Cover and entitlements for ACC clients

Everyone in New Zealand is eligible for ACC cover for personal injuries caused by accident. Once ACC has accepted a client’s claim, a range of entitlements are available to assist them.

What is covered by ACC?

We received 1.8 million injury claims in the 2007/2008 year and paid out $2.72 billion for medical and surgical treatment, rehabilitation and compensation.

ACC generally covers the treatment of personal injury caused by an accident, no matter who was at fault. Common causes of personal injury that ACC covers are:

  • physical injury, eg a sprain, laceration, fracture
  • work-related gradual process, disease or infection
  • treatment injury (called medical misadventure before 1 July 2005)
  • mental injury caused by a physical injury
  • mental injury caused by sexual abuse or assault.

Mental injury

A mental injury is a clinically significant behavioural, cognitive or psychological dysfunction. It does not include emotional effects such as hurt feelings, stress or loss of enjoyment.

When a mental injury is caused by a physical injury, the claim will usually be lodged by a medical practitioner or nurse practitioner. However, the disorder must be diagnosed by a registered psychiatrist or psychologist.

When a mental injury is caused by sexual assault or abuse, the person can lodge their claim through either a medical practitioner, nurse practitioner or an ACC-registered counsellor. For more information, see pages 56 to 59, ‘Mental injuries, sensitive claims and counselling’, in the Section 6 of the Treatment Provider Handbook (PDF 1.6M).

Since 1 October 2008, claims for work-related mental injury can also be considered, providing the injury was:

  • first treated on or after this date
  • caused by exposure to a traumatic event during the person’s work
  • lodged by a registered health provider or treatment provider.

For more information about what, and who, ACC covers and conditions that are not covered, see information for clients in Am I covered?

The Treatment Provider Handbook includes a useful chart ‘How ACC cover works at a glance’. See Section 1 – Overview (PDF 1.6M).

Entitlements for ACC clients

The Accident Compensation Act 2001 provides for a range of entitlements to help people recover from injury. Once a claim for injury cover is accepted by ACC, we work with clients to provide entitlements tailored to their individual needs and situations. Entitlements include:

  • acute treatment
  • public health acute services
  • elective surgery
  • pharmaceuticals
  • imaging
  • home-based care
  • rehabilitation
  • transport
  • compensation for lost earnings
  • lump sum compensation
  • modifications (housing/vehicles)
  • accidental death benefits.

For more information about treatment and rehabilitation entitlements, see the following sections of the Treatment Provider Handbook (PDF 1.6M):

  • Section 2 – Partnership: ACC explained
  • Section 6 – Treatment cover
  • Section 7 – Rehabilitation (including work).

Compensation for lost earnings

After the first week of incapacity, clients may be eligible for compensation for earnings lost as a result of their injury.

Registered medical practitioners and nurse practitioners are the only treatment providers who can certify time off work for ACC clients.

For more information, see Work incapacity certificates.

Lump sum compensation and independence allowance

Lump sum compensation is:

  • a non-taxable payment made to compensate a client for impairment that results from an injury that happened on or after 1 April 2002
  • assessed either when the client’s condition has stabilised, or two years after the injury date, whichever is sooner.

An independence allowance is a weekly payment (made quarterly in advance) to a client for a permanent impairment that results from an injury that happened on or before 31 March 2002.

Note:
If a client’s injury happened before 1 July 1992 and their condition has deteriorated, they may apply for an independence allowance. If accepted, the amount awarded may be adjusted to take into account any previously awarded lump sum payment.

Lump sum compensation and/or independence allowance is only payable if the client is assessed as having a ‘whole person impairment’ of 10% or more. Payment levels are graduated so that more seriously injured clients receive proportionately more than less seriously injured clients.

Lump sum and independence allowance entitlements are regularly reviewed against the Consumer Price Index.

Clients are individually assessed for lump sum compensation and independence allowance according to the AMA Guides to Permanent Impairment (fourth edition) in conjunction with the ACC User Handbook to AMA4 (PDF 3.8M).

Clients can receive both lump sum compensation and independence allowance, but not for the same injury.

Exceptions

Lump sum compensation is not payable in the following situations:

Type of claim

Criteria for non-payment

Treatment injury and medical misadventure claim

The treatment that caused the personal injury occurred before 1 April 2002.

Sensitive claim

The criminal act that caused the mental injury last happened before 1 April 2002.

Work-related gradual process claim

Any of the following occurred before 1 April 2002:

  • The client last performed the relevant task or was employed in the work environment that caused the injury.
  • The client first received treatment for the diagnosed personal injury.
  • The personal injury first resulted in the client’s incapacity.

However, an independence allowance may be payable.

Accidental death benefits

Entitlements that may be payable in respect of an accepted accidental death claim, ie a claim for entitlements arising from injuries resulting in death, include:

  • a funeral grant
  • survivor’s grants for surviving spouses, children and other dependants
  • lost earnings compensation for surviving spouses, children and other dependants
  • childcare for the deceased’s children.

More information about clients’ entitlements is available in the Making a Claim section of this website.

Last updated: 12 May 2014

Last reviewed: 25 August 2015