From lodgement to cover: a qualitative inquiry into the steps and factors that lead to cover decision for a leptospirosis claim in New Zealand : a thesis presented in partial fulfilment of the requirements for the degree of Master in Veterinary Studies, Massey University, New Zealand

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Massey University
Leptospirosis is an occupational hazard for people working with animals, and while occupationally-acquired leptospirosis is a compensable condition, the mechanics of the compensation process are not well understood by patients. In addition, much of the crucial decisions affecting the claim outcome are made by treatment providers and insurance claim assessors largely outside of the patient’s purview. This lack of understanding adds to the disease burden experienced by patients. This study was therefore designed to improve the understanding of the compensation process for leptospirosis, by first establishing what are the bases of a claim, and second, investigating how treatment providers and insurance claim assessors evaluate a case or claim. A qualitative approach was utilised in this study. Government reports and publications were analysed in order to determine the formal procedure and requirements of the process, while interviews with treatment providers and insurance claim assessors revealed how the actual process plays out in real life. The results showed that a claim is assessed against two main requirements: having a confirmed diagnosis and having an appropriate exposure. A claim must have sufficient information to support both of these requirements. The criteria for the exposure are set in legislation, but the diagnostic criteria may vary depending on which case definition is used. The results from the study showed that the assessment may be affected by factors like physician experience, laboratory test preference, and patient and employer compliance.
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