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How to claim accident compensation

Introduction

If you've had an injury - whether a workplace injury, an accident at home, a sports injury or a motor-vehicle accident - you can claim compensation from the Accident Compensation Corporation (ACC), the Government agency that administers the accident compensation scheme.

The Corporation is the only provider of accident compensation, and all claims must be made to it.

The Act that covers the ACC scheme is the INJURY PREVENTION, REHABILITATION, AND COMPENSATION ACT. The Act puts more emphasis, as its title indicates, on preventing injuries, but in general it made no major changes to the kinds of injuries and conditions for which you can get ACC, nor to the types of compensation you can receive. It did, however, re-introduce lump-sum compensation for permanent disability ("impairment") (see below). It also provided for a Code of Rights to be drawn up and adopted for people who claim ACC (see below).

How do I make a claim?

Your first step should be to see a doctor. The doctor has a duty to make you aware of the ACC scheme and will explain the process of lodging a claim. Your doctor will fill in an ACC 45 Injury Claim Form if he or she thinks it's likely that ACC will cover you.

Usually your doctor will send your Injury Claim Form to the Accident Compensation Corporation for you.

What is the time limit for lodging a claim?

You must lodge your claim within 12 months of the accident or incident that caused your injury. But even if your claim is late, ACC must accept it unless the lateness of the claim would hinder ACC in its ability to make a decision.

How long will ACC take to process my claim?

For standard claims, ACC must make a decision and notify you within 21 days. But they can extend this to a total of four months if they need more information.

The time limits are slightly different for complicated claims, which means claims for -

  • mental injury caused by rape, sexual abuse and other sexual crimes
  • work-related gradual process, disease or infection
  • treatment injuries (formerly, "medical misadventure"), or
  • late claims lodged after 12 months

For complicated claims, the time limit for making a decision is two months, which ACC can extend to a total of four months. If you agree, there can be further extensions beyond the four-month maximum, up to a total of nine months.

If ACC doesn't comply with any of these time limits, the law treats ACC as having accepted your claim and you will have cover for your injury.

What kinds of injury are covered by ACC?

There are two main criteria that must be satisfied for your injury to be covered by ACC:

  • you must have suffered "personal injury" within the terms of the Act, and
  • your personal injury must come within one of the categories covered by the Act

Have I suffered "personal injury"?

The first matter to address is whether your injury is a "personal injury" as defined in the Act. Broadly speaking, personal injury means:

  • death (in which case claims can be made by the surviving spouse or civil union or de facto partner, or the deceased person's children)
  • physical injury
  • mental injury as a result of physical injury
  • mental injury suffered as a result of a rape or other sexual assault or abuse, or
  • damage (other than wear or tear) to artificial limbs and false teeth

Is the personal injury covered by ACC?

The next question is whether your personal injury was caused in one of the types of circumstances covered by the ACC scheme.

You'll be covered by ACC if you've suffered a personal injury that -

  • is caused by an accident
  • is a "treatment injury", which means personal injury caused by treatment given by a registered health professional, but not where that injury is a necessary part or ordinary consequence of the treatment. ("Treatment injury" replaced "medical misadventure" on 1 July 2005. Medical misadventure had to be either "medical mishap", which is when your body reacts to proper medical treatment in a way that is both rare and severe, or "medical error", which is when a doctor or other registered health professional makes a mistake that is unreasonable for someone in his or her position to make. The new "treatment injury" category therefore allows for cover in a wider range of situations than medical misadventure, because it does not require there to be any fault on the part of the health professional, as with "medical error", nor for the injury to be rare and severe, as with "medical mishap".)
  • is a consequence of treatment given for another personal injury covered by ACC
  • is caused by a gradual process, disease or infection (such as dermatitis) that is caused by -
    • your job
    • a treatment injury
    • a personal injury covered by ACC, or
    • treatment for a personal injury covered by ACC
  • is a cardio-vascular episode (a heart attack) or a cerebro-vascular episode (a stroke) caused by -
    • a treatment injury, or
    • physical effort or physical strain at work that is "abnormal in application" or "excessive in intensity"

No other types of gradual process, disease or infection, and no other types of heart attacks or strokes, are covered by ACC.

Can I claim for rape or sexual abuse?

Yes, you can claim ACC if you've been raped or sexually assaulted or abused. To be covered you'll have to show that you suffered either physical injury, or mental or nervous shock.

You don't have to provide the details of your injuries on this form; you can simply write "sensitive claim" on the Injury Claim Form.

If you're claiming for mental or nervous shock you must lodge your claim within 12 months after the date on which you first receive treatment for the injury. If you don't lodge your claim in time, ACC can either accept or reject your claim.

What compensation can I receive?

There are several types of compensation that you may qualify for:

  • Medical and hospital treatment - ACC will pay for some or all of the costs of doctors, dentists, physiotherapists, specialists, counsellors and other health professionals. Usually when you receive your treatment you will pay only a part of the fee (a "surcharge"), and the person treating you will claim the rest from ACC. If you're charged the full fee, you can claim back the costs you're entitled to from ACC by sending them your receipts.
    ACC will also pay for emergency treatment at public hospitals. If surgery is not urgent ( "elective" surgery) you'll need to get ACC approval beforehand, particularly if it's at a private hospital.
  • Weekly compensation - ACC will pay you 80 percent of your lost weekly earnings. They won't pay you for your first week off work, but if it's a work-related injury, your employer must pay you for that first week.
  • Loss of potential earnings if you were under 18 - ACC will pay you compensation for lost future earnings if you were injured before you turned 18. (You also qualify for this if you were injured after you turned 18, but you had been doing full-time study or training since before you turned 18.) To qualify for this compensation, you must:
    • now be 18 or older, and
    • no longer be studying full-time, and
    • have been incapacitated for six months or more, and
    • have less than 85 percent capacity for work
  • Rehabilitation - ACC will help you get back into the workforce and become independent again. An ACC Case Manager will work out a rehabilitation plan for you. There are two types of rehabilitation:
    • "Vocational" rehabilitation is aimed at getting you back into the workforce. ACC will, among other things, arrange for independent occupational assessments of your needs and, if you need to find a different job, of your skills and job options. Your plan will also include rehabilitation assistance from ACC and often from your employer or doctor. Your employer must help you in your rehabilitation – for example, by assigning you different tasks.
    • "Social" rehabilitation aims at helping you become independent in the areas outside your working life. This could include alterations to your home, paying for a wheelchair, home help or child-care.
  • Lump-sum compensation for permanent disability ("impairment") - The INJURY PREVENTION, REHABILITATION, AND COMPENSATION ACT 2001 re-introduced lump-sum compensation. If you've suffered permanent impairment as a result of an injury that occurred after 1 April 2002, you'll qualify for a one-off payment. (This replaces the "Independence Allowance", which consisted of regular payments for permanent disability.) Your condition must have stabilised or it must be at least two years since the injury. The impairment must be assessed by ACC as at least 10 percent. For a 10-percent impairment, you would get $2,500. For an 80-percent impairment (for example, if you were a paraplegic), you would get the maximum of $100,000. The impairment can be from -
    • a physical injury, or
    • mental injury caused by a physical injury, or
    • mental injury caused by sexual assault or abuse
  • Transport to treatment - In certain cases ACC will pay for the cost of public transport, or a set amount per kilometre if you use private transport, for you to travel to get treatment. ACC will also pay an amount towards accommodation costs if you have to stay overnight.
  • Funeral grants and survivors' grants - ACC will pay $4,500 towards the costs of the funeral if a person dies from an injury covered by ACC. Family members will also qualify for a survivor's grant.

To find out more about exactly what you might qualify for, ring ACC's Claimant Enquiry Service Centre toll-free on 0800 101 996.

What rights of appeal do I have if ACC denies my claim?

Your rights of appeal are explained in the related article How to challenge a denial of ACC.

Your rights under the Code of ACC Claimants' Rights

The Code of ACC Claimants' Rights came into force on 1 February 2003. Anyone who makes a claim to ACC has rights under this Code and is able to use a complaints procedure if those rights are breached.

The Code gives you the following rights:

  • to be treated with dignity and respect
  • to be treated fairly, and to have your views considered
  • to have your culture, values and beliefs respected
  • to have one or more support people
  • to effective communication
  • to be fully informed
  • to have your privacy respected
  • to complain

You can read a copy of the Code on the ACC website at www.acc.org.nz, under Claims & Care.

What can I do if my rights under this Code are breached?

You can either:

  • raise a problem or concern at the local level, with the person you've been dealing with at ACC or with that person's manager, or
  • lodge a complaint with ACC's complaints service (whether or not you've raised it at the local level)

If you raise a complaint at the local level ACC must work with you on it and try to resolve the problem. They must tell you what steps they've taken in response. They must also tell you about your right to complain if you're not satisfied with their response, and how to go about complaining.

To make a complaint with ACC's complaints service, you should:

  • write to or fax the Complaints Investigator's office at:
  •  
    • Freepost 264
      PO Box 242
      Wellington
      Fax: (04) 918 7580, or
    • Freepost 264
      PO Box 90341
      Auckland
      Fax: (09) 915 8317

What can ACC's Complaints Investigator do about my complaint?

The Complaints Investigator's office will give you its decision in writing, including the reasons for its decision and the action it intends to take. It can, where appropriate, direct ACC to do certain things, including:

  • apologising to you
  • meeting with you so that you can put forward your views
  • providing you with relevant information

What can I do if I'm not happy about the Complaints Investigator's decision?

If you're not happy with the decision, you can apply for it to be reviewed by an independent reviewer. This is the same review procedure that applies to ACC decisions on claims, and is explained in How to challenge a denial of ACC.

What can I do if I'm not covered by ACC?

If your injury isn't covered by ACC, and if some other person was responsible for the injury, you can seek compensation by suing that person in court for damages. (You are barred from suing if your injury is covered under ACC.)

Cautionary notes
  • It's important that you seek medical treatment for any injury; the practitioner will tell you whether the ACC scheme covers you and how the claims process works.
  • If you're not covered by ACC or if you believe that your claim was wrongly refused, you should seek advice from a lawyer (see How to challenge a denial of ACC). If you're not covered by ACC, your lawyer can advise you as to whether you can sue the party responsible for damages. Even if you are covered, it may be possible in some limited cases to sue for exemplary (or "punitive") damages. This will be in cases where it is appropriate to punish the person responsible for the injury; the ACC legislation does not bar these kinds of actions as the function of the ACC scheme is to compensate the injured person, not to punish the person responsible.
  • A lawyer will also help you if you need information in relation to a claim for mental injury, as many complex rules apply in this area.


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