ACC What is ACC? When will I be covered by ACC? When will mental injuries be covered under ACC? What medical procedures can ACC cover? I can’t work because of my personal injury, what happens to my wages? How do I make a claim to ACC? What happens if ACC rejects my claim? How does mediation help resolve the disagreement over my ACC claim? How does facilitation help resolve the disagreement over my ACC claim? I would like an independent review of my ACC claim, how can I go about it? What happens if I don’t agree with the decision of the reviewer? What are my rights when dealing with ACC? What rights do I have when I’m dealing with a health provider?
In New Zealand, the Accident Compensation Corporation (ACC) can compensate you for some or all of your medical costs if you get injured. It usually doesn’t matter how you got injured, or whose fault it was. New Zealand’s ACC system is different from lots of other countries, in NZ, you generally can’t take someone to court to make them pay you compensation if it was their fault you got hurt.
In New Zealand, the Accident Compensation Corporation (ACC) is a government department that can repay some or all of your medical costs if you get injured in NZ. It usually doesn’t matter how you got injured or whose fault it was. New Zealand’s ACC system is different from lots of other countries. You do not need to take someone else to court to make them pay for your medical costs if it was their fault you got hurt. Because we have ACC, you generally aren’t allowed to take someone to court in New Zealand if something they did caused you to get hurt.
To get compensation from ACC for medical costs, you have to have suffered a ‘personal injury’. This means you’ve had actual damage to your body. It could include anything from sprains, dislocations and fractures to burns and wounds.
If you have an injury that comes out of a ‘gradual process’, for example slowly going deaf, you might be covered by ACC. You would need to show that the gradual process happened because of something in your workplace – for example, you were always around lots of loud noise that damaged your ears
ACC doesn’t cover illnesses, emotional issues (not related to physical injuries) and pre-existing conditions.
Mental injuries can sometimes be covered too, but you will need to show that the mental injury was caused by a physical injury or because of sexual assault or abuse.
You can’t get ACC for mental injuries where you haven’t been physically injured – like when you’re sick, stressed or have hurt feelings. You also aren’t covered where there hasn’t been a specific ‘accident’, like if you have an underlying condition that you were born with.
ACC can give you money to cover a range of costs that come from your physical injury. This could include medical treatment, surgery, prescription medicine, home care or counselling.
ACC can also pay you some money weekly if your personal injury makes you unable to attend work. ACC won’t pay for your first week off work. If you were injured at work, your employer has to pay you 80% of your normal weekly wages for the first week. Otherwise, you can take sick leave if you have any. After the first week, ACC will pay you 80% (up to the maximum ACC weekly compensation limit) of what you normally earn for as long as your injury keeps you away from work. You will have regular meetings with an ACC worker who will assess your ability to return to work.
Usually, if you have an injury that was caused by an accident, your doctor will help you fill out an ACC form. You need to go see a doctor or other relevant medical professional before you can apply for ACC, because they have to explain what your diagnosis is, say whether they think it will stop you from working, and sign the form.
The form will then be sent to ACC, who will decide whether to approve or reject the claim. If ACC approves the claim, you can ask them to pay you back for the money you spent on going to the doctor.
ACC will reject your claim if they think that you don’t meet the criteria – for example, because your injury isn’t physical, or was the result of a long-term condition rather than an accident.
If you disagree with the decision from ACC, the first step is to contact ACC on 0800 650 222 or complaints@acc.co.nz to try to resolve the issue with their customer support team as soon as possible. If you cannot resolve with their team, you can then consider going to mediation or conciliation. If none of the previous options came to a satisfactory result, then an independent reviewer can look at your case and make a decision.
You can choose to go to mediation with ACC to resolve your disagreement. This is where you have a meeting with a representative of ACC and an independent mediator. The mediator helps you to talk to each other about the problem, and hopefully come up with a solution that works.
If you choose not to go to mediation, or you go to mediation but can’t reach an agreement, then the problem will be passed on to a reviewer to take another look at the decision.
For more information about mediation, please read the community law manual.
You can choose to go to facilitation with ACC to resolve your disagreement. This is where a qualified and independent facilitator uses their expert knowledge on accident compensation legislation and processes to provide independent advice to the dispute. You and the ACC representative can decide whether to take the advice from the conciliator.
If you choose not to go to facilitation, or you go to facilitation but can’t reach an agreement, then the problem will be passed onto a reviewer to take another look at the decision.
For more information about facilitation, please read the community law manual.
If you haven’t been able to resolve your concerns with ACC through their support team, mediation or facilitation, then you can get an independent reviewer to review ACC’s decision.
There will be a review hearing within 3 months from when ACC receives your review application. The reviewer will make a decision based on the information from your case and any evidence presented to them. To start off the process, you will need to complete the ACC33 Application for review and send it to the ACC address on the form.
For more information about this process, please read the community law manual.
If you don’t agree with the decision that the reviewer makes, you can appeal to the District Court to decide whether ACC made the right decision. You have to appeal to the Accident Compensation Appeals District Court Registry within 28 days of the review decision being made. There may be legal costs involved unless you’re able to get legal aid.
The Code of Claimants Rights outlines what your rights are when you are dealing with ACC (but does not cover any issues of entitlement). As an ACC claimant, you have rights such as: