Sensitive claims are made when a mental injury is caused by ‘certain criminal acts’ specified in sections of the Crimes Act 1961 and listed in Schedule 3 of the Accident Compensation (AC) Act 2001.
Mental injuries (as defined in Section 27 of the AC Act) must meet the criteria outlined in ‘The Diagnostic and Statistical Manual (DSM-IV™) of the American Psychiatric Association’ in order to be eligible for ACC cover.
ACC will consider diagnoses using other relevant clinical tools where that is appropriate to the client’s needs. For ACC to consider a diagnosis of mental injury using an alternative clinical tool, information on why it is reasonable to use that tool should be supplied.
Demonstrating cultural competency is important in the provision of services relating to all claims. Please refer to the ACC1625 Guidelines on Maori Cultural Competencies for Providers (PDF 2.0M).
What do sensitive claims include?
Sensitive claims include mental injury caused by the following criminal acts as listed in Schedule 3 (external link) of the Accident Compensation Act 2001:
Section |
Description |
|---|---|
128B(1) |
Sexual violation |
129(1) |
Attempt sexual violation |
129(2) |
Assault with intent to commit sexual violation |
129A(1) |
Inducing sexual connection by threat |
129A(2) |
Inducing indecent act by threat |
130 |
Incest |
131(1) |
Sexual connection with dependent family member |
131(2) |
Attempted sexual connection with dependent family member |
131(3) |
Indecent act with dependent family member |
132(1) |
Sexual connection with child under 12 |
132(2) |
Attempted sexual connection with child under 12 |
132(3) |
Indecent act on child under 12 |
134(1) |
Sexual connection with young person under 16 |
134(2) |
Attempted sexual connection with young person under 16 |
134(3) |
Indecent act on young person under 16 |
135 |
Indecent assault |
138(1) |
Exploitative sexual connection with person with significant impairment |
138(2) |
Attempted exploitative sexual connection with person with significant impairment |
138(4) |
Exploitative indecent act with person with significant impairment |
142A |
Compelling indecent act with animal |
194 |
Assault on a child, or by a male on a female. For the purposes of this Schedule, section 194 of the Crimes Act 1961 must be seen as relating only to situations where a female sexually assaults a child under 14 years old |
201 |
Infecting with disease |
204A |
Female genital mutilation |
204B |
Further offences relating to female genital mutilation |
Who manages sensitive claims?
Sensitive claims are managed by ACC’s Sensitive Claims Unit because of their highly personal nature. If you have any questions about a sensitive claim, phone the Sensitive Claims Unit on 0800 735 566.
How to lodge a sensitive claim
When lodging a sensitive claim, follow the general process for lodging claims, and remember to include details of the mental injury suffered by your client when completing the ACC45 Injury Claim form. See the section below for further information about completing the ACC45 Injury Claim form for a client with a sensitive claim.
If you are trained and able to complete a DSM-IV diagnosis you can complete a full assessment of your client at this point and send the ACC 45 and the ACC290 including a DSMIV diagnosis of the mental injury linked to the schedule 3 event and any other information relevant to the injury and the client’s situation. Undertaking all of this together will enable ACC to consider fast tracking the client’s claim for a claim’s decision within seven days.
- will also consider a referral where an alternative clinical assessment or diagnostic tool is used. An ACC45 form, accompanied by an ACC290 form and any other relevant information is still required. Please ensure information about the reasons for using that tool are provided.
ACC will fund 2 assessment sessions to complete the ACC290 and will pay for the report prepared. In the event further assessment sessions are required these can be arranged by calling the Triage Psychologist in the ACC Sensitive Claims Unit – (04) 918 7158
Who is qualified to provide a DSM-IV diagnosis of mental injury?
Registered health professionals who are qualified to provide a DSM-IV diagnosis are Clinical Psychologists and Psychiatrists. In addition psychotherapists, other psychologists or other medical practitioners (such as general practitioners) who affirm they have training and experience in the use of DSM-IV can also provide an explicit psychiatric diagnosis.
Training and experience in the use of DSM-IV should involve a post-graduate level paper where DSM-IV is directly taught as part of clinical practice, followed by continuing use in practice.
If you are unable to affirm that you have the requisite training and experience, please advise the client that you can assist in lodging the claim and providing ACC with as much information as possible, but that an assessment by another health professional may be needed to confirm the diagnosis, and then to provide guidance on therapy or support.
Alternatively, you can refer the client to another professional who is able to undertake assessment using DSM-IV.
Please also discuss with the client the range of support options available as this assessment phase is completed.
Only medical practitioners (GPs) and ACC-registered counsellors can lodge sensitive claims. Other treatment providers should refer clients to these professions. A list of ACC-registered counsellors is available on our website (see Registered Counsellors) or you can get a list from any ACC branch.
The medical practitioner or counsellor must complete an ACC45, stating they believe the client has a mental injury (eg major depression) arising from a criminal event listed in Schedule 3 to the Accident Compensation Act 2001. Remember to include the READ code for sexual abuse.
Make sure the correct address for correspondence is shown on the ACC45 Injury Claim form. Clients can request mail related to the sensitive claim be sent to a different address from the one shown on your records.
What happens next?
Information for your client
If we receive the ACC 45/ACC290 and sufficient information to reach a claims decision we will make that decision within seven days
If we receive only an ACC45 we will ask for more relevant information where that is available and we will contact the client to arrange an ACC-funded assessment with a counsellor.
The client will need to attend two to four ACC-funded visits to the assessor before the assessor sends us a report about the client's situation. ACC uses the report to make a decision on the claim.
Within 24 hours of the referral being received, the Pathways Unit in the Sensitive Claims Unit will send the client an acknowledgement letter with a consent form (ACC167) which will enable ACC to collect any additional information reasonably required.
Any information we collect is seen only by Sensitive Claims Unit staff and in some cases an independent assessor. It is used to determine cover and entitlements.
Last updated: 26 March 2010