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 2001, most of which came into force on 1 April 2002. The new 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 -

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:

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:

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 -

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:

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 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:

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:

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:

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:

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