Frequently asked questions

This page answers frequently asked questions about us from the media.

How many claims do you receive each year?

We receive around 1.8 million new claims a year – that is over 150,000 every month. In addition we handle a significant number of ongoing claims.

What does ‘no fault’ mean?

‘No fault’ means that no matter what you were doing when you were injured – whether your actions caused the injury, or were illegal or dangerous – you will be covered by us, so long as the injury falls within the parameters of ACC’s legislation.

Fault-based systems in other countries have often proven to be litigious and expensive. Long court battles for damages can quickly exhaust an injured person’s resources and can also be a strain on their health. Even if damages are awarded, the person being sued may not have the money to pay up.

With ACC, everyone in New Zealand is covered but they forgo their right to sue.

Why do criminals qualify for ACC? What can they get and are there limits?

Under our guiding legislation everyone who has a personal injury in New Zealand (or is ‘ordinarily resident in New Zealand’) can be considered for cover, including people who are in prison. However, people who are imprisoned or injured while committing certain offences are only eligible to receive limited entitlements.

Disentitlement during imprisonment

While someone is imprisoned they are only entitled to rehabilitation and treatment for their injury and are not entitled to any other form of compensation from us. Any periodic ACC payments cease for the period of imprisonment, and there is no eligibility for back payment.

When a person is released from prison they can apply for lump sum payments for injuries incurred before or during their sentence.

Disentitlement for people injured while committing certain offences

From 1 July 2010, people who are injured whilst committing a serious crime will be automatically disentitled from all entitlements relating to those injuries, except:

  • treatment
  • any elective surgery necessary to restore function to enable them to return to work (such as repairing eye socket damage so they can see).

The automatic disentitlement applies if a client:

  • was injured while committing a crime which is punishable by a maximum term of imprisonment of 2 years or more
  • is covered by ACC for his/her injury
  • is sentenced to imprisonment or home detention (for that crime).

The disentitlement takes effect as soon as a client meets all three criteria (ie after sentencing). However, ACC’s legislation does provide the Minister for ACC with discretion, in exceptional circumstances, to exempt criminals from disentitlement. If you would like to the relevant legislation, go to:

Legislation relating to criminal acts and ACC.

Do you help the families of crime victims?

The families of victims of criminal acts, including murder, may be eligible for a wide range of support from us.

This support can include:

  • survivor grants, which are lump sum payments given when the victim dies
  • a percentage of the income of the murdered person payable to the surviving partner and children, usually (depending on the circumstances) amounting to 80% of the deceased person’s income
  • funeral grants
  • child care support.

Anyone who is physically injured as a result of criminal acts is also eligible for support from us. All support is assessed on a case-by-case basis, but could include lump sum payments, compensation for lost income, and ongoing support, care, rehabilitation and treatment.

Why can’t you comment on specific cases? What are the boundaries around privacy?

In most circumstances we are unable to specifically comment on any claim or potential claim without the consent of the individuals concerned.

If the person involved supplies us with a signed ACC privacy waiver authorisation (PDF 24K) we can then comment on any issues specific to the claim in question. If the person involved does not agree to sign the privacy waiver, we can supply general information about processes in similar kinds of situations without commenting directly on the claim.

If, however, a person makes comments about us that are inaccurate and will therefore mislead the public, we will endeavour to clarify the situation and may point out the inaccuracies of a specific claim to do this.

We are also constrained in circumstances where criminal proceedings may ensue and are prevented from making any comment that may impact adversely on the fairness and propriety of those proceedings.

Why do we focus on early rehabilitation?

Our main aim is to support injured people and help with their rehabilitation to ensure that they return back to their normal lives – or as close to as possible – as quickly and effectively as they can.

Immediate treatment for an injury and timely rehabilitation is beneficial on many levels. It means injuries can heal more effectively and rehabilitation outcomes can be improved. This also means there is minimal impact on the country’s workforce.

Deciding when someone is ‘work-ready’ is a huge part of rehabilitation. To help medical practitioners decide when someone should return to work after a specific injury, we usually recommend the Stay at Work service. It uses a team approach with General Practitioners (GPs), client, the client’s family and any related health professional, eg physiotherapist or occupational therapist – they all work to determine the right level of time off for an injury, and how best to manage a return to work.

Clinical evidence clearly shows that an early return to work – once it is medically appropriate – is an important part of a person’s overall rehabilitation. Therefore, getting an injured person back to work is highly beneficial for them, their families and the economy.

In the 12 months from 1 July 2013 to 31 June 2014, 68% of injured people returned to independence within 70 days of being injured, and 93% within 273 days.

We fully accept that the final decision on returning to work is a clinical one and is in the hands of the medical practitioner. Our goal is to provide resources and data to GPs that help them when considering how long off work is appropriate for the many conditions they are presented with.

We have a number of support systems in place to help people get back into work. One of these is what is termed as ‘vocational rehabilitation’, where recruitment companies assess the skills of the injured person. The assessments find the most suitable areas of work for that person, as the injury could mean they can’t return to their old job. We can often assist with retraining.

What are ‘sensitive claims’ and how does the process work?

Our Sensitive Claims Unit, based in Wellington, works with people who are dealing with significant mental effects from sexual abuse or sexual assault. The unit also manages any minor physical injuries from sexual assaults where there is also a diagnosed mental injury.

We can accept a sensitive claim if there is evidence of a mental injury (a significant psychological, behavioural, or cognitive dysfunction) such as significant ongoing depression, caused by the sexual abuse events that relates to an event listed in the Crimes Act 1961.

We will consider the claim if the:

  • client is a New Zealand resident
  • event occurred in New Zealand and treatment is being sought in New Zealand
  • event occurred outside New Zealand to a person who would usually have resided in New Zealand at that time.

Sensitive claims are made by a GP or counsellor who applies to us on behalf of the person who has suffered the sexual assault. When the claim is received, the person will be asked to see an ACC-registered counsellor for up to four counselling sessions. This is to obtain the information we need to make a decision about whether the claim can be accepted.

If the claim is accepted, we can help with the costs of counselling sessions and related costs. People who are experiencing ongoing mental trauma from sexual abuse may also be eligible for other support from us, including compensation for lost earnings, child care and home help.

We receive around 4000 sensitive claims per year, the majority of these relate to historical sexual abuse events, with fewer than 10% relating to recent sexual assault.

When is a lump sum applicable?

An individual may be entitled to receive a lump sum if the:

  • injury occurred on or after 1 April 2002
  • personal injury claim has been accepted for cover by ACC, and
  • level of permanent impairment is assessed to be 10 percent or more of ‘whole person impairment’.

Injuries covered by lump sum payments may stem from:

  • treatment injury
  • work-related gradual process injury, disease or infection (so long as the person last performed the relevant task after 1 April 2002, or was first treated and rendered incapable because of this injury after that date)
  • lost limbs, sight, or hearing
  • back or joint injuries
  • sensitive claims.

In assessing levels of impairment, we use international guidelines to measure a percentage of the body function that has been impaired.

That means that if a whole and healthy person is considered to be 100%, an impairment percentage is a measure of how that injury affects the person as a whole.

For example if a person loses sight in an eye they would be rated at approximately 24% impairment of their whole person (100%), or if they lost a whole leg it might be about 40%, while an arm might be 60%.

However, if these body parts were already injured or damaged in some way, their impairment percentage would decrease, because the new injury would be judged to have less impact on them. That would mean they would receive a lower lump sum.

If the person is assessed to have been impaired by less than 10 percent, there will be no payment. If it is 80% or more, the maximum amount may be offered.

As at 2014, those payments might be approximately:

Impairment %

Lump sum payment

10

$3,345.06

15

$5,766.86

30

$16,113.81

50

$41,520.18

80 or greater

$133,802.28

We will assess lump sum entitlements when a certificate is received from a doctor indicating that it is likely there is permanent impairment, and either:

  • the client’s condition is stable, or
  • it has been two or more years since the date of injury.

Lump sum payments apply per-person, not per-injury. They apply to the combined impairment resulting from all injuries occurring after 1 April 2002. If the impairment level increases, or there is a further disabling injury, further payment may be made following a reassessment.

In some situations, the percentage of any previous lump sums paid may be deducted from the new percentage to avoid clients being paid twice for the same impairment.

People who receive lump sum payments may still be eligible for other ACC cover such as housing and vehicle modifications, mobility scooters or other necessary specialised equipment, treatment costs along with any related travel and accommodation costs, and weekly compensation.

Lump sum payments are not taxed.

Why do you put money into injury prevention, and how do you decide which areas to focus on?

Preventing injuries from happening in the first place is far better for everyone, including levy payers.

In the July 2013-June 2014 year we spent $34 million on injury prevention, compared to the $2.1 billion spent on injury claims for treatment, we consider injury prevention to be a very effective use of money.

Injury prevention information drives are aimed at helping New Zealanders avoid hurting themselves on the job, at home, at play or on the roads. We focus campaigns on areas where we receive the most claims, where claims might be increasing, or where a worrying trend for certain injuries might be occurring.

For example, most injuries (one in three) happen in the home so ACC ran a ‘Slips, Trips and Falls’ campaign for home safety.

Injury prevention may also be run on a seasonal or topical basis. For example, if the holiday season is approaching, ACC might run or support campaigns about road safety, drink-driving, water safety, or the proper use of child restraints.

We also focus on areas that fit with the New Zealand lifestyle. Therefore sporting safety (rugby, netball, skiing and water) is a large part of our injury prevention work.

Certain sectors might also come in for particular attention, especially if we see claims for specific injuries increasing. For example, issues surrounding respiratory illness or noise-induced hearing loss in the wood processing or manufacturing sector. Often we will team with the industry’s training organisation or other representative bodies to promote safety messages.

We are a leader in the government’s NZ Injury Prevention Strategy, with particular responsibility for safety messages concerning drowning and falls.

We also partner up with other governmental and non-governmental bodies to run injury prevention campaigns. Our common partners are the Police, ALAC, Water Safety New Zealand, New Zealand Transport Agency, New Zealand Rugby, the Ministry of Social Development and local councils.

Does the investment in injury prevention pay off?

Yes. We are seeing a definite reduction in claims for most areas where we have focused injury prevention, particularly in sport.

For example, SportSmart (external link) is s website for people to get active in sports safely, and we’ve had particularly good injury prevention results with the RugbySmart campaign (www.rugbysmart.co.nz) which we run with New Zealand Rugby (NZR).

From 2001 all New Zealand rugby coaches and referees have been required to complete RugbySmart. The programme focuses on educating rugby participants about physical conditioning, injury management, and safe techniques in the contact phases of rugby.

Due to that campaign, claims for serious spinal injuries from rugby are reducing each year. For example, the number of serious spinal injuries has stayed under three per year for the last few seasons. Before the introduction of RugbySmart, there were around 10 each year.

It is important to note that the number of New Zealanders playing rugby during that period increased.

Why do people who play dangerous sports get ACC?

We are a ‘no fault’ social health insurance scheme. That means that everyone in New Zealand is covered no matter what they were doing when they were injured – even if it was a sport or activity that could be considered dangerous or extreme.

Also, it must be noted that far more injuries occur in the home than anywhere else.

Why do you advertise?

All New Zealanders pay for ACC so it is their right to know what they can get for their money if they are injured. Advertising is a very effective way to achieve this.

Although we have run some general advertising (such as the ‘Covered’ campaign), the majority of advertising and public awareness campaigns are targeted at groups of New Zealanders that have been identified as not accessing the scheme.

For example, Māori and Polynesian New Zealanders are under-represented in our statistics. They are injured as much as any other ethnic group, but don’t tend to ask for our help in their care, support and recovery.

We may also advertise to reach certain sectors, like road transport or agriculture, or sporting and recreation groups. This is done particularly through injury prevention campaigns.

But advertising is just a small part of how we inform New Zealanders. We also run hui, fono, focus groups and community meetings to raise awareness among all sectors of the community.

Why do you help tourists?

ACC’s legislation covers the medical treatment of overseas visitors who are injured while in New Zealand.

However, they cannot get compensation for lost overseas income and their cover does not continue once they leave New Zealand. In the case of serious injuries, we will assist them only to the point where they are able to safely return home. There are other exclusions as well.

It is important to note that tourists often pay some form of ACC levy. For example, those who hire rental vehicles pay an ACC levy when they buy petrol, so they do pay towards any road-accident related treatment.

Those who legally worked while in New Zealand paid levies through their wages.

It is important to appreciate that in return for this cover, overseas visitors – like New Zealanders – forgo the right to sue if they are injured here.

If they were allowed to sue, the cost to New Zealand would be significantly more than what we pay to cover their treatment. Individual New Zealanders could also have been sued; something that with ACC cover, cannot happen.

Finally, it is most likely that recovering the cost of tourists’ medical treatment from the visitors themselves, or their insurance companies, would be expensive.

Why do you invest the money from levies?

We invest the money from levies simply because we use the investment returns to offset the cost of the claims received. Basically money earned from investments means money that doesn’t have to be collected from levies.

Levies charged after 1 July 1999 are all set on the basis of fully funding the total expected cost of all claims that occur during the levy year. Some of these costs will not be paid until 20-30 years into the future so we invest the levy received for these payments until the time the payment is made (and by doing so, reduces the amount that has to be collected from levies).

Obviously, we must invest in businesses that will maximise returns, but we cannot and will not invest in anything that is illegal, against the provision of the Treaty of Waitangi, or would be repugnant to most New Zealanders.

How are ACC levies set?

ACC levies are calculated regularly, and the main driver of levy levels are forecast claims. If the forecasts indicate that there will be a rise in claims, then pressure will come on ACC Accounts and levies will increase.

Even if the forecasts are for claims to remain steady, levies can still rise because of what’s known as ‘super-imposed inflation’. This is particularly seen in the health industry, where the price of services increase ahead of inflation.

Since our core business is buying services from the health sector, ACC levies must increase to compensate for those price rises.

What is the Residual Claims Account and who pays residual levies?

From 1 April 2016, we no longer collect the residual levy. To find out more, go to the residual portion of your levy will be removed.

The Residual Claims Account funded the ongoing costs of injuries to all earners (including self-employed) that occurred:

  • in the workplace between 1 April 1974 and 30 June 1999
  • outside of the workplace (ie, non-work injuries) between 1 April 1974 and 30 June 1992.

Why are some ACC Accounts over-funded?

The recent over-funding of the ACC Accounts has primarily been driven by the strong New Zealand economy over the past few years.

Strong economic growth means that our income has been greater than expected, from both investment returns and levy income as the national payroll continues to grow.

Our aim is to hold sufficient funds in reserve to cover the future costs of existing claims (ie to be fully funded), even when we don’t know precisely what these future costs will be. Over-funding occurs where the funds held in reserve exceeds the estimated future cost of claims.

There are many variables that influence the estimate of claims costs and levy requirements and therefore there is plenty of scope for forecasting variances.

This level of forecasting uncertainty means that there is potential for ACC Accounts to be over-funded or under-funded at any point in time.

These forecasting variables usually fall into these the two broad areas:

  1. Claim related assumptions, eg the number of claims that will occur, the likely benefits and rehabilitation required.
  2. Economic assumptions, eg inflation, wage rates and interest rates.

To set the levy for the year, our actuaries must make an estimate, not only as to the number of claims that are expected to occur in a year, but also how much each claim will cost over the life of the claim. In some cases, costs for weekly compensation and rehabilitation are spread over many years; sometimes 40 years or more for a seriously injured person.

The actuaries must also estimate how much employees and self-employed people will earn over the coming year, and what the returns on ACC’s investments will be.

ACC is a not-for-profit organisation, therefore any over-funding is returned to levy payers via lower levy rates in future years. Conversely any under-funding would mean higher levy rates until the funding levels had been restored.

What is ‘Treatment Injury and Patient Safety (TIPS)’?

On 1 July 2005 ACC’s Act was changed so that ‘Medical Misadventure’ was replaced with ‘Treatment Injury & Patient Safety’.

The difference is that we no longer investigates for error or fault as it did under ‘medical misadventure’. This has brought the Act in line with the rest of the ‘no fault’ ACC scheme.

Formerly, to have a claim accepted under the Medical Misadventure provisions a:

  • registered health professional had to be found in error (a failure to observe a standard of care and skill reasonably to be expected in the circumstances)
    or
      • mishap must have occurred (a mishap was defined as being an adverse consequence of treatment that was both rare and severe. Rare was defined as being <1% of all cases, severe was defined as death, hospitalisation for over 14 days or incapacitation for 28 days).

      With the law change, a ‘Treatment Injury’ is an injury caused as a result of treatment from a registered health professional. A person must have been actually injured during treatment, not just have had their safety threatened.

      That we no longer investigates to find fault does not mean that there’s no accountability for the profession. We have a legislative responsibility to carry out ‘harm reporting’, so if we see a concerning case, or pattern of behaviour, then we are obliged to report it.

      From there, the appropriate professional associations, the Ministry of Health and/or the Health and Disability Commissioner will deal with the complaint. Our role is to take care of the person who has been injured, rather than investigate the complaint itself.

      Since the law change the number of claims made under TIPS has risen because the requirement to find error or mishap no longer exists. This was entirely expected because it has increased the likelihood of a claim being accepted, and therefore an injured patient is more likely to consider lodging one.

      Do you have a complaints process?

      Yes. ACC aims to provide a high level of customer service at all times and wants to resolve things as fairly as possible quickly after a complaint.

      We have a thorough set of processes for dealing with complaints, aimed at preventing them from escalating into a formal complaint. We believe that good service is essential to recovering from injury, therefore we do all we can to resolve issues as early as possible.

      Generally a client should contact the ACC person they’ve been dealing with, or their manager, or our Customer Support Service with their complaint. Complaints can usually be dealt with at an informal branch level.

      If a client does make a complaint or asks for a review of an ACC decision, we will:

      • take their concern, complaint or review seriously
      • commit to settling it in a fair, open and respectful manner
      • resolve it as quickly as possible
      • treat them with courtesy
      • keep them informed at all stages
      • take responsibility for working with them until the issue is settled
      • not discriminate against the complainant or disadvantage them in any way.

      If a complaint cannot be resolved at a branch level, a client can contact the Office of the Complaints Investigator and complain under the Code of ACC Clients’ Rights.

      Although the Office of the Complaints Investigator is part of ACC, it is completely impartial and independent. For disputes surrounding our decisions, clients can apply to FairWay Resolution Ltd. However, they can also approach various government appointees; the Privacy Commissioner, the Health and Disability Commissioner, or the Ombudsman, depending on the nature of their complaint.

      What are you doing to improve the service you offer businesses and business levy payers?

      We have introduced a range of improvements to streamline processes for business levy payers. This is in direct response to businesses telling us that we needed to make things simpler, make our communication clearer, and clean up our databases.

      After input from organisations like Business NZ and the Small Business Advisory Group, we tested our ideas with groups of customers before implementing them.

      Improvements include:

      • data cleansing to ensure we have more accurate information about business levy payers. When these are wrong it slows down the processes for both sides and can impact on the final levy charged
      • redesigning invoices to make them more easily understood, with plain language and a clear layout that make it easier to know how much is owed, by when, and how it was calculated
      • standardising business classification codes with other government agencies using the appropriate (ANZSIC 2006) codes
      • improving the website used to search for your business classification, go to Find your Business Industry Classification Code (external link)
      • improving our Business Service Centre by training more staff, matching staffing levels to peak call periods, and improving information on our website.

      We are already seeing signs of improvements in responsiveness from these initiatives.

      When is mental health covered by you?

      Many complaints are generated because we don’t cover a certain condition – particularly concerning mental health and post-traumatic stress disorder.

      The hard fact is that we can only cover injuries and disorders that are specified under the Accident Compensation Act 2001.

      However, the Act does extend cover if the mental injury is either the result of a:

      • sensitive claim (ie sexual abuse or assault)
      • physical injury (ie depression from loss of leg, or from the physical effects of sexual abuse).

      If clients believe their condition should be covered by us under the terms of the legislation, there is a robust complaints and appeals process in place.

      If the Act does not cover the condition and the client feels a change is necessary, they must apply to the Minister for ACC and seek an amendment to the legislation.

      What support does a family get when someone dies following an injury?

      After an accidental death, we can offer assistance to help pay for funeral expenses and, depending upon each case’s circumstances, other types of support can be available to mean ongoing bills too.

      After a death, these are the four main types of support ACC can provide:

      1. Funeral grants to help with funeral costs (including burial/cremation and ceremonies).
      2. Survivor’s grants, which are one-off payments paid to the partner/spouse and children of the person who has died.
      3. Childcare payments, which are ongoing payments to support children/dependants of the person who has died.
      4. Weekly compensation if the person who died was an income earner – a portion of their average weekly income can be paid for a period of time.

      This support can be available no matter how old the person was when they died, and no matter what they were doing at the time of injury, eg at home, at work, driving or playing sport.

      If the injury occurred on a short trip overseas, ACC can cover this too as long as the person was a permanent resident in New Zealand.

      When I’m injured overseas and come back to NZ, how do I get you help?

      If you are a New Zealand resident and have been out of the country less than six months, you may be entitled to put in an ACC claim for your overseas injury when you return to New Zealand. However, since we will only cover you from when you get home and won’t pay for any overseas treatment, travel insurance is still a very good idea.

      What to do if you are injured while overseas

      If an injury happens when overseas there are a few things you need to do before you return home for us to determine whether or not the claim can be accepted. Ensure that before you leave the country where you are injured, you have in writing:

      • a full medical report from the doctor, dentist or hospital that first treated you
      • all the details of your injury, condition and treatment
      • the qualifications of the health professional who treated you.

      Returning to New Zealand after being injured overseas

      When you get back to New Zealand, visit your local doctor who will then determine what ongoing treatment you need. If you get back and think you won’t need further treatment, visit you doctor anyway so you can be sure. If you don’t and the injury reoccurs you may not be entitled to claim. So visit them as soon as possible – make sure you don’t leave it for more than 12 months.

      Following the visit to your local doctor, they will complete an ACC claim form on your behalf and send it to us, along with the medical report you got from overseas, so it can be reviewed as part of your claim.

      If you are injured while working aboard for a New Zealand company that is part of the ACC Accredited Employers Programme, you need to contact your employer immediately on your return.

      Reviewed: 18 February 2015