We're reassessing declined surgical mesh claims based on new medical evidence
We're committed to improving the claims experience and health outcomes of those treated with surgical mesh.
We're offering to reassess declined surgical mesh injury claims based on new cover guidance.
The new guidelines have been developed with an external advisory group, that has experience in a range of medical and surgical specialities. Guidelines are based on the latest medical evidence and understanding of mesh injuries.
"Last year, as part of a restorative justice process commissioned by the Ministry of Health, we had the opportunity to hear directly from people who have been harmed by surgical mesh," says ACC Chief Customer Officer Emma Powell.
"We also heard how our claims experience has contributed to the harm some people experienced. We recognise the severity and impact of the harm on people with surgical mesh injuries and the need for us to improve our systems and processes.
"We've committed to taking meaningful action to improve the claims experience and health outcomes for those treated with mesh. This included looking back through declined surgical mesh claims to ensure that past cover decisions are consistent with the latest understanding of mesh injuries. We also looked for opportunities to improve the experience of those who come to us for help.
"An initial look at a sample of declined claims showed that with changes in the medical evidence and understanding, some claims could get a different decision if lodged today. And some might benefit from further assessment. This doesn't necessarily mean cover decisions will change, just that some of these claims may warrant extra investigation."
We've made the reassessment process as easy as possible. To provide extra support, we've formed a dedicated cover assessment team to guide people through the process.
"We know that going through the claims process and further clinical assessments may be difficult for some people, and we want to minimise any further trauma," Emma says.
"We've worked with health professionals to ensure information about the new cover guidance is available and understood. We encourage anyone considering having their claim reassessed to contact us or to speak to their GP or specialist about their individual circumstances. This will help them understand how the latest medical evidence might apply to them, and what further information or tests might be needed to reassess their claim."
The new cover guidance will be used to assess previously declined claims and any new surgical mesh claims. It will help registered health professionals understand ACC cover for surgical mesh injuries, and when it might be beneficial to submit a treatment injury claim for their patient.
Find more information on reassessments of surgical mesh claims: