A treatment injury is a personal injury that has occurred during treatment provided by, or at the direction of, one or more registered health professionals. Until July 2005 it was called a ‘medical misadventure’ injury.
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).
If you have any questions about these claims, contact the Treatment Injury Centre on 0800 735 566.
What do treatment injuries include?
Treatment injuries involve a direct causal link between the treatment and the injury.
Cover for treatment injury differs from the previous medical misadventure rules, as ACC is no longer required to establish a medical error or a ‘rare or severe’ medical mishap. Some injuries that occur in treatment are specifically excluded from cover.
Treatment injury exclusions
Treatment injury does not include injury that is:
- wholly or substantially caused by a person’s underlying health condition
- a necessary part, or ordinary consequence of the treatment, taking into account all the circumstances of the treatment, including:
- the person’s underlying health condition at the time of the treatment and
- clinical knowledge at the time of the treatment
- caused solely by a decision an organisation made about allocating health resources
- the result of a person unreasonably withholding or delaying their consent to undergo treatment.
Note:
Treatment that did not achieve a desired result does not, alone, constitute treatment injury.
Treatment injury inclusions
The following are included in treatment injury claims:
Indirect infection
Indirect infection includes cases where a person with an infection, accepted as treatment injury, passes the infection directly onto their partner, child or other third party or through their partner.
Clinical trials
A claim could be considered for someone who is part of an approved clinical trial and has a complication. There are special conditions. For example, injuries would not be covered if they result from trials that were held mainly for the benefit of the maker or distributor of the item being tested.
Managing the risk of public harm
There is no general reporting requirement under the Injury Prevention Rehabilitation and Compensation Act 2001. However, if ACC determines that there is a potential risk of public harm relating to a treatment injury, the event will be reported to the relevant authority responsible for patient safety.
How to lodge a treatment injury claim
When lodging a treatment injury claim, follow the general process for lodging claims, and in addition remember to:
- Tick the Treatment Injury box on the ACC45 Injury Claim Form. (If you have an older version of the ACC45 this is the Medical Misadventure box.)
- Complete an ACC2152 Treatment Injury Claim form (DOC 124K)
- Attach copies of clinical notes that support the claim (if relevant)
- Attach an invoice if applicable (see What ACC pays for lodging treatment injury claims for further information)
- Lodge the claim.
Post or fax the ACC45, ACC2152, clinical notes and your invoice to us, see Contact us for postal or fax details.
Note:
If you lodge ACC claims electronically, please process the ACC45 as usual, and post or fax the ACC2152 Treatment Injury Claim form, clinical notes and your invoice to us.
Prior approval is required for some treatments
Some treatments must be pre-approved by ACC (eg elective surgery or high tech imaging). If the client requires a pre-approved treatment, please advise them to contact the Treatment Injury Centre on 0800 735 566. See Treatment Costs in the Making a claim section for more information.
What happens next?
ACC will contact the client directly to give progress updates, and when a decision is made, the client will be notified in writing. Treatment providers who lodge a claim will not be advised of the outcome of the claim. This is because the consent that ACC obtains from the client does not extend to releasing this information.
What ACC pays for lodging treatment injury claims
The amount ACC pays for completing the ACC2152 Treatment Injury Claim form (DOC 124K) and/or for providing copies of clinical records varies to reflect both the involvement of the lodging provider and the complexity of the claim. Payment is made regardless of whether the claim is accepted or declined, however the form needs to be fully completed. Payment for consultation that results in completing the ACC45 is made separately.
See the table below for further information:
Lodging provider |
Information supplied |
Straight-forward or moderate claim |
Complex claim |
|---|---|---|---|
District Health Board |
ACC45 ACC2152 Supporting information |
$40 |
Hourly rate |
Private hospital |
ACC45 ACC2152 Supporting information |
$40 |
Hourly rate |
Other health professional |
ACC45 ACC2152 |
$24 |
Hourly rate |
Other health professional |
ACC45 only* |
No payment |
No payment |
* If completing the ACC45 only, please provide, as a minimum, the place of treatment and the name/s of the person/s that provided the treatment that caused the injury.
Last updated: 20 February 2009