Lodge a claim

The method for lodging claims with ACC is the ACC45 Injury Claim Form which treatment providers complete with the client during the first visit and send to ACC.

Demonstrating cultural competency is important in the provision of services relating to all claims. Please refer to the ACC1625 Guidelines on Māori Cultural Competencies for Providers (PDF 2.0MB).

Before you can lodge claims

Before you can lodge claims with ACC you must register with ACC as a provider and be familiar with your responsibilities, ACC treatment profiles and the relevant legislation and regulations. For more information, see:

Register with ACC

Health service provider responsibilities

Treatment Profiles

Regulations and legislation.

Which treatment providers can lodge a claim?

There are 14 treatment providers defined in the Accident Compensation Act 2001 that can lodge a claim with ACC on behalf of a client. Ambulance officers can also lodge claims.

ACC has developed the Provider claim lodgement framework that specifies which provider groups can lodge a claim on behalf of the client for each injury type, based on Read Codes.

What forms do you need for lodging claims?

There are five forms generally used when claiming for an injury.

Form name

Description

ACC45 – Injury claim form

Use the ACC45 form to lodge an injury claim.

You can also lodge claims online using an electronic version of the ACC45 either by using a compatible Practice Management System (PMS) or by completing an online form that you access directly from your desktop.

All ACC45 Injury Claim Forms have a unique number that acts as a secure reference number and identifier for the client's claim once it is lodged.

ACC1 – Request for assistance

The client should complete an ACC1 if they need assistance with the cost of treatment.

ACC18 – Medical Certificate

The ACC18 describes the client’s ability to work. It needs to be completed by a medical practitioner.

Employers can ask a different type of registered health professional to complete an ACC18 for their employee’s first week off work. You can also submit medical certificates (eACC18s) online using a compatible Practice Management System (PMS) or by using a stand-alone version of the eACC18.

ACC2152 – Treatment Injury Claim Form

Use this form to accompany the ACC45 when lodging a treatment injury claim.

ACC42 – Dental injury claim form

A specialised form of the ACC45 that dentists use to provide more specific details about a client’s dental injury.

How do I lodge a claim with ACC?

The general process for lodging claims with ACC is:

  1. Complete the ACC45 Injury Claim Form (and additional forms as required)
    Note:
    If your client presents with a complicated claim, ACC requires additional information. For further information see:
    1. Sign the ACC45 Injury Claim Form
    2. Lodge the claim.

    Complete the ACC45 Injury Claim Form

    Once you have finished assessing the client, you and the client complete an ACC45 Injury Claim Form. This should be done during the client’s first visit if you think the injury will be covered by ACC.

    Note:
    Dentists use a specialised version of this form – ACC42 Dental Injury Claim Form – to provide more specific details about dental injuries.

    Make sure you:

    • check if the client works for an Accredited Employer. These clients should present a card. If you are unsure, you can check by phoning the Provider helpline 0800 222 070.
    • enter a Read Code on the claim form that matches your diagnosis of the injury. If you cannot find an accurate Read Code please give a written description of your diagnosis. Refer to full Read Code list ACC6343 Read Code reference list (XLS 3.5MB)
    • complete the Ethnicity section. This data is a key component in tracking and addressing the servicing by ACC of several population groups in New Zealand, including Asian, Māori and Pacific peoples.

    Complete the following sections as required:

    • If the patient needs time off work, complete the Incapacity section of the ACC45.
      You must be a medical practitioner (GP) or nurse practitioner to complete this section. Other treatment providers may indicate a client’s incapacity to work, however this must be verified and countersigned by a medical practitioner.
      Note:
      If the client needs time off work and the ACC45 has already been lodged, then complete a medical certificate (ACC18 Medical Certificate). See Issue work-incapacity certificates for guidelines on how to do this.

        For help completing the ACC45 Injury Claim Form see ACC469 Information for Treatment Providers (PDF 230KB).

        Sign the ACC45 Injury Claim Form

        The client, parent/guardian or authorised representative filling in the form must sign the ACC45. This means the client authorises ACC to collect all relevant information, including information about the injury from you and any other treatment providers.

        Explain this to the client and if necessary highlight the Important Information section of the ACC45.

        If the client is under 15 years of age, ACC prefers forms to be signed by the parent or guardian and ACC will address correspondence to the parent or guardian unless advised otherwise.

        Clients under 15 years may sign the form, if they understand what they are signing and agreeing to.

        Important:
        ACC recommends that you retain a signed copy of the ACC45 in paper or image form for audit purposes.

        Show any co-payment

        If your charges are higher than the set amount ACC will contribute, you are able to charge clients a co-payment for the shortfall. This extra fee should be shown as a co-payment on your receipt.

        You cannot charge the client for ACC’s contribution to acute treatment.

        Lodge the claim

        To make sure we can deliver prompt service to your client, send your claims in regularly, eg send claims by post daily (where practicable) and online regularly during each day.

        To lodge claims by post, see contact us for the postal address.

        To lodge claims online, see lodging a claim.

        To lodge claims for clients who work for an Accredited Employer see Lodge claim for employee of Accredited Employer.

        Important:
        Make sure the ACC45 is signed by both you and the client. Failure to do so will result in delays in providing cover to the client and payment of your invoices. ACC is unable to issue a cover decision without the client’s signature on the claim form, unless for example the client is unconscious.

        What happens after you have lodged the claim?

        We make a decision on cover, generally within 24 hours of receiving a claim.

        Note:
        Cover decisions for complicated claims are likely to take longer.

        We will contact you if there is an issue with the claim, eg if the ACC45 is incomplete, or if we seek a second opinion on your diagnosis, choice of treatment or duration of treatment.

        You invoice ACC for your services and receive payment. See Invoicing and payment for further information.

        Reviewed: 25 March 2015