A New Zealand single mother who suffered a hip injury six years ago and was subsequently diagnosed with post-traumatic stress disorder is embroiled in a multi-year battle with ACC and the public health system after struggling to get either of her conditions covered.
Cathy Livermore suffered years of chronic pain after the Crown entity refused to fund a badly-needed hip replacement for her.
Livermore told Newshub she was formerly a professional dancer but suffered an injury while performing in 2015.
"We put it to ACC, they declined the claim," Livermore said.
"I went through two reviews with them. Basically, their rationale for declining the claim was that my hip morphology - the shape of my hips - meant I had micromovement happening and that, even if I'd been a secretary, I could possibly have [still] had that injury."
Livermore said she was told it couldn't be proven her injury happened while dancing. She said subsequent reviews still saw her claim declined.
"How can you overlook the basic, physical logic that I'm a professional dancer? This is what I do, this is my income."
ACC acting deputy chief executive of service delivery Andera Conlan confirmed it couldn't find a "causal link" between her work and her need for hip surgery. As such, ACC "declined the request to fund the surgery", Conlan said. "This decision was upheld by an independent reviewer.
"I was sorry to read about the challenges Cathy has faced getting treatment for her hip pain," Conlan said.
"Cathy has an accepted claim for a hip sprain. We received a request to fund surgery to repair a labral tear, which the medical evidence suggested was caused by an underlying condition rather than the covered sprain.
"We investigated whether her work had contributed to the underlying condition. However, the medical evidence didn't support a link between her injury and her work."
To add to Livemore's physical pain, she started to struggle mentally - but that was just the beginning of her battle.
After that, she went into a "floating spiral" in the public health system - claiming the surgeon she saw refused to give her a hip replacement because she was only 40 years old.
But she was desperate to undergo the operation so she could continue her dancing career.
"I'm a professional dancer, this is all I know, this is my income, I'm starting to really struggle with anxiety and depression around this because of the pressures of even, 'What do I do for work?' [I] laid all of that out to the surgeon," Livermore said, adding the doctor's solution was instead cortisol injections.
"I said to him… 'Actually, the best thing for me would be to have surgery and if I've got to have surgery again when I'm 70, I'll deal with that.'"
But the surgery was refused. In the meantime, Livermore said she had "no options".
The Auckland Charity Hospital, however, was able to give Livermore hip labral surgery in 2019.
While the surgery was successful, Livermore also had arthritis - meaning there were no guarantees she'd be back dancing again.
In 2020, while Livermore, was working to get back to strength, her hip pain came back.
"The pain didn't go away and it didn't get better, the arthritis had increased too much."
By March of that year, Livermore said the pain became "severe" - leading her back to the public health system where she was finally put on the waiting list for a hip replacement.
Fast-forward to December of the following year, Livermore said she tweaked the injury further - leaving her unable to walk.
"Then, I was put on crutches and went all the way through to February [2022]... the pain's worse and I literally can't even really go anywhere," she said, adding that's when she asked to be moved up the waiting list.
"I went in for a reassessment and [the surgeon] declined me moving up."
She's now had the surgery, but the constant battle between ACC and the health system has taken a toll on her mental health.
"I've been from anxiety to depression to PTSD," she said.
"[There were] huge mental health impacts of which I was also trying to resolve and get myself better - I couldn't afford to go to a counsellor.
"After the surgery, I was like, 'OK, now I've got the capacity to actually address the failure in the system' - and so I contacted ACC again, to find out that my actual case was actually still open this whole time."
Livermore said she questioned ACC about whether it would cover the cost of her counselling, given the repercussions her hip injury had caused. ACC told her the counselling would be covered, she said.
"So, I applied for counselling. My GP sent notes - and [ACC] declined the diagnosis of PTSD."
This was the final straw for Livermore: "The trauma in my body is severe," she said, holding back tears.
Livermore said she wanted to detail her struggle with the system as he felt at a "dead end".
"I've kept trying to engage [with the system] and now I'm just back at the same place I was at when that surgeon sent me out of the hospital… No one sees me, no one cares.
"I want to take ACC to task. I'm just like, 'How can they continue… to completely deflect?'"
Conlan also confirmed Livermore's GP asked CC to consider cover for PTSD last year.
"A diagnosis such as PTSD has to be confirmed through a formal mental injury assessment and despite best efforts, we were unable to reach Cathy to arrange an assessment," Conlan said, a claim that Livermore disputes.
"If Cathy would like us to reconsider this, or if she would like more information about the process, we encourage her to get in touch."
In a statement, Te Whatu Ora hospital and specialist services planned care group manager Duncan Bliss said when a person is referred to Health New Zealand's services for planned care, "they are assessed against Clinical Priority Assessment Criteria (CPAC) to determine whether they are eligible for publicly-funded surgery".
"Patients who do not meet the threshold are referred back to their GP and reminded of the importance of seeing their GP if there are changes to their condition or overall health.
"If this occurs, the GP can make another referral and the person will be assessed again to determine whether or not their condition has changed and they now meet the eligibility threshold under CPAC."
