Making a claim and dealing with ACC

Making an ACC claim

How do I make an ACC claim?

You claim by lodging an ACC 45 Injury Claim Form. The form must always be completed by a treatment provider such as a doctor, physiotherapist or ambulance driver. Usually they will send the form to ACC for you. This is often done electronically.

How much time do I have to lodge my claim?

Accident Compensation Act 2001, s 53

You have to lodge your claim for ACC cover within 12 months after the date of your accident or injury.

Claims for particular ACC entitlements (as opposed to whether you’re covered by ACC in the first place) have to be lodged within 12 months after the date on which your need for the particular entitlement arose.

But ACC will still accept a claim that’s lodged outside those time limits, unless the lateness of the claim affects their ability to make decisions about the claim.

How ACC processes the claim

Who decides whether to grant my claim?

ACC‘s service centre staff will make an initial decision about whether you’re covered. You’ll then get a letter telling you about this initial decision.

The ACC service centre staff then decide what level of risk your claim involves. This will affect how they manage the claim from then on:

  • No risk – Simple claims involving only medical fees are seen as “no-risk” cases and are paid immediately.
  • Low-to-medium risk – Low-risk and medium-risk cases, where claimants need additional assistance, are managed by case co-ordinators in one of ACC‘s four contact centres.
  • High-risk – High-risk cases, where there is a serious injury requiring significant involvement from ACC or lengthy time off work, are managed by case managers in ACC branches.

What is the time limit for processing a claim?

Accident Compensation Act 2001, s 56

For standard claims, ACC has 21 days after receiving a claim to process that claim and make a decision about your entitlement. They can extend the time for making the decision if they need more information, but they can’t extend it to more than four months after you lodged your claim.

Accident Compensation Act 2001, s 57

For complicated claims, the ACC has two months to make a decision. Complicated claims are claims involving:

  • a mental injury caused by rape or other sexual crimes, which ACC calls “sensitive” claims (see “Sexual abuse: Cover for resulting mental harm” above in this chapter, and for the specific claims process, see below How ACC processes sensitive claims (mental harm caused by sexual abuse)”), or
  • personal injury caused by a work-related gradual process, disease or infection (see “Conditions caused gradually: Covered only if work-related” in this chapter), or
  • treatment injuries (see Injuries caused by medical treatment: ‘Treatment injuries’” in this chapter), or
  • late claims (claims lodged later than 12 months after the date of your accident or injury).

If ACC needs more information, it can extend the time for making the decision by up to two months. You and ACC can also agree to extending the time further, but ACC do have to decide about your claim within nine months after you lodged it.

Note: Accident Compensation Act 2001, s 58

If ACC don’t meet the deadlines for processing your claim, the law says you’re covered for your injury, just as if ACC had approved your claim.

How ACC processes “sensitive claims” (mental harm caused by sexual abuse)

The ACC scheme provides cover for mental harm caused by rape and sexual abuse. ACC calls these types of claims “sensitive claims”, and they’re dealt with by a special ACC unit – the Sensitive Claims Unit. For information about when you’ll be covered by ACC and what therapy and financial help you may be entitled to, see “Sexual abuse: Cover for resulting mental harm” in this chapter.

Your rights when dealing with ACC

Accident Compensation Act 2001, ss 39-47

The Code of ACC Claimants’ Rights explains how ACC works with people who make claims. The Code is intended to foster positive relationships between you and ACC. It gives you rights and describes the responsibilities of ACC.

Note: The code is concerned with how a claimant is treated by ACC. It does not deal with entitlement. If you have a concern about an ACC decision regarding cover or entitlement, you must use the review processes available for challenging an ACC decision (see “Challenging an ACC decision” in this chapter).

What rights do you have under the code?

You have the right to:

  • be treated with dignity and respect
  • be treated fairly and have your views considered
  • have your culture, values, and beliefs respected
  • a support person or people
  • effective communication
  • be fully informed
  • have your privacy respected
  • complain if ACC breaches your rights under the Code.

How can you make a complaint under the code?

If you think that your rights under the code have been breached, or you have some other complaint about the way you have been treated by ACC, you can either:

  • raise the problem at a local level with the person you have been dealing with at ACC, or with that person’s manager, or
  • lodge a complaint with ACC‘s complaints service, the Office of the Complaints Investigator. This must be done using the ACC‘s own ACC Code Complaint Form. It does not cost anything to make a complaint.

What can the Office of the Complaints Investigator do?

The Office of the Complaints Investigator is part of ACC, but it has to investigate complaints and help resolve them impartially and independently. Once the Office has finished investigating a complaint, it will provide a written decision. It will give reasons for its decision and describe any action it intends to take.

The Office of the Complaints Investigator can tell ACC to do certain things, including:

  • apologise to you
  • meet with you so that you can put forward your views
  • provide you with relevant information
  • provide interpreting services.

The Office of the Complaints Investigator can also recommend “other remedial actions”, for example recommending to ACC that it change its decision.

What if you don’t agree with the decision of the Office of The Complaints Investigator?

If you are unhappy with the Office of the Complaints Investigator’s decision, you can request a review of the decision by an external reviewer, using the same procedure that applies to ACC decisions on claims (for information see “Challenging an ACC decision / External review” in this chapter).

Note: Unlike other external review decisions, an external reviewer’s decision about an alleged breach of the Code of ACC Claimants’ Rights cannot be appealed to the District Court.

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