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Health & disability

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?

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.

Accident Compensation Act 2001, s 58

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.

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Accident compensation (ACC)

Where to go for more support

Community Law

www.communitylaw.org.nz

Your local Community Law Centre can provide free initial legal advice and information.

Accident Compensation Corporation (ACC)

www.acc.co.nz

Claims

Claims helpline: 0800 101 996
Treatment Injury and Sexual Abuse (sensitive claims): 0800 735 566
Accidental death: 0800 101 996
Deaf community fax: 0800 332 354
Email: claims@acc.co.nz

General enquiries

Phone: (04) 816 7400
Email: information@acc.co.nz

Complaints

Phone: 0800 650 222
Email: complaints@acc.co.nz

Health and Disability Commissioner

www.hdc.org.nz

Health and Disability advocates are available to help users of health services make complaints about their health service provider. Health and Disability advocates are free.

Sexual abuse claims (“Sensitive” claims)

ACC Sensitive Claims team

Phone: 0800 735 566
Email: sensitiveclaims@acc.co.nz

Find Support website – www.findsupport.co.nz

This is an ACC website that will help you find information and support. You can click on “Find a therapist” on the home page to find a therapist in your area who can help you begin the process of making an ACC claim.

Support organisations

Sexual abuse support centres

www.toah-nnest.org.nz/get-help

TOAHNNEST: Te Ohakii a Hine – National Network for Ending Sexual Violence Together has a list of places where you can get help.

Medical Council of NZ

www.mcnz.org.nz

The Medical Council registers doctors in New Zealand and has responsibilities in the areas of standards, conduct and competence.

Privacy Commissioner

www.privacy.org.nz

The Privacy Commissioner has a wide range of functions, including investigating complaints about breaches of privacy, running education programmes, and examining proposed legislation and how it may affect individual privacy.

Wayfinders

www.wayfinders.org.nz

Phone: 0800 273 030

Email: info@wayfinders.org.nz

Wayfinders are a free national service that’s available to anyone who have questions about ACC or a specific ACC claim. Their service is available for people who may want an alternative way to interact with ACC rather than deal with ACC directly.

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