B) ACC’S APPROACH AND PROCESSES IN REGARDS TO WORK CAPABILITY ASSESSMENTS AND REHABILITATION
B.1.: Legislation: The Accident Compensation Act 2001
Incapacity for employment
“102 Procedure in determining incapacity under section 103 or section 105
(1) The Corporation may determine any question under section 103 or section 105 from time to time.
(2) In determining any such question, the Corporation—
(a) must consider an assessment undertaken by a medical practitioner or nurse practitioner; and
(b) may obtain any professional, technical, specialised, or other advice from any person it considers appropriate.”
“103 Corporation to determine incapacity of claimant who, at time of personal injury, was earner or on unpaid parental leave
(1) The Corporation must determine under this section the incapacity of—
(a) a claimant who was an earner at the time he or she suffered the personal injury:
(b) a claimant who was on unpaid parental leave at the time he or she suffered the personal injury.
(2) The question that the Corporation must determine is whether the claimant is unable, because of his or her personal injury, to engage in employment in which he or she was employed when he or she suffered the personal injury.
(3) If the answer under subsection (2) is that the claimant is unable to engage in such employment, the claimant is incapacitated for employment.
(4) The references in subsections (1) and (2) to a personal injury are references to a personal injury for which the person has cover under this Act.
(5) Subsection (4) is for the avoidance of doubt.”
“104 Effect of determination under section 103 on entitlement to weekly compensation
If the Corporation determines under section 103(2) that the claimant is not incapacitated for employment—
(a) a claimant who is receiving weekly compensation for loss of earnings from employment—
(i) loses that entitlement immediately; and
(ii) cannot be subject to a determination under section 107 in respect of that incapacity:
(b) a claimant who is not receiving weekly compensation for loss of earnings from employment is not entitled to begin receiving it.”
“105 Corporation to determine incapacity of certain claimants who, at time of incapacity, had ceased to be in employment, were potential earners, or had purchased weekly compensation under section 223
(1) The Corporation must determine under this section the incapacity of a claimant who—
(a) is deemed under clause 43 of Schedule 1 to continue to be an employee, a self-employed person, or a shareholder-employee, as the case may be; or
(b) is a potential earner; or
(c) has purchased the right to receive weekly compensation under section 223.
(2) The question that the Corporation must determine is whether the claimant is unable, because of his or her personal injury, to engage in work for which he or she is suited by reason of experience, education, or training, or any combination of those things. (3) The references in subsection (2) to a personal injury are references to a personal injury for which the person has cover under this Act.
(4) Subsection (3) is for the avoidance of doubt.”
“106 Effect of determination under section 105 on entitlement to weekly compensation
If the Corporation determines under section 105(2) that the claimant is able to engage in work for which he or she is suited by reason of experience, education, or training, or any combination of those things,—
(a) a claimant who is receiving weekly compensation—
(i) loses that entitlement immediately; and
(ii) cannot be subject to a determination under section 107:
(b) a claimant who is not receiving weekly compensation is not entitled to begin receiving it.”
“107 Corporation to determine vocational independence
(1) The Corporation may determine the vocational independence of—
(a) a claimant who is receiving weekly compensation:
(b) a claimant who may have an entitlement to weekly compensation.
(2) The Corporation determines a claimant’s vocational independence by requiring the claimant to participate in an assessment carried out—
(a) for the purpose in subsection (3); and
(b) in accordance with sections 108 to 110 and clauses 24 to 29 of Schedule 1; and
(c) at the Corporation’s expense.
(3) The purpose of the assessment is to ensure that comprehensive vocational rehabilitation, as identified in a claimant’s individual rehabilitation plan, has been completed and that it has focused on the claimant’s needs, and addressed any injury-related barriers, to enable the claimant—
(a) to maintain or obtain employment; or
(b) to regain or acquire vocational independence.”
“108 Assessment of claimant’s vocational independence
(1) An assessment of a claimant’s vocational independence must consist of—
(a) an occupational assessment under clause 25 of Schedule 1; and
(b) a medical assessment under clause 28 of Schedule 1.
(2) The purpose of an occupational assessment is to—
(a) consider the progress and outcomes of vocational rehabilitation carried out under the claimant’s individual rehabilitation plan; and
(b) consider whether the types of work (whether available or not) identified in the claimant’s individual rehabilitation plan are still suitable for the claimant because they match the skills that the claimant has gained through education, training, or experience.
(3) The purpose of a medical assessment is to provide an opinion for the Corporation as to whether, having regard to the claimant’s personal injury, the claimant has the capacity to undertake any type of work identified in the occupational assessment and reflected in the claimant’s individual rehabilitation plan.”
“109 When claimant’s vocational independence to be assessed
(1) The Corporation may determine the claimant’s vocational independence at such reasonable intervals as the Corporation considers appropriate.
(2) However, the Corporation must determine the claimant’s vocational independence again if—
(a) the Corporation has previously determined that the claimant had—
(i) vocational independence under this section; or
(ii) a capacity for work under section 89 of the Accident Insurance Act 1998; or
(iii) a capacity for work under section 51 of the Accident Rehabilitation and Compensation Insurance Act 1992; and
(b) the Corporation believes, or has reasonable grounds for believing, that the claimant’s vocational independence or capacity for work may have deteriorated due to the injuries that were assessed in the previous vocational independence or capacity for work assessment.
(3) The claimant may give the Corporation information to assist the Corporation to reach a belief under subsection (2)(b).”
B.2.: Information on assessments from the ACC website
‘Work rehabilitation assessment – medical and occupational’
“Purpose of the service
The purpose of the work rehabilitation assessment services (medical and occupational) is to:
1. Receive an occupational assessment to provide ACC with a comprehensive list of occupations for which the claimant is suited by reason of experience, education, or training (or any combination of these). These are the ‘Identified Jobs’.
2. Receive a medical assessment to consider the consequences of the claimant’s personal injury and make one recommendation to ACC as to whether the claimant has capacity to engage in work for each of the occupations identified as suitable by the occupational assessor, or whether further rehabilitation is required.
Medical practitioners are approved by ACC from time to time to provide assessments/reassessments under this Agreement.
The assessment services may only be carried out by the approved assessor/s who must:
● have a tertiary qualification relevant to vocational guidance
● be trained in using and interpreting validated psychometric test and assessment instruments
● have experience in assisting people to identify realistic job choices, and
● have and retain current membership of a relevant professional association (eg, NZAC, NZPS, or NZAOT).
The provider will ensure that all assessors receive clinical supervision and participate in a minimum of ten supervised assessments per year with an experienced clinical psychologist (or some other similarly qualified supervisor).
The provider will not change any approved assessor unless:
● the assessor is unavailable for reasons of ill health, poor performance, parental leave or resignation
● the substituted assessor has the qualifications described in (a) above, and
● ACC has, in its sole discretion, agreed to such substitution”
“What do the services involve?”
Assessment or reassessment of a claimant by an assessor must include, but need not be limited to:
● Review of background information provided with the referral, prior to the appointment with the claimant, to enable the approved assessor to become familiar with the claimant’s personal injury, interventions to date and the identified jobs;
● Explaining the medical assessment component of the work capacity assessment process to the claimant;
● Clinical examination of the claimant which has as its focus the claimant’s personal injury or injuries. Where a claimant has multiple injuries, covered by ACC or another insurer, all injuries should be taken into account when determining capacity for work;
● Use of professionally recognised objective assessment methodologies during the clinical examination that achieve defensible and recognised findings;
● The results of any specialist medical assessments of the claimant’s condition;
● Inviting the claimant to comment on all job options identified as suitable for the claimant and ensuring the claimant’s comments are contained within the report;
● Inviting the claimant to make submissions and raise any issues or concerns about their personal injury or injuries, their capacity to work in the job options identified as suitable, and the assessor’s findings and proposed recommendations. These claimant issues, comments, submissions, and/or concerns will be included in the report and considered prior to recommendations being made to ACC;
● Consideration of the claimant’s current capacity to consistently engage in work for 35 hours or more per week in each of the job options identified as suitable having regard to the present consequences of the claimant’s personal injury (Capacity for Work).”
“In considering capacity for work, the approved assessor will:
● Consider the claimant’s capacity as at the date of the examination;
● Disregard factors other than the claimant’s personal injury(s) which may affect the claimant’s capacity, such as:
● illness before the personal injury
● non-injury related illness developed after the personal injury
● alcoholism or drug dependency
● psychological conditions present before the personal injury, or
● lack of job opportunities.
● Requesting additional information where necessary and taking all steps contemplated in this schedule on receiving that information, such as incorporating that information in the medical assessment report;
● If the claimant does not have capacity for work in any of the identified jobs, consideration of the health and rehabilitation needs and goals of the claimant, with the aim of increasing their ability to engage in work for more than 35 hours per week in at least one of the identified jobs;
● Preparation and provision to the case manager of the medical assessment report.”
“When pain presents as an issue in the medical assessment process, the approved assessor is to consider the following:
● Does the pain represent an objectively verifiable medical condition because of which the claimant is likely to suffer harm if they resumed work in any of the identified jobs?
● The medical condition must be attributable to the claimant’s personal injury. While a claimant may experience similar or greater levels of pain upon resuming work, this does not indicate in itself that harm is occurring.”
Assessment of a claimant by an assessor must include, but need not be limited to:
● Review of the information provided with the referral, prior to the appointment with the claimant, to enable the assessor to become familiar with the claimant’s background, current skills and vocational interventions to date;
● Explaining the occupational assessment component of the WRAP process to the claimant;
● Consultation with the claimant, which has as its focus the skills the claimant has obtained through experience, education and/or training (including any skills developed since the injury, through vocational rehabilitation and work experience);
● Use of professionally recognised objective assessment methodologies during the consultation that achieve defensible and recognised findings;
● Identification of all paid jobs requiring a minimum of 35 hours per week that the claimant is suited for by reason of the claimant’s experience, education or training, or any combination of these (the Identified Jobs).”
“In identifying such jobs, the assessor will:
● Consider the claimant’s suitability as at the date of the consultation;
● Disregard the following factors:
● the effects of the claimant’s injury on the claimant’s ability to work. The assessor should not exclude jobs because s/he believes the claimant may not be able to perform them due to the claimant’s Injury (this is the role of the WRAP medical assessor)
● job availability
● the claimant’s child care requirements
● transportation availability
● the claimant’s pre-injury occupation, except when prioritising job options, ie, job options must not be limited to those which compare with the claimant’s pre-injury earnings, hours of work or perceived status or prestige
● Be realistic about job choices. Jobs must exist within the current New Zealand labour market or be stated within the NZ Standards of Classification of Occupations (1995);
● Document claimant reaction to all job choices; …”
Also from the website
‘Helping people return to work – workplace rehabilitation’
“Return to work is ACC’s workplace rehabilitation philosophy. It reflects an international view, based on a growing body of research, that injured workers heal faster and avoid psychological impairment if they can safely recover in the workplace, or return to it as soon as possible after their injury.”
“Positive work fitness certification
ACC is focussed on supporting GPs to make informed clinical decisions on certifying patients for time off work, because helping injured patients to recover at work, or return quickly and safely, is recognised as good practice.
In the past, health professionals and employers focused on return to work for injured patients only after their full recovery.
Today, the benefits of early return to work are recognised by health professionals and employers, and modern practice supports safe and sustainable work that quickly integrates people back into the workplace and their normal lives.”
‘Making a Claim’ and ‘What support can I get?’
“ACC is committed to helping you recover and get back to work as soon as possible. We call this vocational rehabilitation. If you have a job, we will help you to return to it. If you can’t return to your old job because of your injury we will help you to prepare for finding a new one.”
“What help can I get?”
“Your ACC case owner or General Practitioner (GP) will arrange for a professional, non-ACC staff assessor to determine your needs in the workplace.
The assistance you receive will depend on your individual needs, but may include:
• purchasing or modifying equipment for your workplace
• short-term transport assistance to help you get to and from work
• developing a rehabilitation plan to gradually increase your hours or tasks at work, and providing a support person to monitor your progress
• preparing for job seeking and re-entering the employment market
• a work-ready programme to help you regain your ability to work and build your confidence through work experience
• training to build on your existing skills and prepare you to enter a new occupation.”
“What do I need to do to get help?”
“Your case owner will arrange a time to meet to develop your rehabilitation plan. Your vocational rehabilitation is a part of your overall rehabilitation plan. It may be good idea to talk through your needs for your rehabilitation plan with a support person beforehand and you are welcome to bring them with you when you meet with your case owner.
Your case owner will discuss the following options with you to decide which one best meets your needs:
• maintaining your employment by continuing with the same job, or doing a different job with the same employer
• obtaining new employment by searching for the same type of job with a different employer
• getting assistance, such as training, to help you use the skills you had before your injury to find new employment.”
“How am I eligible?”
“ACC can provide vocational rehabilitation if your injury has been approved for cover and you are either:
• entitled to weekly compensation
• likely to be entitled to weekly compensation if ACC does not provide vocational assistance or
• on parental leave.
Your actual entitlement depends on your individual circumstances. Contact us to confirm if you are eligible, or to identify other ways in which we can help.
“How long might ACC take to determine if I am eligible?”
“ACC regards 21 days as a reasonable timeframe for the majority of decisions about what assistance you may be entitled to; however, you may be contacted by ACC or a provider within the first week to discuss appropriate services.
Contact us if you have not heard from us within 21 days.”
“What happens next?”
“If you have not been referred to a service by your GP already, your case owner will discuss your needs with you. If you are returning to your current work:
• a professional non-ACC staff assessor will conduct a workplace assessment to determine how much of your old job you can still do
• the assessor will report back to your case owner and help them to determine the assistance you will need to reach your goals.
If it is likely that you will be unable to return to your current work, your case owner will organise:
• an occupational assessment to help us to identify your skills and suitable work options
• a medical assessment to find out which work options are medically suitable for you. These assessments will help determine the assistance you need to reach your goal.
Your case owner will discuss your needs with you, and if appropriate, your employer and GP. Together everyone will work out the types of assistance that best meet the needs identified by your assessments.
Once you and your case owner agree, the rehabilitation plan is updated to include the assistance you can expect from us, the date it will begin and the date your rehabilitation is expected to be complete.
If you complete a rehabilitation plan and still feel you need to continue receiving weekly compensation payments, you may need to take part in a vocational independence assessment to measure your ability to return to work.”
If you are unhappy with the decision, you can ask for it to be reviewed. See What if I have problems with a claim?”
“Last updated: 4 March 2014
Last reviewed: 17 February 2014”
Rehabilitation Plan (and related information):
Registered Counsellors (e.g. Auckland Region):
ACC publication for GPs:
‘Making Return to Work a reality for your patients’
“In the past, health professionals and employers focused on return to work for injured patients only after full recovery. Today, the benefits of early return to work are recognised by health professionals and employers, and modern practice supports safe and sustainable work that quickly integrates people back into the workplace and their normal lives. Work, modified for the patient’s circumstances, should be viewed as a form of therapy.”
Electronic ACC18 Work Capacity Certificate – User Guide:
“ACC supports workplace rehabilitation and accepts that, for many injured people, it’s better at work. Research shows that, in many cases, an early return to work after injury will result in a better recovery for your patient.”
‘Helping employees get back to work’, ‘medical certificates’ ACC resource for employers, 2006
Conclusions and own comments:
From the ‘Accident Compensation Act 2001’ (and I presume related regulations) and especially the website information made available by the Accident Compensation Corporation (ACC) it becomes clear, that ACC does have a strong emphasis and focus on rehabilitation, where this is considered as being an option for a person, who lost earning ability due to a suffered injury.
They can expect repeated medical and occupational assessments, to establish entitlement to weekly compensation and to rehabilitation plan services, and there have been enough factual and anecdotal cases where such assessments, to establish injuries, suffered consequences like work incapacity, and vocational independence have been flawed for various reasons. Of course ACC claims, like Work and Income, that their contracted assessors are totally independent and sufficiently qualified. At least re the first aspect, there have been disputed claims, and many have gone through reviews and also to the courts. What is important to note is that for a number of years, there has been the adoption of concepts, ideas and approaches, that clearly come from mostly UK based “experts” like Mansel Aylward, who have links to the ‘Research Centre for Psychosocial and Disability Research’ at Cardiff University in Wales. We get the same information presented on the ACC website, which has now also been adopted by MSD and Work and Income, namely that work is “therapeutic”, that it is “beneficial” to person’s health, and that work is part of rehabilitation and recovery.
It is not within the scope of this summary study to analyse in detail what ACC now does and expects off claimants, but with the information that media have published over especially the last few years, there is some evidence of ACC having made every attempt to “exit” certain costly, complex claims cases, in order to save costs, which has usually happened by disentitling them to compensation and shifting them onto the benefit system administered by Work and Income. By way of re-assessments questioning claimants’ own medical practitioner and specialist reports, and by using other information obtained from other “experts”, or even from non medical and rehabilitation sources, this has happened in a number of cases. See also part ‘B.4.’ in this study, for media reports on this and other details. A useful source for feedback and experiences by affected claimants has for years been ‘ACC Forum’.
B.3.: Critical reports and submissions on ACC processes and practices
ACC Futures Coalition, December 2010:
‘Submission to the Welfare Working Group’ on “Reducing Long-Term Benefit Dependency: The Options” (referring to issues with ACC practices that were considered for welfare reform)
“4. Lessons from ACC
4.1 The paper floats the use of a number of tools currently used by ACC as having relevance for the welfare system.
4.2 Under ‘gatekeeping’ on page 6 the paper suggests the use of “robust work capacity assessments to ensure people with work capacity are on the unemployment benefit”. If it is envisaged that something like the VI process of ACC be introduced we would recommend against it.”
‘Vocational Independence: outcomes for ACC claimants’
“A follow up study of 160 claimants who have been deemed vocationally independent by ACC and case law analysis of the vocational independence process.”, Wellington, Feb. 2007
From the Foreword:
“The basic flaws in the legislation are, first, that it sets a low standard for actual rehabilitation outcomes, and, secondly, that it uses work-capacity assessment for a purpose for which it is ill-suited – namely, for legitimizing the termination of weekly compensation.”
B.4.: Media reports on ACC and their questionable practices and failures
You Tube video w. ’60 minutes’ expose “The eye of the storm”, 12 June 2012:
You Tube video with ’60 minutes’ program “ACC Exit Strategy”, loaded June 2013:
“ACC pays millions to send its ‘hatchets‘ “, Stuff.co, by Phil Kitchin, 08 Sept. 2012:
“ACC is spending millions of dollars flying doctors around New Zealand to assess long-term clients who have already been assessed by other doctors.
The policy has been slammed by John Miller – one of the country’s top lawyers specialising in ACC legislation – who said the so-called “independence” of some assessors was a sham. ACC lawyers, advocates and claimant groups know those doctors as “hatchet men and women”, Mr Miller said. “They are not independent, as a substantial part of their income comes from ACC,” he said.
ACC figures reveal the corporation pays millions of dollars a year to a group of “independent assessors”, often flying them to towns or cities where other doctors with suitable qualifications already practise.” “Mr Miller said medical professionals had expressed serious concerns to him about the issue. Because some assessors earned virtually all their income from ACC it was “inevitable” they would tend to “provide reports ACC wants”.
“The old saying of ‘he who pays the piper calls the tune’ definitely applies with ACC assessors. The use of such assessors actually damages and diminishes ACC’s reputation,” Mr Miller said. “ACC knows the assessors who have particular fixed medical views, for example on degeneration . . . and they keep sending injured claimants to be assessed by those assessors as they know they will receive reports they want.”
“ Mr Miller said ACC advocates know when clients are sent for assessments by “the same usual suspects . . . there will be an adverse outcome for the injured claimant”.
ACC has seen a drop in the number of cases it is winning as claimants fight assessments. The corporation won 77 per cent of cases challenged by clients in 2009 but in the year to date that figure has dropped to 56 per cent. Mr Miller said his firm had experienced cases where independent assessors such as occupational therapists for seriously injured clients refused to provide reports “for us in ACC disputes”. “They fear that it will affect their livelihood from ACC contracts,” he said.”
“Few trust ACC: report”, Fairfax, Stuff.co, “Businessday”, by Rob Stock, 09 Feb. 2014:
“Dismal figures showing a collapse in public confidence in ACC after a government-led claims crackdown have been released to the Sunday Star-Times.
In an internal report titled “Change ACC” from November 2012, the insurer said just 26 per cent of its customers believed it was “honest and open”, and only 30 per cent agreed it could “be relied on to do what is right”.
The release follows publication by the Sunday Star-Times on January 19 of one segment of the report showing the effect of political interference in ACC’s payouts. The report, prepared for a former ACC chief executive after warnings of a funding crisis under former ACC Minister Nick Smith’s watch, found the level of coverage provided by the no-fault accident compensation scheme rises under Labour governments and falls under National.
ACC has now released the rest of Change ACC, showing that the crackdown under Smith resulted in “customer” satisfaction figures which no private insurer could live with. Among other findings, 36 per cent of customers surveyed agreed that ACC “ensures people get the help they are entitled to”, and nearly six in 10 were “detractors” of ACC, willing to bad-mouth the organisation, with just 17 per cent “promoters”.
ACC chair Paula Rebstock, appointed in September 2012, has told MPs the organisation’s trust ratings are now improving.” “Rebstock indicated ACC was also aiming to counter a perception that it sought out medical professionals who would provide biased advice.
“Our medical assessments project is focused on clients having a choice of assessor and on making the process more transparent,” Rebstock said. “We are exploring the use of external medical panels covering various specialties to advise on claims and help monitor ACC decisions. We believe expert independent consensus opinion will enhance the quality assurance of clinical advice in ACC, and that in turn will increase client satisfaction.”
While ACC under a National government may be criticised for its focus on reducing claims, under Labour, Change ACC concluded there had been “mismanagement over the last decade”. ““Demoralised staff, many of whom felt the organisation had a poor reputation, was not a great place to work, but who would personally go the extra mile to “make sure that a customer/client feels good about the service”.
Scott Pickering, the chief executive of ACC from early 2013, said the 2012 report was “helpful as a starting point”, but that he “set little store” by some of it. And he said he was disappointed at the nicknames given to certain classes of ACC customer in the report, which conveyed “unfortunate impressions that are the antithesis of ACC’s current desire to better understand its customers and to tailor the delivery of its services in a more user-friendly way”. The nicknames included long-term claimant “Dependent Doris”, and the self-employed “Frustrated Felix”.”
“Thousands of ACC forms now illegal”, Stuff.co, “businessday”, by Phil Kitchin, 14 April 2014:
“ACC has been given a judicial kicking for demanding claimants sign an unlawful form gathering private information, or face their claims being cut off.
Two decisions just released from the District Court say ACC acted unlawfully when it told two clients it could insist they sign the consent forms and that, if they didn’t, their compensation would end.
A lawyer specialising in ACC work said there were huge ramifications for the corporation because “there must be hundreds of thousands of these forms that are now illegal”.
“This is wholesale collection of information that they had no right to,” Dunedin lawyer Peter Sara said.”
B.5.: Comparison between the WINZ / MSD approach and the ACC approach to work ability and related assessments
I have provided some information on the way ACC administer, conduct and follow up on medical, occupational and vocational independence assessments, in order to establish their claimant’s work incapacity or alternatively work capabilities. It is not my intention to go too much into the details of the processes and practices followed, about which there has been no lack of criticism, which in many cases appears quite justified. What is important to note is, that the focus by ACC is to establish, whether there is a serious degree of incapacity, that warrants paying a claimant weekly income compensation payments. The incapacity must be accident and injury related, and the claimant must due to the suffered incapacity be unable to work in the previous role, and/or earn an income.
ACC also expects clients to agree to rehabilitation programs, to re-establish at least some work capacity and vocational independence, where this is considered being an option. The goal is to return injured to the work they used to do, or to prepare them and “support” them to be available for other forms of work and employment. Supports are being offered in different types and ways.
The main difference between ACC and Work and Income support is of course, that ACC run a compensation scheme (somewhat similar to an insurance organisation) for those who suffered work related or other accidents or injuries, while WINZ provide basic income support for those who fall outside of that category, and cannot work for other reasons, to earn a living. It is my understanding that those assessed as capable to do some work, can be exited by ACC onto WINZ benefits, if there is no work available, for which they are considered capable to apply for.
It is important to notice, that in regards to medical and work capability assessments (or incapacity assessments), WINZ are to some degree now following similar approaches to the ones already in place at ACC. There is at WINZ now a similar approach towards assessing and re-assessing sick, injured and disabled for work ability, and with using new forms of assessment and new contracted outside providers, the focus is on establishing what types and degrees of work clients can do.
It is very evident and of great concern that both ACC and WINZ have adopted measures based on the supposedly “evidence based” approach to assess work ability along the lines strongly recommended, supported and propagated by Professor Mansel Aylward, Professor Gordon Waddell and others.
I am certain that this is no co-incidence, and that it is due to the input by consulted “expert advisors” of the types of Dr David Beaumont, formerly employed by ATOS Healthcare in the UK, now operating his own ‘Pathways to Work’ business based in Cromwell, Otago, and also “co-incidentally” President Elect of the AFOEM, who formulated their “Position Statement” on the “health benefits of work” primarily on Aylward’s UNUM sponsored “research”.