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ACC and Making a Claim
(Last updatedJan 2007)
The Accident Insurance Scheme (ACC) can help you if you are injured, by providing you with ‘rehabilitation’ (time to get well) and ‘compensation’ (money to cover costs). This means that you do not have the right to sue someone who’s hurt you if you are covered by the scheme. The scheme is set up through the Injury Prevention, Rehabilitation and Compensation Act 2001.
What is covered?
You are covered for personal injury that is:
Personal injury means:
What is an accident?
This occurs where:
What is a work injury
Work injury means:
Can I claim for sexual abuse
Special claims are managed by the ACC’s “Sensitive Claims Unit” and are dealt with in a confidential and personal nature. The AC realises that emotions and feelings are involved and they take this into consideration when dealing with this type of claim.
There are several ways to make a “sensitive claim” due to sexual abuse injury, but overall they follow the following steps:
If you have any questions or would like a list of ACC approved counsellors, you should contact the following:
“Sensitive Claims Unit”
Free phone 0800 735 566 or Wellington (04) 918 7138.
Fax (04) 918 7577, PO Box 1426, Thorndon, Wellington
When is injury not covered?
Generally an injury is not covered when it is caused by a: gradual process, disease or infection. This includes situations such as when
ACC is a ‘no fault’ scheme. Because of this you can usually get compensation even if you’re injured while committing a crime.
You usually have to fill in a claim form within 12 months of being injured. But ACC can accept a claim after 12 months, so make sure you ask for help if your claim is rejected.
For help see “Useful Contacts” at the end of this information sheet.
How do I make a claim?
You can lodge a claim for yourself or your doctor will fill in a “Claim for Cover” form when you go to see him or her about the injury. This is sent to the Accident Rehabilitation and Compensation Insurance Corporation who may reject or accept the claim. If you are turned down you can apply to have the decision reviewed.
Are there age limits?
No. You are eligible for ACC at any age [1]. But if you are under the age of 16 years, any compensation (other than loss of earnings) will be paid to your parent or guardian.
[1] s3 Injury Prevention, Rehabilitation, and Compensation Act 2001.
What if I’m injured outside of NZ?
If you usually live in New Zealand, then you are covered by ACC. It also covers those New Zealanders who are overseas as long as they are paid in New Zealand and pay New Zealand taxes in New Zealand.
If you are a visitor to New Zealand, then you are also covered, except if you are injured while on board a ship or plane.
What compensation can I claim, and who pays for it?
If you suffer a work injury, which stops you working, the employer must pay you 80% of your weekly wage for the first week off work. ACC will pay 80% of your weekly wage after the first week.
If the injury that stops you from working didn’t happen through work, ACC will pay 80% of your weekly wage after the first week. Before that you will have to use up your sick leave or your savings if you have no sick leave left.
Can my employer contract out of the scheme?
No. But they can give you more benefits for injuries in your contract.
Types of Compensation
Rehabilitation
The aim of rehabilitation is to help those who suffer personal injury to regain their independence.
The two types of rehabilitation are:
Reviews
If you don’t agree with ACC’s decision about your injury, you can ask them to review it. Make sure you get ACC to put the decision in writing first. You must make an application for review within 3 months of the decision you disagree with. Forms are available from ACC. You can ask YouthLaw or your local Community Law Centre to help you fill the form in. You can also appeal against the review decision but you need to do it within 28 days of the decision. If you are outside this time the Court will only hear your appeal if there are special circumstances.
Do I have any rights?
Yes, you do. On 1 February 2003 a new code of ACC Claimant’s Rights (“the Code”) came into force. The Code provides that you have the right to:
Complaints
If you’re unhappy with ACC, their policies, a decision they’ve made or something they’ve done you can make a complaint to the Complaints Service, which is part of ACC.
Freephone: 0800 650 222;
Wellington: Freepost 264, PO Box 242, Fax: 04 918 7580;
Auckland: Freepost 264, PO Box 9034, Fax: 09 915 8317 or Complaints@acc.co.nz.
From 1 February 2003 you can also make a complaint about a breach of your rights under the Code. The first step is to raise the problem or concern at the local level with the person you are dealing with, or that person’s manager. If it can’t be resolved there and you want to take the complaint further you can lodge a complaint with the Complaints Service. You can complain to the Complaints Service even if you haven’t raised the issue at the local level.
The Complaints Service will then investigate your complaint. If they find there was a breach of the Code they may direct ACC to:
If you disagree with the decision ACC makes on your complaint you can apply for a review of the decision. However, there is no right to appeal if you don’t like the decision on review.
Can I sue in any circumstances?
You can take the person who you think caused your injuries to the civil court to get compensation only in very special circumstances. The person must have been so careless about your safety that the Court thinks they should be punished by paying you compensation. If the person has already been punished in the criminal court (e.g. for dangerous driving that injured you), you can still get compensation in the civil court.
Useful Contacts
Website: www.acc.co.nz
Email: claims@acc.co.nz
Free Fax: 0800 222003
Call Free: 0508 222 993
Or under A.C.C. in blue “Government phone listings section” in front of the phone book.
What is personal injury?
What is an accident?
What is a work injury
Can I claim for sexual abuse
When is injury not covered?
How do I make a claim?
Are there age limits?
What if I’m injured outside of NZ?
What compensation can I claim, and who pays for it?
Can my employer contract out of the scheme?
Types of Compensation
Rehabilitation
Reviews
Do I have any rights?
Complaints
Can I sue in any circumstances?
Useful Contacts
What is ACC?What is an accident?
What is a work injury
Can I claim for sexual abuse
When is injury not covered?
How do I make a claim?
Are there age limits?
What if I’m injured outside of NZ?
What compensation can I claim, and who pays for it?
Can my employer contract out of the scheme?
Types of Compensation
Rehabilitation
Reviews
Do I have any rights?
Complaints
Can I sue in any circumstances?
Useful Contacts
The Accident Insurance Scheme (ACC) can help you if you are injured, by providing you with ‘rehabilitation’ (time to get well) and ‘compensation’ (money to cover costs). This means that you do not have the right to sue someone who’s hurt you if you are covered by the scheme. The scheme is set up through the Injury Prevention, Rehabilitation and Compensation Act 2001.
What is covered?
You are covered for personal injury that is:
- caused by an accident; or
- caused by a gradual process, disease or infection which happens because of your job; or
- a medical ‘misadventure’ (mistake); or
- because of treatment for personal injury; or
- mental or nervous shock causedbycertain criminal acts committed after 1 April 2002 (see below)
What is personal injury?
Personal injury means:
- physical injuries, like hurt or loss caused to your body; or
- a person’s death; or
- mental injury caused by physical injuries to you.
- or a mental injury caused by certain criminal acts if:
- if the criminal act occurs in or out of New Zealand after 1st of April 2002 and
- the injury occurs due to another persons actions and
- it is an offence listed in Schedule 3 of the Injury Prevention, Rehabilitation and Compensation Act 2001, (which covers mostly sexual offences andincludesan adult assaulting a child, assault with intent to commit sexual violation, infecting with disease,sexual abuse or rape).
What is an accident?
This occurs where:
- you’re hit by someone or something (but not a gradual process); or
- you breathe in or swallow something. This does not include a virus or bacteria, unless this was caused by someone else’s criminal act; or
- you’re outside for a certain time (no longer than one month), and this causes death or a disability that lasts longer than a month; or
- you’re burned (but does not include sunburn); or
- you absorb chemicals through your skin (for a certain time lasting no longer than one month).
What is a work injury
Work injury means:
- An injury to you that wouldn’t have happened unless you were at work; and
- The injury occurs:
A work injury does not include injury that happens:
- while you were doing your job at work; or
- during the work break; or
- while you were travelling between places where you work; or
- while you were attending a paid training course for work; or
- while you are travelling from work to get treatment for a work injury
- while you are travelling to or from work, unless transport is organised by your employer; or
- while you are in accommodation provided by your employer, and you are not working; or
- while you are doing recreational activities (e.g. sport) outside of work.
Can I claim for sexual abuse
Special claims are managed by the ACC’s “Sensitive Claims Unit” and are dealt with in a confidential and personal nature. The AC realises that emotions and feelings are involved and they take this into consideration when dealing with this type of claim.
There are several ways to make a “sensitive claim” due to sexual abuse injury, but overall they follow the following steps:
- Visit an ACC approved counsellor or doctor (take a friend for support if you like)
- Tell the counsellor or doctor what happened
- Fill out the appropriate ACC forms with your doctor or counsellor
- The doctor or counsellor will send the forms to the Sensitive Claims Unit
- Some Counsellors or doctors may request an extra charge
- ACC sends you a letter about your claim. If the claim is accepted you will receive up to 10 hours of counselling and be assigned an ACC case-manager. More hours may be made available if you need them. You may also be eligible for a lump sum payment if you first received treatment for you mental injury after 1 April 2002.
- All claims are completely confidential. ACC will support you through the process. If you need other help from ACC talk to your case-manager.
If you have any questions or would like a list of ACC approved counsellors, you should contact the following:
“Sensitive Claims Unit”
Free phone 0800 735 566 or Wellington (04) 918 7138.
Fax (04) 918 7577, PO Box 1426, Thorndon, Wellington
When is injury not covered?
Generally an injury is not covered when it is caused by a: gradual process, disease or infection. This includes situations such as when
- you injure yourself on purpose; or
- you are in prison; or
- it is caused by growing older; or
- it is injury to teeth caused by the natural use of those teeth; or
- it is mental injury alone; or
- it is a heart attack or stroke, unless it is the result of a medical mistake or a work injury; or
- it is an unwanted pregnancy, abortion, or injuries you received during birth, unless there was a medical mistake.
ACC is a ‘no fault’ scheme. Because of this you can usually get compensation even if you’re injured while committing a crime.
You usually have to fill in a claim form within 12 months of being injured. But ACC can accept a claim after 12 months, so make sure you ask for help if your claim is rejected.
For help see “Useful Contacts” at the end of this information sheet.
How do I make a claim?
You can lodge a claim for yourself or your doctor will fill in a “Claim for Cover” form when you go to see him or her about the injury. This is sent to the Accident Rehabilitation and Compensation Insurance Corporation who may reject or accept the claim. If you are turned down you can apply to have the decision reviewed.
Are there age limits?
No. You are eligible for ACC at any age [1]. But if you are under the age of 16 years, any compensation (other than loss of earnings) will be paid to your parent or guardian.
[1] s3 Injury Prevention, Rehabilitation, and Compensation Act 2001.
What if I’m injured outside of NZ?
If you usually live in New Zealand, then you are covered by ACC. It also covers those New Zealanders who are overseas as long as they are paid in New Zealand and pay New Zealand taxes in New Zealand.
If you are a visitor to New Zealand, then you are also covered, except if you are injured while on board a ship or plane.
What compensation can I claim, and who pays for it?
If you suffer a work injury, which stops you working, the employer must pay you 80% of your weekly wage for the first week off work. ACC will pay 80% of your weekly wage after the first week.
If the injury that stops you from working didn’t happen through work, ACC will pay 80% of your weekly wage after the first week. Before that you will have to use up your sick leave or your savings if you have no sick leave left.
Can my employer contract out of the scheme?
No. But they can give you more benefits for injuries in your contract.
Types of Compensation
- Payment for your medical treatment (e.g. doctors, dentists, physiotherapists...).
- Payment for your hospital treatment - All charges at public hospitals will be paid by ACC. Private Hospital charges may also be covered sometimes.
- Weekly compensation (see Work Injury above).
- Loss of future earnings – To get this compensation you must:
- have suffered personal injury before the age of 18, or suffered personal injury after the age of 18 but have been studying full-time since your 18th birthday; and
- be currently over 18 years of age; and
- be no longer studying full-time; and
- have been unable to work for 6 months or more because of the injury; and
- have been assessed as not being able to work; and
- only be able to do 85% or less of the work you used to do. ACC may review this every 6 months.
- Independence Allowance – if you are permanently affected as a result of an injury that occurred before April 1 2002 you may be able to claim an independence allowance if your injury means you can’t do the things you used to. Payment can begin as soon as you put in a claim for the injury that caused the problem. ACC pays the independence allowance every 3 months in advance. ACC may reassess whether you still need the allowance (or the same amount)
- Transport - ACC may pay some of your travel costs to receive medical treatment and physical rehabilitation.
- Accommodation costs in some cases.
- Death - when a person dies from their injuries, ACC will pay for the cost of the funeral, or $4500, whichever is the smaller amount. That person’s husband, wife, children or dependants may also be able to get a survivor’s grant, and weekly compensation, and weekly childcare payments for bereaved children living in New Zealand.
- Lump Sum Compensation – To get this compensation:
(a) Your injury must have occurred on or after 1 April 2002 (special rules apply for sensitive, gradual process and medical misadventure claims which depend on the last date the event or factor causing your injury last occurred); and
(b) Your level of permanent impairment must be 10% or more
Rehabilitation
The aim of rehabilitation is to help those who suffer personal injury to regain their independence.
The two types of rehabilitation are:
- Vocational rehabilitation - to help get injured people back into work; and
- Social rehabilitation - to give independence back to injured people. This may include changes to your car or home, childcare, buying a wheelchair, etc.
Reviews
If you don’t agree with ACC’s decision about your injury, you can ask them to review it. Make sure you get ACC to put the decision in writing first. You must make an application for review within 3 months of the decision you disagree with. Forms are available from ACC. You can ask YouthLaw or your local Community Law Centre to help you fill the form in. You can also appeal against the review decision but you need to do it within 28 days of the decision. If you are outside this time the Court will only hear your appeal if there are special circumstances.
Do I have any rights?
Yes, you do. On 1 February 2003 a new code of ACC Claimant’s Rights (“the Code”) came into force. The Code provides that you have the right to:
- Be treated with dignity and respect
- Be treated fairly, and to have your views considered
- Have your culture, values and beliefs respected
- A support person or persons of your choice
- Effective communication
- Be fully informed
- Have your privacy respected
Complaints
If you’re unhappy with ACC, their policies, a decision they’ve made or something they’ve done you can make a complaint to the Complaints Service, which is part of ACC.
Freephone: 0800 650 222;
Wellington: Freepost 264, PO Box 242, Fax: 04 918 7580;
Auckland: Freepost 264, PO Box 9034, Fax: 09 915 8317 or Complaints@acc.co.nz.
From 1 February 2003 you can also make a complaint about a breach of your rights under the Code. The first step is to raise the problem or concern at the local level with the person you are dealing with, or that person’s manager. If it can’t be resolved there and you want to take the complaint further you can lodge a complaint with the Complaints Service. You can complain to the Complaints Service even if you haven’t raised the issue at the local level.
The Complaints Service will then investigate your complaint. If they find there was a breach of the Code they may direct ACC to:
- Give you a written apology
- Send you a letter clearly explaining what is happening in your case
- Meet with you to talk to you about the problem and try to sort it out
- Send information to you which explains your claim and related entitlements, review and appeal rights; and any appropriate law
- Allow you to see your file
- Get communication going between you and your case worker by ensuring you get a response to any questions and requests
- Provide interpretation services
- Provide other any other action that is required to sort the situation out
If you disagree with the decision ACC makes on your complaint you can apply for a review of the decision. However, there is no right to appeal if you don’t like the decision on review.
Can I sue in any circumstances?
You can take the person who you think caused your injuries to the civil court to get compensation only in very special circumstances. The person must have been so careless about your safety that the Court thinks they should be punished by paying you compensation. If the person has already been punished in the criminal court (e.g. for dangerous driving that injured you), you can still get compensation in the civil court.
Useful Contacts
Website: www.acc.co.nz
Email: claims@acc.co.nz
Free Fax: 0800 222003
Call Free: 0508 222 993
Or under A.C.C. in blue “Government phone listings section” in front of the phone book.
YouthLaw |
Latest page update: made by YouthLaw
, Dec 9 2008, 4:18 PM EST
(about this update
About This Update
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| Started By | Thread Subject | Replies | Last Post | ||
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| Anonymous | Confused - bereavement and stat days? | 0 | Jan 11 2012, 6:18 AM EST by Anonymous | ||
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Thread started: Jan 11 2012, 6:18 AM EST
Watch
Does anybody know or can anyone help answer this please. i was currently covered by ACC - work injury, during this time my sister passed away and i had to go overseas for her funeral, this time period also fell on stat days, Christmas and New Years period.
i just want to know, who is responsible to pay for my bereavement days and stat days please. my work or acc? |
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| Anonymous | which act? | 0 | Nov 15 2011, 3:31 PM EST by Anonymous | ||
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Thread started: Nov 15 2011, 3:31 PM EST
Watch
My son was born in 1995 and had a fall in 1997 resulting in a head injury- acc have supported claim since he was 11 with 11 hours teacher aide at school. as he is nearly 16 he has declined further TA . he will be at school next year working on nzea2.
Our acc person has suggusted applying for / seeing if he is available for the lump sum, but i am aware the act changed at times in the 90's. as his injury was middle of the year 1997 which act will be come under? sump sum or independent allowance? many thanks lynne |
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| Anonymous | Why wont Acc cover Lisa lewis's dentistry care? | 1 | Oct 18 2011, 11:23 PM EDT by YouthLaw | ||
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Thread started: Oct 18 2011, 10:46 PM EDT
Watch
Why does Lisa Lewis have to fund raise to get the denistry care she needs after having her teeth punched out? Surely this should be covered 100% from ACC.
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