Reassessing declined surgical mesh claims

We're committed to looking back through declined surgical mesh claims to check past cover decisions are consistent with the latest understanding of mesh injuries.

If you've had a claim for a surgical mesh injury declined, you can ask us to reassess it based on the latest evidence and understanding of mesh injuries.

ACC and surgical mesh

In 2019 we were part of the surgical mesh restorative justice process commissioned by the Ministry of Health and run by Victoria University of Wellington. More than 600 people shared their experiences of harm caused by surgical mesh.

We heard from mesh-injured people about how our claims experience has contributed to the harm they've 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 committed to looking back through declined surgical mesh claims to check those past cover decisions are consistent with the latest understanding of mesh injuries. We'll also to look for opportunities to improve the experience of those who come to us for help.

We've now looked back at a sample of declined claims and worked with medical experts to consider the latest medical evidence and understanding of surgical mesh injuries. In the sample, we found that some claims could potentially get a different decision today based on the new evidence and understanding. Some claims might also benefit from more clinical investigation.

We know these injuries have had a huge impact on people and we want to provide support where we can. To allow that, people who have had a claim declined in the past are able to have their cover decision reassessed. The decision may not change.

Reassessing declined claims

We'll reassess any declined surgical mesh, claim regardless of the type of surgical mesh you have implanted, at your request. This applies to cover decisions made before 28 October 2020.

We know that going through the claims process and further clinical assessments may be difficult for some people. We’re committed to minimising any further trauma. Our small dedicated team will help guide you through the reassessment process.

If you think you might benefit from having your declined claim reassessed, you can:

  • contact our dedicated team
    Phone 0800 735 566 (choose option 5)
    Email surgical-mesh@acc.co.nz
  • visit your GP and take this information with you (print this page or save view it on your phone)
  • discuss this with your specialist doctor (if you're receiving specialist care) at an upcoming appointment.

We can reimburse you for the cost of the appointment with your GP or specialist. If you're unable to cover the initial cost, please contact us about other options.

When you first contact our team, we'll take your details and arrange a time to call or email you back (depending on your preference).

We'll then look at the information we have on file and let you know what the next steps are. You'll have a dedicated specialist cover assessor who'll be in regular contact with you and will support you through the process. You can choose if they're male or female.

To reassess some claims, we may need more medical information. This may or may not involve further medical assessment. If an assessment is needed, we'll:

  • talk this through with you
  • help arrange the assessment
  • cover the costs of the assessment
  • support you through the process.

You'll need to give us your consent to start the reassessment process. If you would rather see your GP or medical specialist first instead of contacting us, they can contact us and start this for you. We'll then contact you to confirm your consent.

If you think you have a surgical mesh injury that can be covered and haven't made a claim yet, talk to your GP or specialist about submitting one now.

How we'll assess your claim

We've worked with an external advisory group to develop new cover guidance for surgical mesh injuries. They're based on the latest medical evidence and understanding of mesh injuries. We'll use this guidance to assess both previously declined claims and new claims.

What the new guidance means

  • Where there is clear evidence of mesh erosion/extrusion, specific nerve damage, or surgical error, we're likely to accept the claim.
  • In some cases, there is evidence of symptoms such as pain or sexual dysfunction, but no clear diagnosis of a physical injury causing the symptoms. In some cases, new medical evidence may support the link to mesh injury. We can support further assessment to investigate if there is a physical injury, if you're happy to have the necessary assessments done.
  • We now know that 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.

We look at every injury claim on a case-by-case basis, in line with the latest medical evidence, and with the information available.

More information

For more information or to request a reassessment, you can:

  • contact our dedicated team
    Phone 0800 735 566 (choose option 5)
    Email surgical-mesh@acc.co.nz
  • visit your GP and take this information with you (print this page or view it on your phone)
  • discuss this with your specialist doctor (if you're receiving specialist care) at an upcoming appointment.
  • read our client information document, question and answers, and process chart.

Reassessing declined surgical mesh claims - client info

Reassessment declined surgical mesh claims Q&A

Reassessing declined mesh claims cover - process

Declined surgical mesh claims 'look back' summary

We can reimburse you for the cost of the appointment with your GP or specialist. If you're unable to cover the initial cost, please contact us about other options.

If you need support while going through this process you can:

  • talk to your GP about what local support is available
  • call or text the free 'Need to talk?' service on 1737, for emotional support.
Last published: 30 October 2020