New cover guidance for surgical mesh injuries
We've recently finalised new cover guidance for surgical mesh injuries. Based on this new guidance we're giving people with previously declined surgical mesh claims the opportunity to have their cover decision reassessed.
ACC cover for surgical mesh injuries
Our guide to ACC cover is a useful tool for clinicians in explaining our approach to making decisions on claims related to mesh injuries, and understanding when it may be beneficial to submit a treatment injury claim.
The guidance is based on the latest medical evidence and understanding of mesh injuries and was developed with experts in urology, obstetrics and gynaecology, surgery, and pain.
The new guidance means:
- Where there is clear evidence of mesh erosion/extrusion, specific nerve damage, or surgical error, ACC is likely to accept the claim.
- In cases where there is evidence of symptoms such as pain or sexual dysfunction, but no clear diagnosis of a physical injury causing the symptoms ACC can support further assessment to investigate if there is a physical injury. This new medical evidence may support the link to mesh injury.
- Age, menopause and/or use of oestrogen therapy aren’t relevant to the cause of surgical mesh injuries. Claims are unlikely to be declined because of these reasons alone.
Reassessment of declined surgical mesh claims
We are giving people with previously declined surgical mesh claims the opportunity to have their cover decision reassessed at their request, based on our new cover guidance.
Although the guidance is specific to pelvic surgical mesh injuries, there were learnings found that are relevant to the way we assess other mesh injuries. We will reassess any declined surgical mesh claim (decided prior to 28 October 2020) at the client’s request.
We encourage providers to discuss this with patients whose claim may benefit from reassessment.
Read case examples of claims that may be impacted:
Surgical mesh claim examples
We are not communicating directly with clients with declined claims about this opportunity as we know this may cause further trauma. Instead we will make this information publicly available through advocacy groups, health professionals, our website, and other public channels.
The reassessment process
We will begin accepting reassessment requests from 28 October 2020. To request reassessment or find out more, we are advising people to:
- contact our dedicated team on 0800 735 566 or firstname.lastname@example.org
- visit their GP
- discuss this with their medical specialist at an upcoming appointment.
We will reimburse patients for the cost of an appointment with their GP or specialist. Either clinicians or patients can contact us to start the reassessment process.
Any new surgical mesh injury claims should be submitted via the standard treatment injury lodgement process.
To request reassessment for a patient or to find out more, contact us on 0800 735 566 or email@example.com.