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Consultation On Regulations For Noise-Induced Hearing Loss

Your Details:

Name:

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I am responding:

  • as an individual
  • on behalf of an organisation

Organisation:

Please tick to describe who you represent:

  • Hearing Advocacy Group
  • Person with hearing loss
  • Employee
  • Small business (up to 10 staff)
  • Medium business (11 to 50 staff)
  • Large business (over 50 staff)
  • Business representative organisation/industry group
  • Trade Union
  • Training Organisation
  • Consultant
  • Other (please describe)
  • Hearing service provider
  • Audiology vendor

Context

  1. Hearing loss is covered under the Accident Compensation Act 2001 (the Act) if it is caused by a work-related gradual process, an accident, or a treatment injury. From 1 July 2010, a minimum of 6% binaural injury-related hearing loss will be required to gain cover.
  2. A substantial proportion of ACC’s hearing loss expenditure is on entitlements required for non-injury-related needs. Hearing aids and fitting fees are the biggest cost drivers. Injury is only one cause of hearing loss (age is the other main cause), and is estimated to account for only half of ACC claimants’ total hearing loss on average. However, because hearing aids are fitted to meet the needs of overall hearing loss, employers (through levies) end up paying the cost of entitlements required as a result of all causes of hearing loss, not just those for covered personal injury.
  3. The expected future cost to ACC of both existing claims and claims expected to be lodged in future for exposure that has already occurred is estimated to stand at $1.3 billion. Because the majority of hearing loss claims are for work-related noise-induced hearing loss, this sum represents the amount required to be collected from employers via the residual portion of the Work Account levy over time.
  4. The dual objectives of regulatory proposals are to limit ACC’s liability for hearing loss expenditure to injury-related costs, and to reduce ACC’s outstanding claims liability for hearing loss.
  5. There is an opportunity to ensure regulations pertaining to assessment of work-related noise-induced hearing loss are up-to-date at the same time as other regulation changes.

Financial Sustainability

  1. This consultation is taking place in an environment of financial concerns. The financial sustainability of the ACC scheme was severely eroded during the late 2000s. Between 2005-2009 there was a 57% increase in claim costs, due mainly to increased numbers of claims, increased medical costs, people staying on the scheme longer, and a more realistic approach to estimating the true costs of claims. These factors, coupled with the economic downturn, meant that the Corporation incurred losses of $4.8 billion in 2008/09 on top of a $2.4 billion loss in 2007/08. Although some improvement is expected this year, the reality is that the Corporation’s liabilities still exceed its assets by over $10.5 billion.
  2. This Government is actively working on a number of fronts to reduce costs while maintaining a 24/7, no fault, and comprehensive accident compensation scheme. The steering group for the Stocktake of ACC Accounts is due to report to the Minister at the end of June this year, indicating where savings or improvements can be made. ACC is also making operational changes which are expected to produce considerable cost savings. Also, earlier this year Parliament passed legislation that aims to lower costs, improve flexibility and financial management within the scheme, and improve co-operation between ACC and government departments.
  3. As part of that work the Government is considering the contribution that hearing loss claims are making to claim costs and the unfunded liability. Both the volume and cost of hearing loss claims is increasing significantly. ACC estimates that, as at 30 June 2010, the net present value of existing hearing loss claims will be $500 million[1], with an extra $806 million estimated as the liability for future claims yet to be made from exposure to work-related noise prior to 1 July 1999. This is mostly from the Work Account (mostly the residual amount). ACC faces increases in both the numbers of injury-related hearing loss claims and increases in the amount they pay out. As employers fund the Work Account this means increasing pressure on the levies they pay. While the Accord between ACC and the hearing sector has reduced the average amount paid per hearing aid, the total costs and rate of hearing loss claims growth continues to increase.
  4. ACC assumes that the current trends of increasing hearing loss claimants will continue. The key driver is work-related gradual process claims where there are significant time lags between the activities that caused the injury and when the claim is made. ACC expects claim numbers to increase as more of the population ages and have hearing loss needing treatment.
  5. One way to address this problem is to ensure that ACC is correctly paying only for the injury-related portion of any hearing loss.

Do you agree that ensuring the ACC correctly pays for only the injury-related component of claims is a fair way to assist ACC in managing the rapidly increasing costs of hearing loss entitlements? Why

If not can you suggest alternative ways of keeping hearing loss entitlements sustainable?

 

Part 1: New Regulation specifying ACC’s contribution to hearing loss costs

  1. The Act requires ACC to provide hearing aids and other entitlements for claimants who have hearing loss that is a personal injury covered by ACC, and are assessed as having a clinical need for entitlements as a direct consequence of that covered personal injury. Many claimants also have hearing loss caused by other factors, such as ageing, recreational noise exposure, or hereditary conditions. This means that ACC currently collects levies to fund the full cost of hearing aids and other hearing services that may be required in part for hearing loss that is not covered by the ACC Scheme. The majority of ACC hearing loss costs are paid from the residual portion of the Work Account, which is funded by employers.
  2. The Act allows for regulations to be made in relation to the costs that ACC is liable to pay for rehabilitation entitlements, and the circumstances in which ACC must make payments. New regulations are required to clarify ACC’s liability to contribute to hearing loss costs.
  3. The consultation document proposes two regulatory options for delivering hearing loss entitlements, both of which are premised on ACC making a contribution to hearing loss costs based on the claimant’s level of injury-related hearing loss relative to his or her total hearing loss. Regulations would also prescribe the circumstances under which ACC’s contribution is payable. Regulations would apply to both new and existing claims.

Part 2: Updating Procedures

  1. The second proposed change is about how ACC assesses work-related noise-induced hearing loss under the Accident Insurance (Occupational Hearing Assessment Procedures) Regulations 1999 (the Regulations).
  2. The Accident Compensation Act 2001 (the Act) requires claims for work-related gradual process noise-induced hearing loss to be assessed according to regulations made under the Act. The Regulations set the procedures and conditions for assessing noise-induced hearing loss for ACC claimants caused by work-related gradual process.
  3. It is proposed to ensure those regulations remain relevant and representative of best practice by making three technical changes:
    1. update the adjustment for age-related hearing loss
    2. update the update the acoustical standard used for testing
    3. remove Schedule 3 and references to base-line hearing tests.

Part 1: Consultation on new regulations specifying ACC’s contribution to hearing loss costs

  1. The proposed new regulation would specify ACC’s contribution to the cost of a claimant’s hearing loss entitlements, based on the claimant’s degree of injury-related hearing loss relative to the total hearing loss. On behalf of the Minister, ACC and DoL are consulting on two possible options:
    • Option 1: ACC makes a contribution to hearing device and fitting fee costs based on each individual’s proportion of covered injury-related hearing loss; or
    • Option 2: ACC makes a contribution to hearing device and fitting fee costs based on standardised bands of proportionate covered injury-related hearing loss.

Option 1: ACC makes a contribution to hearing device and fitting fee costs based on each individual’s proportion of covered injury-related hearing loss

  1. ACC would make a contribution to the costs of a claimant’s hearing device/s based on each individual claimant’s percentage proportion of covered injury-related hearing loss, up to a maximum of $2,000 per covered ear.
  2. ACC would also make a contribution to the costs of a claimant’s audiological fitting fees based on the percentage proportion of covered injury-related hearing loss, up to a maximum of $1,100 (binaural), or $900 (monaural).
  3. The percentage proportion of a claimant’s covered injury-related hearing loss would be determined by the following calculation:
    A (covered injury-related hearing loss) ÷ B (total hearing loss) = C (percentage proportion of covered injury-related hearing loss).
  4. ACC would also pay other fees and charges up to maximums that would be specified in the regulations.
  5. ACC would seek to maintain a contractual relationship with hearing aid manufacturers, and continue to operate a price list (updated periodically) for purchasing hearing devices. All costs payable for audiology services will be prescribed in regulations. ACC would pay for ear, nose and throat (ENT) reports and battery costs outside regulations.

Example: Mr Jones is a 74-year-old man assessed as having 43% total binaural hearing loss. 8.1% is deducted for age as per the standardised tables in regulation. Of the remaining 34.9% hearing loss, an ear, nose and throat (ENT) specialist attributes 20% to occupational noise-induced hearing loss, and 14.9% to other causes, based on available clinical information and the claimant’s medical and employment history. The claimant’s injury-related hearing loss as a proportion of his total hearing loss is therefore 47% (20% out of the total 43%).

ACC advises Mr Jones that it will contribute $517 to the cost of the binaural fitting fee (47% of $1,100), and contribute 47% of the cost of hearing devices (per covered ear) that Mr Jones is prescribed, to a maximum contribution of $2,000. Mr Jones can then decide whether to undergo a hearing needs assessment (which ACC will pay for at a cost of $150) and fitting of hearing devices.

Mr Jones decides to proceed with having hearing devices fitted. He is prescribed hearing aids at a cost of $1,700 each, based on ACC’s latest published price list. ACC pays 47% of the cost of the aids, ie $799 per aid. Mr Jones is responsible for the remainder of the cost of each aid (in this case, $901 per aid), as well as any co-payment the audiology service charges him for fitting services (up to the maximum prescribed in regulations). Alternatively, Mr Jones can ask the audiologist to prescribe lower cost hearing aids that reduce the level of his co-payment (although the proportion will remain the same).

ACC will also pay the costs of repairs and future assessments as prescribed in regulations.

Proposed process under Option 1

  1. The proposed process under Option 1 is set out below.[2]
    1. The claimant visits an audiologist or medical practitioner on noticing hearing problems, and may undergo some initial hearing tests. If ACC assistance is considered appropriate, the claimant is advised to lodge an ACC claim with a medical or nurse practitioner.*
    2. For work-related gradual process hearing loss claims, ACC sends the claimant a questionnaire to collect medical and employment history information.* (This information may not need to be collected for trauma or treatment injury claims.)*
    3. Once the necessary preliminary information is received from the claimant (eg questionnaire and any previous hearing tests), ACC reviews this and determines whether further information is required (eg relevant available information from current or previous employers).*
    4. ACC arranges for a cover assessment to be completed by an ear, nose and throat (ENT) specialist, including an audiological assessment (this may be completed by an ENT or audiologist). The ENT determines whether the claimant has a level of hearing loss attributable to causes covered by ACC (ie occupational noise-induced hearing loss, trauma, or treatment injury).*
    5. ACC provides cover to the claimant if they are assessed as having at least 6% binaural hearing loss caused by a personal injury covered under the Accident Compensation Act 2001.[3] Once cover is accepted, ACC decides whether the claimant is eligible for entitlements.
    6. ACC calculates the percentage injury-related hearing loss the claimant has as a proportion of his or her total hearing loss, based on the ENT’s report. This percentage provides the basis for ACC’s contribution to hearing devices and fitting fee costs.
    7. ACC notifies the claimant of:
      • the percentage amount it will contribute to hearing device costs (actual dollar amount will be dependent on the price of the prescribed hearing device/s, up to a maximum of $2,000 per covered ear), and
      • the dollar amount it will contribute to fitting fee costs (dependent on the proportion of injury-related hearing loss, up to a maximum of $1,100 binaural, or $900 monaural; claimant co-payment permitted, but when added to ACC contribution, must not exceed the prescribed maximums).
    8. If the claimant wishes to continue the entitlements process, ACC pays for a hearing needs assessment to determine the most appropriate hearing device/s for the claimant. When requesting the hearing needs assessment, ACC will advise the selected audiologist of the amount ACC will contribute to hearing aids and fitting fees. If the claimant chooses to proceed, an audiologist fits hearing devices that are acceptable to the claimant, involving initial fitting, a trial period, and follow-up appointments.
    9. ACC pays the audiologist the covered injury-related percentage of the cost of the claimant’s hearing device/s that the claimant ultimately decides to purchase from the audiologist (to the maximum of $2,000), as well as the relevant dollar contribution to fitting fee costs.
    10. ACC will also pay for repairs and future assessments under regulation.
  2. The following table summarises the proposed costs payable by ACC under Option1

Table 1: Option 1: Summary of costs payable by ACC under regulations for hearing services

Option 2: ACC makes a contribution to hearing device and fitting fee costs based on standardised bands of proportionate covered injury-related hearing loss.

  1. In this option ACC’s contribution would be based on standardised bands instead of percentages of actual costs. The regulations would prescribe four bands for hearing aids and fitting fee contributions according to each claimant’s percentage of covered injury-related hearing loss, as outlined below.
Standardised bands for ACC contribution to hearing devices and fitting fees (Option 2)

Band 		Percentage proportion of injury-related hearing loss relative to total hearing loss Hearing devices per covered ear (maximum) Fitting fees
1 0 – 24.9% $444 $275 binaural / $225 monaural
2 25 – 49.9% $800 $550 binaural / $450 monaural
3 50 – 74.9% $1,200 $825 binaural / $675 monaural
4 75 – 100% $1,500 $1,100 binaural / $900 monaural
  1. The percentage proportion of a claimant’s covered injury-related hearing loss would be determined by the following calculation:
    A (covered injury-related hearing loss) ÷ B (total hearing loss) = C (proportion of covered injury-related hearing loss).
  2. ACC would also pay other fees and charges up to maximums that would be specified in the regulations.

Example: Mr Jones is a 74-year-old man assessed as having 43% total binaural hearing loss. 8.1% is deducted for age as per the standardised tables in regulation. Of the remaining 34.9% hearing loss, an ear, nose and throat (ENT) specialist attributes 20% to occupational noise-induced hearing loss, and 14.9% to other causes, based on available clinical information and the claimant’s medical and employment history. The claimant’s injury-related hearing loss as a proportion of his total hearing loss is therefore 47% (20% out of the total 43%).

ACC allocates Mr Jones to funding band 2, because his proportion of injury-related hearing loss total is between 25% and 49.9%.

ACC advises Mr Jones that it will contribute $550 to the cost of the binaural fitting fee, and contribute up to $800 per covered ear to the cost of hearing device/s Mr Jones is prescribed. Mr Jones can then decide whether to undergo a hearing needs assessment (which ACC will pay for at a cost of $150) and fitting of hearing devices.

Mr Jones decides to proceed having hearing devices fitted. He is prescribed hearing aids at a cost of $1,700 each. ACC pays $800 per aid. Mr Jones is responsible for the remainder of the cost of each aid (in this case, $900 per aid), as well as any co-payment the audiology service charges him for fitting services (up to the maximum prescribed in regulations). Alternatively, Mr Jones can ask the audiologist to prescribe lower-cost hearing aids that reduce his level of co-payment. ACC will also pay the costs of repairs and future assessments as prescribed in regulations.

Proposed process under Option 2

  1. The proposed process under Option 2 are set out below:
    1. The claimant visits an audiologist or medical practitioner on noticing hearing problems, and may undergo initial hearing tests. If ACC assistance is considered appropriate, the claimant is advised to lodge an ACC claim with a medical or nurse practitioner.*[4]
    2. For work-related gradual process hearing loss claims, ACC sends the claimant a questionnaire to collect medical and employment history information.* Once the necessary preliminary information is received from the claimant (eg questionnaire and any previous hearing tests), ACC reviews this and determines whether further information is required (eg relevant available information from current or previous employers).*
    3. ACC arranges for a cover assessment to be completed by an ear, nose and throat (ENT) specialist, including an audiological assessment (this may be completed by an ENT or audiologist). The ENT determines whether the claimant has a level of hearing loss attributable to causes covered by ACC (ie occupational noise-induced hearing loss, trauma, or treatment injury).*
    4. ACC provides cover to the claimant if they are assessed as having at least 6% binaural hearing loss caused by a personal injury covered under the Accident Compensation Act 2001.[5] Once cover is accepted, ACC decides whether the claimant is eligible for entitlements.
    5. ACC calculates the percentage injury-related hearing loss the claimant has as a proportion of total hearing loss, based on the ENT’s report. ACC uses this information to allocate each claimant to one of four standardised funding bands for these costs. ACC notifies the claimant of the maximum dollar amount it will contribute to hearing device costs (as per funding band), and the dollar amount it will contribute to fitting fee costs (as per funding band).
    6. If the claimant wishes to continue the entitlements process, ACC pays for a hearing needs assessment to determine the most appropriate hearing device/s for the claimant. When requesting the hearing needs assessment, ACC will advise the selected audiologist of the amount ACC will contribute to hearing aids and fitting fees. If the claimant chooses to proceed, an audiologist fits hearing devices that are acceptable to the claimant, involving initial fitting, a trial period, and follow-up appointments.
    7. ACC pays the audiologist the relevant dollar amount for the claimant’s hearing device/s (as per funding band), as well as the relevant dollar contribution to fitting fee costs. ACC will also pay for repairs and future assessments under regulation.

The following table summarises the proposed costs payable by ACC under Option 2:

Table 2: Option 2: Summary of costs payable by ACC under regulations for hearing services

Implementation of Option 1 or 2

  1. In both of the models ACC would rely on the current practice of an audiologist making an assessment of overall hearing loss followed by an ENT specialist. Within their scope of practice, ENTs are able to diagnose the percentage of hearing loss that is injury related. They do this by considering a range of relatively detailed information for hearing loss including an audiogram, standardised tables for age deduction, employment and medical histories, and other relevant epidemiological information.
  2. ACC recognises that both options place more importance on the process of ENTs diagnosing injury-related hearing loss. ACC intends to expand its current engagement with ENTs, seeking to jointly develop more standardised processes and build on the current methodology for attributing injury-related hearing loss.

Part 1: New Regulations

Do your prefer Option 1 or Option 2? Why?

What issues do you see with Option 1, and what measures would you suggest?

What issues do you see with Option 2, and what measures would you suggest?

Is there an alternative approach you would suggest to meet the policy objectives of limiting ACC’s liability to injury-related hearing loss costs and reducing the outstanding claims liability?

Part 2: Consultation On Updating Procedures in Regulations For Noise-Induced Hearing Loss

  1. ACC and the Department of Labour have identified a number of changes required to ensure the regulations on work-related noise-induced hearing loss assessment procedures remain relevant. Implementation of these changes requires changes to the Accident Insurance (Occupational Hearing Assessment Procedures) Regulations 1999 (the Regulations).
  2. The Regulations were made under the Accident Insurance Act 1998. They were set in 1999 and have not been updated since. They now do not refer to the most relevant international standards and contain outdated requirements.

Proposed Change Number 1:

Update Schedule 2 – Adjustment of percentage loss of hearing caused by presbyacusis

  1. Schedule 2 of the Regulations sets the standard percentage amounts that must be deducted from a claimant’s total percentage loss of hearing for hearing loss caused by presbyacusis (age related hearing loss). The current table in Schedule 2 showing percentage amounts is not the most recent version available.
  2. We propose to update this Schedule to prescribe deductions in accordance with the most recent version of the table, which is “The National Acoustics Laboratories 1988 Report 118: Improved Procedure for Determining Percentage Loss of Hearing” (the 1988 NAL Report). This is an Australian industry standard used by compensation schemes to determine hearing loss. The tables in Schedule 1 of these Regulations (for determining total percentage loss of hearing) already align with the 1988 NAL Report, however the current Schedule 2 table is based on an earlier version of a NAL Report.
  3. The proposed change will improve the quality of the information in the Regulations, and increase clarity and consistency in the assessment of claimants.
  4. The current Schedule 2 table and the proposed table are set out below. Under the new age tables, there will typically be less hearing loss attributable to age than under the old tables. This will mean that a claimant’s total percentage loss of hearing, after it has been adjusted for age, is likely to be slightly greater than under the current tables
CURRENT TABLE
Schedule 2: Adjustment of percentage loss of hearing for presbyacusis 		PROPOSED TABLE
1988 NAL Report: Values of age-related loss of hearing for males and females at various ages
Male Female Male Female
Age Percentage Adjustment Age Percentage Adjustment Age Percentage Adjustment Age Percentage Adjustment
        <55 0    
<57 0     56 0.1    
57 0.2     57 0.2    
58 0.5     58 0.4    
59 0.7     59 0.6    
60 1.0     60 0.8    
61 1.4     61 1.0    
62 1.7     62 1.3    
63 2.1     63 1.7    
64 2.5 <65 0 64 2.0    
65 2.9 65 0.1 65 2.4    
66 3.4 66 0.2 66 2.9    
67 3.9 67 0.3 67 3.3    
68 4.4 68 0.4 68 3.8 <68 0
69 5.0 69 0.5 69 4.4 69 0.2
70 5.5 70 0.7 70 4.9 70 0.4
71 6.1 71 1.0 71 5.5 71 0.6
72 6.8 72 1.3 72 6.2 72 0.8
73 7.4 73 1.6 73 6.8 73 1.1
74 8.1 74 1.9 74 7.5 74 1.4
75 8.8 75 2.3 75 8.3 75 1.7
76 9.6 76 2.7 76 9.0 76 2.1
77 10.3 77 3.2 77 9.8 77 2.5
78 11.1 78 3.7 78 10.7 78 2.9
79 12.0 79 4.3 79 11.5 79 3.4
80 12.8 80 4.8 80 12.5 80 3.9

PART 2: Proposed Change 1:

Do you agree with this change?

Do you see any issues with making this change?

Any other comments on this proposal?

Proposed Change Number 2:

Update the acoustical standard used for testing
  1. The current Regulations require that every pure tone audiometry test undertaken must comply with the technical and procedural standards of ISO 6189, which is:
    the International Organisation for Standardization Standard on Acoustics—Pure Tone Air Conduction Threshold Eudiometry for Hearing Conservation Purposes Ref No ISO 6189—1983(E).
  2. We propose that the Regulations be amended to require compliance with AS ISO 8253.1-2009, which is:
    Audiometric test methods, Part 1: Basic pure tone air and bone conduction threshold audiometry AS ISO 8253.1-2009.
  3. ISO 8253.1-2009 is a more appropriate standard for producing audiograms for medico-legal compensation purposes.

PART 2: Proposed Change 2:

Do you agree with this change?

Do you see any issues with making this change?

Any other comments on this proposal?

Proposed Change Number 3:

Remove Schedule 3 and the references to base-line hearing tests
  1. Under the Accident Insurance Act 1998, an insurer was not liable to pay entitlements for hearing loss caused by a work-related gradual process suffered during his or her employment in a prescribed industry or place of employment, if the employee had refused to undergo a base-line hearing test.
  2. ACC recommends removing Schedule 3 and the references to base-line hearing tests in the Regulations because the disentitlement provision under the Accident Insurance Act 1998 does not apply to claims lodged under the Accident Compensation Act 2001. The provision can cause confusion. The change is not intended to affect any active claims under the 1998 Act.

PART 2: Proposed Change 3:

Do you agree with this change?

Do you see any issues with making this change?

Do you have any other comments on this proposal?

Thank you very much for your participation in this consultation.

Footnotes

[1] These calculations do not include cash handling expenses nor a risk margin.

[2] *Denotes current process

[3] This provision applies to claims lodged on or after 1 July 2010.

[4] *Denotes current process

[5] This provision applies to claims lodged on or after 1 July 2010.