Review of a medical decision

If you want to challenge a decision about something that's not medical, there are different rules and processes for this.

Kinds of decisions you can challenge

You can challenge medical decisions about whether you qualify for:

• Jobseeker Support
• Supported Living Payment on the grounds of a health condition, illness or disability
• Child Disability Allowance
• Veteran's Pension, if you're under 65 and have a medical condition, injury or disability not related to your service.

You can also challenge medical decisions about your obligations (eg, work or drug testing obligations), while you're on:

• Jobseeker Support
• Supported Living Payment, either on the grounds of:
  • a health condition, illness or disability, or
  • caring for a person at home
• Sole Parent Support
• a partner of someone who's on a main benefit, eg:
  • Jobseeker Support
  • Supported Living Payment
  • Sole Parent Support
  • Emergency Benefit.

How to apply for a medical review

Before you start

First, call us to talk about the decision you're challenging and what you don't agree with. We may be able to fix it over the phone.

Apply for a medical review of decision

If we can't fix it over the phone, you can fill out a 'Medical Appeals Board hearing application'.

Once you've completed it, you can hand it in or post it to your nearest service centre.

If you can't print the form:

• call us on 0800 559 009 and we'll send you one, or
• pick one up from your nearest service centre.

What happens next

After you apply, we'll carry out an administrative review. We'll do this with either a:

• regional health and disability adviser, or
• health practitioner.

This is where we take another look at the original information you gave us for the decision. We'll see if we missed anything or made a mistake which means the decision should be different.

Outcome of administrative review

We'll send you a letter within 2 weeks letting you know whether we've decided to change the decision or not.

• If we change it, we'll let you know what this will mean for you.
• If we don't change it, we'll lodge an appeal with the Medical Appeals Board. They'll take a fresh look at your case.

If we don't change the decision

The Medical Appeals Board will receive the appeal and contact you to set a date for a hearing. We'll also send a report to the Medical Appeals Board and send a copy of this to you as well.

The Medical Appeals Board is made up of 3 independent health practitioners who either:

• rehabilitate people when they have a health condition, injury or disability, or
• have some other expertise relevant to your case.

The hearing

If you need help attending the hearing, we can help with:

• transport costs to and from the hearing
• wheelchair access
• an interpreter (including a New Zealand Sign Language interpreter), or
• for you to take part by phone or a video call, e.g. by Zoom.

You can bring a support person, advocate or lawyer with you to the hearing if you want, just let us know beforehand. You can also have a lawyer appear for you if you don't want to go yourself.

Before the hearing takes place, you can give us and the Board any further medical documents or evidence you would like considered.

At the hearing

The hearings usually last about one hour. You (or your advocate or lawyer) can explain why you're unhappy with the decision and present whatever evidence you want. Board members can ask questions. If you attend the hearing, we'll also attend to explain how the original decision was made. If you decide not to take part, we won't either.

The Board may ask you to have another medical examination. We'll pay for this and any travel or other related costs. If you don't want to be re-examined, you need to let the Board know.

The outcome

We'll send you a letter to let you know the Medical Appeals Board's decision. We'll also send you a copy of their final report. We'll send this about 3-4 weeks after the hearing.

If the Board agrees with you and the decision needs to be changed, the service centre you've been dealing with will put things right.

The decision of the Medical Appeals Board is binding for you and us. There's no right of appeal. You can talk to us if you want something clarified.

If you apply late for a review

Usually, you need to apply for a review of decision within 3 months of a decision being made. We can accept later applications if there's a good and sufficient reason for the delay.

The Medical Appeals Board will meet to consider your reasons for delay and may decide to go ahead with a hearing. If it doesn't think your reason is good enough, the original decision will stand.

Reasons for delay could include:

• you were unwell
• your health condition, disability or stress impacted you
• problems related to language (eg, not reading or understanding English)
• you didn't have access to the information you needed
• you didn't understand the decision and have now got advice from an advocate or lawyer
• waiting until a criminal prosecution related to this decision progressed.

You may have other reasons for the delay. It's important you tell us about them so we can consider it at the hearing.

Don't want to continue with your application

If you don't want to continue with your review of decision application, you can withdraw it at any time.

To do this, you can either:

• call us on 0800 559 009 and we'll put you in touch with the unit or person that's working on your application, or
• contact the Medical Appeals Board Co-ordinator as soon as possible. You can find their phone number on the letter we sent you about the hearing.