If your injury is covered by ACC, then you’re entitled to medical treatment; compensation for loss of wages or salary; rehabilitation to help you regain your independence at work and outside work; and other assistance. The ACC scheme calls these your “entitlements”.
The main ACC entitlements are:
ACC can refuse you entitlements in certain cases, including for as long as you unreasonably refuse or fail to:
You can also be refused an entitlement if you:
After you start receiving ACC entitlements, ACC can suspend or cancel an entitlement if they’re not satisfied on the basis of the information they have that you’re entitled to go on receiving it. If they intend to do this ACC have to give you advance notice in writing, a reasonable amount of time before they suspend or cancel the entitlement.
Typical examples of treatment include:
If you get emergency treatment at a hospital A&E after an accident, you don’t need to make a specific ACC claim for this. This is because emergency hospital treatment is bulk-funded by ACC.
Other treatment providers you can see under the ACC scheme include: acupuncturists, audiologists, chiropractors, counsellors, dentists, doctors, medical laboratory technologists, nurses, occupational therapists, optometrists, osteopaths, physiotherapists, podiatrists, and speech therapists.
ACC has to pay for your treatment if the treatment is:
ACC may also have to cover some or all of the cost of other services related to the treatment (“ancillary services”), such as accommodation, transport, medicines and lab tests.
In deciding if your treatment meets these requirements, ACC takes into account:
Weekly compensation is compensation for loss of income or loss of the ability to earn money as a result of your injury. You’re paid 80 percent of your pre-injury weekly earnings, up to a weekly maximum.
ACC starts paying weekly compensation only after your first week of being off work. However, if you were injured at work, your boss has to pay you compensation in the first week. If your injury didn’t happen at work, you don’t get any compensation for the first week, either from ACC or your boss.
If you have some income during the period of incapacity from your injury, ACC will reduce the amount of weekly compensation they pay you.
You qualify for weekly compensation both if you’re an employee and if you’re self-employed. (This includes independent contractors.).
You may also qualify for weekly compensation even though you recently stopped working. This applies if:
If you were working when you were injured and you’re unable to work because of the injury, you’ll qualify for weekly compensation.
You’ll also qualify if you were on parental leave when you were injured, if your injury means you’re unable to go back to work when your parental leave ends. Your entitlement to weekly compensation begins from the date you would otherwise have had to go back to work at the end of the parental leave.
The test is different if:
In those cases, the test for whether you’ll get weekly compensation is: Does your injury stop you doing the kind of work you’re qualified for?
Usually, you’ll get weekly compensation until you’re able to do your job again. But if you’re permanently incapable of doing your pre-injury job, ACC doesn’t usually allow you to get weekly compensation indefinitely (although this does happen in some cases – for example, with serious brain or spinal injuries).
Instead, when your vocational rehabilitation is finished, you’re assessed on the basis of the “vocational independence” test – that is, whether you’re capable of working full-time in a job for which you’re suited by your experience, education or training. In deciding what kinds of jobs you’re suited for, the assessors have to take into account how much you were earning before you were injured.
If the assessors decide you do have vocational independence, your weekly compensation will continue for another three months and then it will stop.
If you can’t find a job during those three months, you’ll need to register with Work and Income to apply for a benefit, such as jobseeker support (see the chapter “Dealing with Work and Income”).
If your condition gets worse later on, so that you no longer have vocational independence, you can reapply to ACC for weekly compensation.
If you’re covered by ACC, you’re entitled to rehabilitation services to help you regain your health and your independence as much as practicable. You’re responsible for taking an active part in your rehabilitation with the goal of leading as normal a life as possible, given your injuries.
You’re entitled to:
If you need longer-term support (more than 13 weeks), ACC will prepare an Individual Rehabilitation Plan for you as part of deciding what treatment and rehabilitation you need. The plan will set out targets and appropriate services and support. It will be updated so that it records the steps as you get better, including the results of occupational and medical assessments.
Your Individual Rehabilitation Plan must include:
ACC must meet the cost of preparing the plan as well as the cost of any assessments agreed in the plan.
ACC must develop the plan “in consultation with” you (and with your representative, if you want to have one). You have a right to negotiate the contents of the plan with ACC. If ACC simply presents you with a draft plan to sign, this probably falls short of real “consultation”. An Individual Rehabilitation Plan is sometimes described as a “contract”, with rights and responsibilities for both parties.
Note: You should normally get advice from a lawyer before you sign an Individual Rehabilitation Plan.
Developing an Individual Rehabilitation Plan involves negotiation. You may need mediation to reach a reasonable resolution to disputes around the contents of the plan. If you unreasonably refuse to agree to the plan ACC have proposed, ACC can finalise the plan and treat it as if you agreed to it, or it can refuse to provide you with something you’d otherwise be entitled to, such as weekly compensation.
If you have a problem with your Individual Rehabilitation Plan, including if ACC take away entitlements because you didn’t follow the plan, you can apply for a review (see “Challenging an ACC decision” in this chapter).
Social rehabilitation is help provided by ACC to make you independent again, as far as possible, in your everyday life, outside work.
You’re entitled to:
ACC also has discretion to provide other social rehabilitation, if this other rehabilitation would help you become more independent. This could include help to restore your independence in: cognitive tasks of ordinary daily living (like listening, planning your day, and getting tasks done); communicating; domestic activities; taking part in education; managing money; health care; keeping clean; mobility; motivation; keeping safe; and sexuality. For example, ACC can agree to provide you with sexual dysfunction products such as Viagra, to help restore your independence in the area of sexuality.
There will be assessments and reassessments to ensure that the social rehabilitation you’re getting is:
Vocational rehabilitation is help provided by ACC to restore your independence in your working life. It’s aimed at helping you either:
ACC has to provide you with vocational rehabilitation if you:
Note: Vocational rehabilitation usually isn’t available if you weren’t working at the time of your injury.
Vocational rehabilitation is always provided as part of an Individual Rehabilitation Plan, which should include an appropriate rehabilitation path (see above).
ACC must identify whether it’s reasonably possible for you to go back to your pre-injury job with the same employer. If it isn’t, ACC must work out which of the following four other options are appropriate for you:
Examples of vocational rehabilitation include:
The types of help you’ll get will depend on the rehabilitation path that’s been chosen, your particular needs and the particular barriers you face. For example:
If you can’t go back to your old job and you can’t find a new job, the vocational rehabilitation provided by ACC stops when you’re able to work full-time in some job for which you’re suited by your training, experience and so on (that is, when you have “vocational independence”).
But ACC doesn’t have to keep helping until you actually have a job.
The maximum period of time for ACC-funded vocational rehabilitation is usually three years.
Lump-sum compensation is payable for permanent disability (called “permanent impairment” in the ACC laws) – for example, if you lose a finger in a machine accident at work. These are one-off, non-taxable payments that are paid on top of other ACC entitlements.
These lump-sum payments don’t include compensation for pain and suffering, or for loss of enjoyment of life, resulting from the disability. However, “permanent impairment” can include not only physical disabilities but also mental harm caused by rape and sexual abuse: see “Sexual abuse: Cover for resulting mental harm” in this chapter.
Eligibility for lump-sum compensation is based on a medical assessment of the claimant’s impairment. The ACC-appointed assessor must decide if the claimant is permanently impaired, and if so, to what degree or “percentage”. In assessing impairment, ACC uses the American Medical Association guidelines. To qualify for lump-sum compensation, a claimant must have suffered a minimum threshold of 10 percent degree of impairment.
Usually, assessment for lump-sum compensation takes place after ACC receives information, from a registered medical practitioner, that the claimant’s personal injury has stabilised, and that it is likely that there is permanent impairment.
Alternatively, if after two years the practitioner states that the claimant’s personal injury has not stabilised but that permanent impairment is likely, an assessment can take place.
If a person dies in an accident, a number of grants and ongoing financial support are available from ACC: for more details, see the chapter “A death in the family”, under “Financial support for bereaved families”.