Unfortunately, people are sometimes injured as a result of seeking or receiving medical treatment. A treatment injury could result from a diagnosis, the actual treatment itself or a lack of treatment that should have been provided.
Do I qualify for cover?
You may qualify for cover for a treatment injury if:
- you are injured as a result of treatment by a registered health professional, and
- the treatment, not your health condition or some other factor, has caused your injury.
If you believe your injury was caused by treatment by a non-registered health professional, we may still be able to consider your claim.
What do I need to do?
- If you or someone you care for suffers a treatment injury, see a health professional as soon as possible after the event. Don’t wait until you feel better, as this can often make the injury worse and your recovery longer. We may not be able to get all the information we need to accept a claim more than 12 months after an injury.
The Accident Compensation Act 2001 lists the health professionals whose treatment ACC can contribute towards. See the list of approved treatment providers.
- Your health professional (doctor, physiotherapist, dentist, nurse etc) will help you fill out an ACC claim form and send it to us. They will also fill out an ACC2152 Treatment Injury Claim form, attaching any clinical notes that support your claim.
- Usually you will need to pay at least part of the cost of this first visit to a health professional; they can claim the rest back if your clam is accepted. If you are asked to pay the full amount, keep the receipt, because you may be able to claim some of the money back if ACC accepts your claim.
- It is important to remember that ACC is not able to pay for any assistance you seek while your claim is being investigated.
- If you need to take time off work because of your injury, discuss this with your doctor or nurse practitioner. They will complete a medical certificate for you if they confirm that you do need time off work.
Important:
It is important to realise that medical treatment can be complex, and sometimes the desired outcome is not always achieved. Not all outcomes or treatment are covered by ACC.
Your actual entitlement depends on your individual circumstances. While we are assessing your claim, please contact us to confirm if you are eligible, or to identify other ways in which we can help. See Contact ACC Claims for the Treatment Injury Centre’s contact information.
What information does ACC need from me?
ACC needs the same information for all claims in the first instance. See Injury in New Zealand.
In addition, your health professional will ask you for information to help complete the Treatment Injury Claim form on your first visit.
When ACC receives your claim forms, they will be forwarded to the Treatment Injury Centre, who will send you a consent form for completion and return. Your consent is required to obtain relevant medical information and advice from health professionals.
Note:
Your claim may be declined if ACC does not receive your consent to access your medical records.
How does ACC decide if I am covered?
See Injury in New Zealand for some of the standard questions ACC considers when assessing cover.
We may not be able to accept cover for your claim for a treatment injury if your injury is:
- wholly or substantially caused by a health condition you had before you received treatment
- a necessary part, or an ordinary consequence, of your particular treatment
- caused solely by a decision an organisation made about allocating health resources
- caused because you unreasonably delayed or refused to give consent for your treatment
- a result of treatment that was not as good as you hoped it would be.
For claims for treatment injury, here are some examples of what ACC does and doesn’t cover:
- You react to an anaesthetic due to an unknown allergy. The reaction results in you suffering a stroke.
ACC can cover the injury because the stroke was not a necessary part or ordinary consequence of receiving treatment. - You suffer hair loss due to chemotherapy treatment.
ACC cannot cover this injury because hair loss is an ordinary consequence of receiving chemotherapy treatment.
How long might ACC take to decide?
Most treatment injury claims are assessed for cover within two months of being lodged, during which time the Treatment Injury Centre will investigate your claim and let you know the cover decision.
Sometimes a decision on a claim cannot be made within two months because additional information is required. If that happens in your case, ACC will extend the timeframe for making a decision by another two months and you will be told about the extension as soon as possible.
Occasionally, a decision cannot be made before the first extension expires. We will seek your written agreement for any further extensions.
A decision must be made within nine months of the date the claim is lodged.
ACC recommends you apply for other assistance while waiting to hear about your claim for treatment injury. Keep receipts of your costs and get medical certificates for any time you have off work. See What support can I get?
What happens next?
We will contact you by letter to let you know if your claim is accepted. If it is declined, we will tell you why.
If your claim is accepted, we may be able to help with the cost of treatment and other assistance, such as rehabilitation or weekly compensation. See What support can I get?
If you need ACC to assist with private surgery costs, it’s important to contact ACC before you have surgery.
Note:
If you are unhappy with the decision, you can ask for it to be reviewed. See What if I have problems with a claim?
Treatment Injury Centre
The Treatment Injury Centre assesses and makes decisions on claims that involve injuries resulting from medical treatment provided by registered health professionals. The Centre also collects data from treatment injury claims. This information is made anonymous and patterns or trends are shared with the health sector and researchers to use to enhance local quality patient safety initiatives.
Adverse Event Reporting
ACC is required to assess treatment injury claims for ‘risk of harm to the public’. If we believe, after considering the specific circumstances of a treatment injury, that a sentinel event or serious event has occurred, and this has caused a risk of public harm, we will report the event to the relevant authority responsible for patient safety. These events are most frequently reported to the Director General of Health and MedSafe.
The Office of the Health and Disability Commissioner may be able to assist you if you have concerns about the quality of care you receive during treatment. For more information about the HDC’s role in dealing with complaints about health and disability providers, as well as the independent nationwide advocacy service available to you, phone 0800 112 233.
Related legislation
Accident Compensation Act 2001
- Section 32: Treatment injury (external website)
- Section 33: Treatment (external website)