Am I covered?

Everyone in New Zealand has 24-hour, seven-day-a-week, no-fault comprehensive injury cover through ACC. Find out what is and isn’t covered, and what happens if you injure yourself while travelling overseas or visiting New Zealand.

To claim for injuries covered by ACC, see How do I make a claim?

Eligibility for injury cover for everyone in New Zealand

Everyone in New Zealand is eligible for comprehensive injury cover:

  • no matter what you’re doing or where you are when you’re injured – driving, playing sport, at home, at work
  • no matter how the injury happened, even if you did something yourself to contribute to it
  • no matter what age you are or whether you’re working – you might be retired, a child, on a benefit or studying.

What injuries am I covered for?

Wounds, lacerations, sprains, strains, fractures, dislocations and work-related injuries such as hearing loss may all be covered. Most physical injuries are covered if they’re caused by:

  • an accident
  • a condition that comes on gradually because of your work (gradual process)
  • medical treatment
  • sexual assault or abuse.

There is a specific definition of ‘injury’ in the Accident Compensation (AC) Act 2001, which is the law that ACC must apply when considering applications for claims and assistance.

ACC has to be satisfied that you have suffered a personal injury, which can mean any of:

  • physical injury
  • mental injury suffered because of physical injury
  • mental injury caused by certain criminal acts (Listed under Schedule 3 of the Accident Compensation Act 2001 )
  • work related mental injury where a person suffers a clinically significant mental injury caused by a traumatic work related event
  • damage (other than wear or tear) to dentures or prostheses that replace part of the human body
  • death due to a physical injury.

To claim for injuries covered by ACC, see How do I make a claim?

Definition of physical injury

Physical injuries can include:

  • wounds, lacerations, contusions (bruising)
  • burns
  • sprains and strains
  • fractures, amputations or dislocations
  • damage to dentures or prostheses (artificial body parts)
  • work-related gradual process injuries, such as tendonitis, and deafness caused by noise at work
  • infections or diseases caused at work by performing a particular task or being exposed to a particular environment (this excludes any conditions you may have had since birth)
  • blindness
  • poisoning
  • choking
  • loss of consciousness
  • a foreign body in the eye.

ACC considers that a physical injury has not occurred unless there is actual damage to the body from the injury. Neither is a diagnosis of pain sufficient to establish there has been a physical injury; an actual diagnosis of the injury is required.

When you visit your doctor, dentist, physiotherapist or other treatment provider, they will tell you if you may be covered by ACC for the injury. If there are any doubts, you should contact ACC as soon as possible. Contact ACC Claims for our contact information.

Because no two injuries are the same, the type of assistance ACC is able to offer varies depending on individual circumstances. It is important to talk to us to confirm if you are eligible for particular services.

To claim for injuries covered by ACC, see How do I make a claim?

Information about implants

If you have had an implant fitted such as a hip replacement, and are concerned about a physical injury as a consequence of that device, then seek advice from your GP or surgeon in the first instance.

The failure of an implant, which replaces a body part, could be covered by ACC as a treatment injury if that failure has caused a physical injury. ACC will accept these claims if they meet our criteria for cover.

If ACC accepts the treatment injury claim, then your surgical specialist could submit a request for ACC funding of surgery, if necessary, to get the implant taken out and replaced.

If the manufacturer decides to recall the implants, it doesn't mean every implant needs to be removed. As ACC understands the situation, most of these implants should not fail and patients will be better off if they don't have to undergo further surgery.

Any ACC claim would be handled on your behalf by your GP or surgeon.

What doesn’t ACC cover?

ACC does not cover:

  • illness
  • stress, hurt feelings, loss of enjoyment or other emotional issues (these may be covered if these are the direct result of a physical injury or sexual abuse)
  • injuries related mainly to ageing. That means we don’t cover injuries to teeth from normal use, or heart (cardio-vascular) disease or brain (cerebro-vascular) disease, unless it stems from medical treatment or a work injury involving abnormal or excessively intense effort
  • non-traumatic hernias, eg from coughing or sneezing, or not directly as a result of trauma
  • injuries that come on gradually and are not due to a work task (non-occupational gradual process injuries)
  • damage to items that do not replace body parts such as hearing aids, glasses, pacemakers and gastric bands.

To claim for injuries covered by ACC, see How do I make a claim?

What about injuries that cause death?

ACC provides financial assistance when someone dies as a result of an accident, a work-related disease or infection, or medical treatment. We may also be able to help following a self-inflicted injury, however this will depend on the circumstances of the injury or death.

If a member of your family is fatally injured, and ACC receives confirmation that the cause of death is a physical injury, we will work with you and/or your advisors and friends to work out what assistance is available.

Various payments are available, depending on your circumstances, to contribute to such things as funeral costs and survivors’ grants. Dependent partners and children may be eligible for some weekly compensation or childcare costs. ACC support applies regardless of life, funeral or other insurance policies that may also provide protection in the event of the death of a family member. For more information about accidental death claims, see Injury causing death.

What if I am a visitor to New Zealand?

If you need information about ACC in your own language we have interpreters for over 30 different languages, and Pacific and Asian advisors who can provide cultural support and help. See In your language for more information, or contact ACC Claims.

If you’re injured during your visit to New Zealand, ACC may be able to help with the cost of treatment and support you need while you’re here. However, it is important to be aware that you cannot sue for damages arising from your personal injury – ACC cover removes that right.

ACC only covers treatment and rehabilitation costs while you are in New Zealand; it is not a replacement for travel insurance and does not cover illness, disrupted travel plans or emergency travel to get you back home. We strongly recommend you arrange travel insurance before visiting New Zealand.

Do I qualify?

ACC support may be available to you as a visitor if you are:

  • injured in an accident within New Zealand
  • in certain circumstances suffering from a health problem related to working in New Zealand
  • injured as a result of medical treatment while you are in New Zealand
  • dealing with the mental effects of a sexual assault or abuse suffered in New Zealand.

The injury must have happened in New Zealand. You are considered outside New Zealand, and so not covered:

  • if you are injured while aboard the boat or plane on which you travelled to New Zealand, or in getting on or off that boat or plane
  • if you are injured while travelling around the country in the craft you arrived in, such as a yacht or cruise ship. You are not covered whenever you are on board or on the gangway
  • if you take an excursion during your visit that takes you 300 nautical miles or more from New Zealand.

To claim for injuries covered by ACC, see How do I make a claim?

What if I am a New Zealander travelling overseas?

ACC may be able to help you if you return home with an injury that happened while you were overseas. Our cover applies whether you have been travelling on business, on holiday or your OE, or if you’re visiting friends or family.

To qualify, you must be an ordinarily resident in New Zealand at the date of the injury.

Cover normally applies to injuries incurred on trips of up to six months, but if you are travelling on business and still paying income tax in New Zealand, ACC cover can be available even if you are away for more than six months.

If you decide to extend your business trip for personal reasons once your overseas work is finished, cover will be available for up to six months longer, provided you intend to come back to New Zealand permanently.

Note:
You will still need travel insurance because ACC doesn’t cover you for illness or things such as overseas treatment costs, disrupted travel plans and lost deposits, assisted travel or emergency travel for a relative.

To claim for injuries covered by ACC, see How do I make a claim?

Last updated: 27 March 2014

Last reviewed: 17 February 2014