claimants are aware of their rights. Additionally, the more standardised process means that more complaints are being directed to Head Office. In our view, the number of complaints received is not as important as:

  • the cause of complaints;
  • the issues they raise; and
  • whether the types of complaints change over time.

ACC staff who deal with complaints suggested to us that many complaints relate to simple misunderstandings or miscommunications, and are able to be resolved with a quick explanation. Other complaints relate to the perceived attitude or behaviour of a case manager (such as seemingly being discourteous or sceptical), or a delay.

However, because complaints can be dealt with at different levels within ACC, and because each complaint and its remedies are fact-specific, it is difficult for ACC to gather accurate qualitative information about complaints trends overall. ACC told us that it plans to do more to collect and analyse overall information about the types of complaints that it receives, and to monitor trends.

Such collection and analysis are very important. Otherwise, the lessons learned from individual complaints may not always lead to organisational improvements, and it will be difficult to tell whether or not practices and relationships are improving over time.

In addition, while the ACC Complaints Office is able to achieve results in individual cases, it could usefully take a more active role in influencing improvements throughout ACC.

Recommendation 11
We recommend that ACC prioritise the collection and analysis of qualitative information about the types of complaints that it receives and how the nature of those complaints has changed over time.

Recommendation 12
We recommend that ACC use qualitative information about complaints to help identify areas where changes to policies or practices may be necessary.

Reviews and Appeals

A claimant can challenge an ACC decision by filing an application for review with Dispute Resolution Services Limited. When this happens, ACC follows a two-step process.

First, the branch conducts an internal reconsideration of the decision, to assess whether it ought to be defended. The staff member who made the decision (often, but not always, a case manager) writes an internal report and recommendation about the decision. The branch manager and team manager (and perhaps the technical claims manager and branch medical advisor) consider the report and decide whether or not to stand by the original decision.

The matter can sometimes be resolved at this point if, for instance, the application for review includes the provision of new information which changes the situation.

Secondly, if ACC decides to defend the original decision, it proceeds to a contested hearing. This is a formal, quasi-judicial process. A reviewer with Dispute Resolution Services Limited – who is not otherwise employed by ACC and has a statutory duty to act independently – hears evidence and submissions on behalf of the claimant and ACC.

Claimants are sometimes represented by advocates or lawyers. ACC is represented by the original decision-maker, who prepares and presents submissions in support of their original decision.

The reviewer issues a written decision, containing detailed reasons explaining the outcome, after the hearing, which is binding on the parties (subject to any appeal rights).

In 2002-03, a total of 79% of review applications were dismissed or withdrawn, which indicates to us that most of ACC’s decisions are justifiable when placed under close scrutiny.39 This figure compares with 72% as reported by ACC for 1999.

However, in our view, the way in which case managers are involved – particularly at contentious review hearings – has the potential to create risks for both the case manager and ACC.

Often, the ACC representative’s presentation at the review hearing is a mixture of advocacy and evidence. However, in a formal legal setting, those roles are different: the first involves representing and arguing a legal position, and the second involves testifying as to the relevant factual events.

In cases where the relationship between the case manager and claimant has deteriorated considerably, the claimant’s case may involve challenging the behaviour, actions, motives, and factual recollections of the case manager. The case manager is in effect a witness whose credibility is under challenge. Where this is the case, the case manager may be put in a difficult position, and their ability to act effectively as an advocate and representative may be undermined.

Accordingly, in some cases, we think the roles of witness and advocate may need to be separated at the review hearing. While the case manager will be required to give evidence about factual matters and explain their actions, it may also be necessary for ACC to be represented by an advocate who is not personally connected to the factual disputes in the case.

Recommendation 13
We recommend that ACC consider whether, in contentious review hearings, the role of the case manager should be limited to that of a witness, with another staff member acting as ACC’s advocate.

Staff from the Office of the Ombudsmen expressed concern to us about the length of time that ACC sometimes takes to remedy review cases in which its decision has been overturned on appeal and it elects not to appeal. Examples were cited where claimants have been left waiting before the revised entitlements – determined at review or appeal – have been implemented.

ACC’s response is that some delays are caused by the need to liaise with third parties to organise financial arrangements. An example of this is where a claimant receives a social welfare benefit but subsequently establishes a claim to an entitlement under the accident compensation scheme. Depending on the level of support provided by Work and Income in contrast to the entitlements allowed under the scheme for the same period, sections 252 and 253 of the Act specify how the department responsible for the administration of the Social Security Act 1964 (in this case Work and Income) and ACC are to work out any difference by way of any repayment from one to the other.

While we understand that ACC is sometimes bound by the timeliness of the response from third parties, we nevertheless share the Ombudsmen’s concern about any delay, because this can have severe consequences for the claimant, and cause significant disruption to their life.

Recommendation 14
We recommend that ACC prioritise action to implement a reviewer’s decision as quickly as possible in cases where ACC’s decisions are overturned and it elects not to appeal.

Senior management at Head Office monitors all decisions on reviews on a weekly basis. Lessons learned from these cases are used to amend relevant policies and practices but decisions to make changes, and subsequent policy amendments, occur in an informal way.

There could be value in formalising the process for considering review decisions and following through on any necessary changes. This will help ACC to be sure that all relevant issues arising out of reviews are addressed fully and quickly.

Recommendation 15
We recommend that ACC formalise its processes and timetables for considering issues arising out of review and appeal decisions, and implementing any subsequent changes to policies or practices.

Head Office manages ACC’s role in any subsequent appeals. During the year ended 30 June 2003, 79% of appeals to the District Court were decided in ACC’s favour or were withdrawn40, and about 80% (16 out of 20) of appeals to the High Court. This indicates that, generally, ACC applies the law properly.

Claimant Satisfaction Surveys

ACC commissions seven types of claimant satisfaction survey. The surveys are detailed in Figure 9.

Figure 9
ACC Claimant Satisfaction Surveys

1. The Network Management Survey, which is conducted monthly, and is based on a current sample of 550 to 600 claimants, with results reported quarterly. The survey measures the satisfaction of case-managed, branch-based claimants.
2. A monthly survey of contact centre claimants, conducted since April 2003. The survey is based on a sample of about 1200 claimants a year.
3. A survey of Catalyst claimants, attached to the Network Management Survey in February 2003. Catalyst handled long-term claimants who were actively managed to return to work. The research was based on a small sample of only 205 claimants, which limited the possibility of long-term tracking research.
4. An annual medical misadventure claimant survey, first conducted in May 2002, and based on a sample of about 400 claimants whose claims have been accepted or declined in the previous six months.
5. An annual survey, first conducted in 2002, of claimant complaints received in the previous six to nine months.
6. An annual survey of about 200 Partnership Programme claimants.
7. An annual survey of 70 to 80 serious injury claimants and their support persons, conducted since 2001.

Network Management Survey

Conducted by telephone, the Network Management Survey measures claimant satisfaction with the service received at the branch.

We particularly looked at this survey because of its focus on claimant satisfaction with branch performance.

In our view, this claimant satisfaction survey is based on a sound methodology, and produces reliable information on which to base statements in ACC’s accountability publications.

ACC’s surveys dating back to 1996 indicate that overall claimant satisfaction has improved since then, and is now 83%, which meets ACC’s target of 80%.41

Before September 2001, this survey did not distinguish between short-term and long-term claimants. Results from the survey since then have shown that long-term claimants are far less satisfied with ACC’s service than short-term claimants. Figure 10 below illustrates quarterly rates of overall satisfaction, as well as that of claimants who have received assistance from ACC for less than, and more than, 52 weeks.

Figure 10
Claimant Satisfaction by Category of Claimant as Shown by ACC’s Network Management Surveys from September 2001 to June 2003

Graph of survey results.

ACC uses the information from the Network Management Survey to target areas of case management service where performance must be improved. This information has also been used in ACC’s Annual Reports on a number of occasions. Reference is made each year to overall claimant satisfaction, along with an analysis of results extending back to 1997.

ACC’s Annual Report for 2002-03 describes claimant satisfaction rates for both short-term and long-term claimants. However, the report does not show the difference between them on the corresponding graph, instead showing only shortterm claimant satisfaction. In our view, both short-term and long-term claimant satisfaction data should be presented in a consistent manner when using a graph or text.

Recommendation 16
We recommend that ACC report both short-term and long-term claimant satisfaction rates in a consistent manner in its accountability publications.

Our evaluation of the information contained in a range of published ACC material found a number of minor discrepancies between the survey findings and the information shown in ACC’s Annual Report for 2001-02.

For example, in the Operational and Financial Highlights section on page 3 of ACC’s Annual Report for 2001-02 there is a statement describing an improvement in claimant satisfaction to 78%; “up from 71% five years ago”. At the bottom of the same page there is a six-year claimant satisfaction bar graph. This graph shows that claimant satisfaction five years before was only 60%.

Annual reports dating back to 1996-97 show quite different results for claimant satisfaction than those displayed on the bar graph. The Annual Report for 2001-02 shows an improvement of claimant satisfaction over five years of 18%, twice the increase reported in individual Annual Reports.

In addition, the Statement of Service Performance does not show a comparison with ACC’s performance for the previous year, which is usually how results are presented in an Annual Report.

In our view, the overall results of ACC’s claimant satisfaction surveys were inaccurately and incompletely presented in the Annual Report for 2001-02. Inaccuracy in the reporting of the overall satisfaction scores undermines the credibility of the Annual Report. We reviewed ACC’s 2002-03 Annual Report and the same errors were not apparent. Nevertheless, ACC should ensure that no inaccuracies, however small, are published.

Recommendation 17
We recommend that ACC implement a process to ensure that claimant satisfaction survey results are accurately reported in published material.

We interviewed a selection of claimants, both short-term and long-term, to obtain their views on the standard of service that they are receiving, or have received, from case managers. These claimants expressed divergent views about their experiences with ACC, which is consistent with the range of views recorded through ACC’s claimant satisfaction surveys. For example, differing views were that:

  • ACC is not providing them with everything they are entitled to;
  • they had been forced through the process, had been treated like a number and like everyone else, without reference to their individual circumstances;
  • while they had been treated badly in the past, the level of service is much better now; and
  • ACC could not have been more helpful during their recovery.

Given this range of views, it is not possible for us to arrive at an opinion on a majority claimant perspective of ACC. However, our interviews proved extremely useful in allowing us to understand some of the underlying issues that claimants experience in their dealings with ACC. We have referred to information gained through our claimant interviews throughout this report.

39: Of a total of 4118 review applications, 2234 were dismissed (i.e. ACC’s decisions were upheld), and 1007 applications were withdrawn, while 802 ACC decisions were quashed and 75 modified. Accident Compensation Corporation Annual Report 2003, page 63.

40: Of a total of 492 appeals, 214 were dismissed in ACC’s favour and 175 were withdrawn, while 93 were allowed and 10 had an interim order made. Accident Compensation Corporation Annual Report 2003, page 63.

41: Accident Compensation Corporation Annual Report 2003, page 11.

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