Most cases of anaphylaxis are covered by the Accident Compensation Corporation, although allergy itself is not, Dr John Monigatti, Director ACC Workwise, told the Allergy New Zealand National Conference in August.
“ACC provides cover for personal injury caused by accident (a specific event, or a series of events within a short period) or by work-related gradual process, disease or infection. Allergy is considered a gradual process, as sensitisation occurs over a period of time from repeated or continual exposure to an allergen,” he said.
Allergy is accepted for cover as a gradual process disease provided that the worker is exposed to the allergen in the workplace, that there is no material exposure to that allergen away from work, and that the risk of developing the allergy is significantly greater for people in general who perform that type of work than for workers who do not.
“Allergic reactions are regarded as more acute manifestations of the allergy and are covered if the allergy itself is work-related.” A specific exception exists for anaphylactic shock, however.
“ACC’s policy is to accept anaphylactic reactions as personal injury caused by accident, whether work-related or not,” Dr Monigetti explained.
There are several definitions of accident under section 25(1)(b) of the ARCI Act, 2001. These include:
a) an event or series of events involving application of external force to the body;
b) inhalation of substance on a specific occasion leading to physical injury;
c) oral ingestion of substance on a specific occasion leading to physical injury;
d) absorption of chemical through skin leading to physical injury.
Most cases of anaphylactic reaction will qualify under a) to c) above, with b) accounting for most cases of anaphylactic shock to food.
“In terms of the case study, the reaction occurred following eating at work so would be classified as a work accident causing injury (not to be confused with work-related allergy) for employer liability purposes.”
The hospital or general practitioner would lodge the claim on the patient’s behalf. This would be sent to ACC’s Contact Centre for cover determination.
For cover, ACC requires a standard of proof of “more likely than not”. To establish cover the Corporation would need the hospital records, the patient’s account of the incident, possibly the GP’s records, and referral to a specialist if the diagnosis or trigger needed clarification. Absolute proof is not required.
The decision to accept or decline the claim would be made by the Case Coordinator in conjunction with the Medical Advisor. Review rights would apply.
“ACC would pay entitlements for the disabling effects of the injury. This might include costs for transport, hospital and medical care, home help and earnings related compensation if applicable. It is likely that the Corporation would fund the EpiPen as treatment for future attacks.”
ACC has a “no-fault” approach to accident liability. “To me, it seems inconsistent that ACC provides cover for anaphylactic reactions in non-work related allergies but not for milder hypersensitivity reactions,” Dr Monigatti said.