ACC compensation process - Mental Injury

(Update: I didn't notice I kept saying the word 'process' until I read this out on my vlog. Repeating myself is one of the ways my disabilities affect me. I will leave this minimally edited as it takes a lot of time and energy for me to do tasks).

I have been through the Accident Compensation Corporation (ACC) process all the way to a District Court hearing. My case involved conflicting impairment assessments by psychiatrists for my mental injury of post-traumatic stress disorder, PTSD (sensitive claims). I am writing some blog posts to process while I am in the process of archiving the files from a 2 year battle with ACC. Before, I go for round two. To be reassessed, yet again, even though I have little confidence in the process. Hopefully sharing some of my experiences will be helpful for others who are making a decision whether to go though this process. I will outline the process I went through, which may or may not be applicable to others.
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Referral to ACC

After being in and out of Mental Health Services multiple times over the past 3 decades, a mental health nurse finally referred me to ACC for trauma therapy. In New Zealand, Mental Health Services deal with moderate to severe mental health issues and ACC deal with PTSD. My mental injury comes under 'Sensitive Claims' with ACC. Sensitive claims includes criminal acts like sexual abuse and sexual assault, whether criminally prosecuted or not.

If you are looking at processing trauma from sexual violence, which includes historical sexual abuse, you can ask to be referred by a GP. You don't need to detail anything about the trauma, just say you want to be referred to ACC for 'Sensitive Claims.' Sensitive claims are handled by a separate unit within ACC. Details of the trauma are not listed on any general records.
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ASSESSMENT for mental injury

After a long wait, I finally saw a clinical psychologist who assessed me for mental injury of PTSD. During the wait and because of the severity of my symptoms, another clinical psychologist from Mental Health Services had done a psychological assessment (approx 6 hours over a few months) and diagnosed me with PTSD. I've had lots of diagnoses from Mental Health Services over the years but clinicians agree that bipolar disorder and PTSD are now my main diagnoses. 

The psychologist contracting to ACC assessed me over approximately 6 hours in 1 hour weekly sessions. This part involved detailing the trauma and it was very triggering. ACC requires this before they approve or decline funded therapy. There are loads of assessment tools and reports. After the initial assessment sessions, there are no funded therapy sessions until ACC officially accept the injury.

Unfortunately, this process is very triggering and can even be retraumatising for victims/survivors, so many pull out at this point.

ACC ACCEpted my injury of PTSD

After some 9 months or so wait, ACC finally accepted my injury of PTSD. I cried when I got the letter. The reason for the delay, was that ACC was trying to blame my difficulties on bipolar disorder (without seeing me) and also because there was a sexual assault overseas as an adult (linked to vulnerability from the childhood sexual abuse trauma).  ACC do not cover events occur overseas. Another reason for the delay, is that ACC didn't seem familiar with the childhood presentation of PTSD aka the 'avoidance and shutdown presentation'.

The psychologist who assessed me advocated strongly for me. I am grateful, as if it had not been for the mental health nurse who referred me and for the psychologist who advocated for me, I don't think I would be here today. I was so severely incapacitated at times, that I was unable to function at all. I couldn't even complete a basic form, do basic meal preparation like cook a scrambled egg, work or drive at all. Severe bipolar dsorder and severe PTSD.
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TREATment for PTSD

I was very fortunate to be able to see a clinical psychologist who was a good fit for me. She decided that a slower approach was best for me, given the complexity and severity of my presentation, with two major sexual assault traumas with bipolar disorder tangled in. Processing trauma too fast risked destabilising my mood and being stuck on a loop of being retraumatised.

I had already started processing in my own creative ways. I was encouraged to keep doing this but to take my time - not go too fast. 

My psychologist said that most people with a similar picture to me take 1 to 1.5 years to treat PTSD. I have been in therapy for 4 years. This was 1 hour weekly appointments, reducing to fortnightly for the last 6 months or so. I am expected to stop treatment soon.

An analogy to the severity of PTSD I deal with that the psychologist gave, is that treatment is like helping someone adjust to amputated legs. Whereas other people might have an injury that improves quicker, like someone with a 'simple' break of a leg, compared to smashed apart in an accident.

The payments directly to my psychologist for my therapy is a form of compensation by ACC. 

Compensation for permanent impairment

After being in therapy for at least 18 months to 2 years, some people, like myself, still have permanent impairment and disability from the injury. Some of the ways I am affected, is that I cannot work fulltime and I have some cognitive impairments.

I need a lot more sleep than most people and it's very difficult for me to try maintain relationships, like friendships. I can only drive short distances and sometimes I cannot drive at all. I am now effectively independent, although not particularly effectively and  rely on a benefit to survive. I am a mental health advocate (unpaid) as it gives me a sense of purpose. It's been years of an uphill battle to get to where I am today, to be able to write this blog post.

I was advised that I could apply for compensation if I wished. It is a completely different process and my treating psychologist could not be part of this process. I was allowed to talk about the stress of it though.

I talked it over with my GP and he agreed that it might be helpful for my personal growth to do it. I have to say, that it is one of the most challenging things that I have ever done. The process starts with requesting an application pack from ACC. I emailed them a request. The first step is for a GP to complete a medical certificate.

I chose the lump sum payment option, as I thought this would get ACC out of my hair, rather than to have weekly payments. Also, the lump sum payment would not affect my benefit, whereas weekly payments would.

Impairment Assessment

ACC said I could go to a city an hour's drive away for an assessment. I asked if there was another option, as driving was stressful for me. They said I could have an asssessment by a phone call and they would be assessing four functional categories. They didn't detail and I had to look them up just now to remind myself of what they were. 

• activities of daily living
• social functioning
• concentration, persistence and pace
• adaptation/decompensation

ACC said that PTSD is usually rated low, between 10-20% Whole Person Impairment (WPI). The threshold for payout is 10%. They told me how much the compensation would be for 10% and 20%. It was very low. I forgot the exact figures but if I recall correctly, it was just over NZ$3,000 for 10%, around NZ$9,000 for 20% and nothing if under 10%. They assigned me a psychiatrist to do the assessment. I would later learn that it is nearly impossible to shift the decision of this first assessor. The bias is there form the start, to avoid paying out compensation. I will write more about this in another blog post.

I also didn't know until this point, that impairment and disability are two different things. Impairment is how the assessor sees a person - the loss of functioning etc. Disability is more how the person sees the gap between what they could be doing without the impairment. Disability can be reduced, whereas impairment is considered to be permanent and stable. However, when it comes to some injuries, there is subjectivity.
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To be continued

I have been writing this blog post in several short chunks, with breaks to do other activities. I think I will end it here, and continue describing the process in another post, hopefully within a few days. I am quite keen to get this out of my system, so I can put it out of sight, out of mind, to have a complete break from it, before I start the process again.