Making a claim and dealing with ACC
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 coordinators 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?
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.
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: 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.