What if I have problems with a claim?

Unhappy with a decision ACC has made?

You can apply for a review if you disagree or are unhappy with a decision ACC has made about your claim.

On this page

  1. What help can I get?
  2. Who can apply for a review?
  3. What do I need to do to get a review?
  4. How long might Dispute Resolution Services take to review my claim?
  5. What support is available?
  6. How does the review happen?
  7. What happens next?
  8. Do I have to pay anything towards the cost of the review hearing?
  9. Related legislation

What help can I get?

You have the option of going to mediation with ACC, facilitated by an experienced mediator. If you choose mediation, but your concerns cannot be resolved, then your claim will be looked at by an independent reviewer from Disputes Resolution Services Ltd (DRSL). DRSL’s role is to take a fresh look at all the information. They will do this at a review hearing, which must be set within three months from the date that ACC receives your application.

The reviewer will make their decision based on information from your case file and evidence that is presented to them at a hearing by you, ACC and other people directly involved in the hearing.

For detailed information about the review process and DRSL, see the Dispute Resolution Services Limited website www.drsl.co.nz (external link).

Important:
You can still make a complaint at any stage about anything to do with the management of your claim or any decision ACC has made, even if you apply for a review. If all parties agree, you can put the review on hold while a complaint is sorted out.

What is mediation?

Mediation is where a professionally qualified independent person – a mediator – brings you and ACC together to look at an issue or relationship problem and work out a solution that meets everyone’s needs. The mediator isn’t there to make your decisions for you – he or she is simply there to help both you and ACC reach agreement. Mediation doesn’t affect any other rights or entitlements you have.

Either you or ACC can suggest mediation, so if you think it would be a good idea, talk it over with us. If both you and ACC agree to mediation, we will contact the mediator to make arrangements that suit everyone.

Who can apply for a review?

You can apply for a review if you are:

  • a client, or their representative, in relation to any of ACC’s decisions on a claim
  • an employer challenging a work injury decision
  • any levy payer disagreeing with the levy paid or payable
  • a registered health professional, or organisation, disputing their involvement in an injury caused by medical error (for decisions relating to claims lodged with ACC prior to 1 July 2005).

What do I need to do to get a review?

  1. Complete form ACC33 Application for review, (also available from your local ACC branch, or ACC Inquiry Service Centre (0800 101 996), or write a letter to ACC stating:
  • you are applying for a review
  • the date of decision on your claim.
  • your reason(s) for wanting a review
  • the result you want from the review.
  1. Send the completed form to the:
  • ACC Review Unit, PO Box 242, Wellington, for reviews relating to claims and entitlement.
  • ACC Business Service Centre, PO Box 795, Wellington, for reviews relating to levies.

Important:
You must apply for a review within three months of the decision date on your claim. Late applications for a review may be accepted where extenuating circumstances exist. For example, if your injury prevented you from being able to meet the timeframe.

If you require assistance in completing this form please contact ACC, see Contact ACC Claims.

How long might Dispute Resolution Services take to review my claim?

The reviewer must contact you to set a date for the review within three months from the date ACC received your application, unless the case is resolved prior.

Note:
Please contact ACC if you have not heard from us within a month of lodging the review application. See Contact ACC Claims.

What support is available?

You can bring someone to the hearing to speak on your behalf, eg a lawyer, union representative, family member or friend. You can also bring a support person, eg someone from your family/whanau.

Note:
If you wish to have a lawyer speak on your behalf you are responsible for instructing this person and meeting their costs.

Special needs

If you have special needs (such as language, religion, lack of mobility, and vision or hearing problems) please let us know when you apply for a review.

Cultural Support

Special arrangements for Maori people may include:

  • holding the hearing on a marae
  • conducting the hearing in te reo Maori
  • conducting the hearing with some degree of Maori protocol
  • providing access to assistance from local pae arahi.

Special arrangements for Pacific people may include:

  • allowing family or elder support
  • conducting the hearing in the relevant Pacific language
  • holding the hearing at an appropriate community venue
  • arranging to have the hearing conducted by a specially appointed Pacific people’s reviewer.

Requests for special arrangements must be indicated on the review application. Granting of special arrangements is at the discretion of the reviewer.

Who can attend the hearing?

Anyone who is directly involved can attend the hearing, including:

  • your reviewer
  • you and/or your representative
  • a support person if you wish
  • a designated representative from ACC
  • your employer and/or their representative (for work injuries)
  • witnesses or experts (if applicable).

Note:
Review hearings are not open to the public.

How does the review happen?

Request for review hearing

  1. The ACC Review Unit receives your application and will write to you to let you know they have received it. Your case will then be sent to the relevant part of ACC to review the claim decision.
  2. During the review a panel of staff at the local branch will reconsider your case. If your case cannot be resolved (ie if they reach the same decision), then you can either go to mediation or ACC can request the Dispute Resolution Services Ltd to formally appoint a reviewer. All information about your claim is gathered by ACC and made available to the reviewer.
  3. The Disputes Resolution Services Ltd will contact you within 3 months of the date ACC received your application to set a time for review.

Prepare for review hearing

  1. You prepare for the review.
  • If you intend to have a representative (e.g. lawyer) at the hearing, let them know as soon as you can, so that they have time to prepare your case
  • If you would like to have a witness give evidence, you must let the reviewer and other parties know before the hearing date, and you must provide details about what the witness’s evidence will be
  • Present any new evidence to the reviewer and other parties at least 3 working days before the hearing
  • Write down the main reasons why you disagree with ACC’s decision, to refer to during the review.
  1. Attend the review with your representative and/or support.
    Note:
    You don’t have to attend the hearing, but it is a good idea. You can give evidence in writing instead, or have someone else present it for you.

    Withdrawing from a review

    You can withdraw from a review at any time prior to the hearing without giving a reason why. You must notify ACC and/or your reviewer in writing that you are withdrawing and it is also a good idea to follow-up with a phone call.

    At the review hearing

    1. The reviewer manages the hearing, which is generally informal. All the information that was used by ACC to make the original decision is made available usually before the hearing. This information is confidential and can only be used for the review hearing. Each party has the chance to have a say and ask questions.
    2. The review hearing will be tape-recorded, to provide a record in case there are any later hearings.
    3. Anyone giving evidence may be asked to take an oath or affirmation (promise to tell the truth). Reviewers can look at a range of material relevant to your case that at a more formal hearing (for example at the District Court) may not be able to be considered. The reviewer will sometimes allow cross-examination of a witness.

    What if I can’t attend the review hearing?

    If you planned to attend the hearing, but are prevented from doing so (eg because of an emergency), then:

    • contact the review support officer before the hearing to let them know that you can’t attend, or
    • get someone to go to the hearing for you and ask the reviewer to reschedule.

    Note:
    If the reviewer decides the hearing date can’t be rescheduled, then it will continue in your absence.

    What happens next?

    After the hearing, the reviewer decides whether costs can be awarded. If you want to know more about this, contact the review support officer or ask the reviewer at the hearing.

    The reviewer will write to you with their decision, within 28 days of the hearing. The decision is binding on all parties involved.

    Note:
    If you are unhappy with the decision, you can request an appeal. See Want to appeal a review decision?

    Do I have to pay anything towards the cost of the review hearing?

    No, ACC is legally required to pay the reviewer’s costs.

    Once the reviewer has made a decision, they may award costs for expenses you have incurred for representation, medical reports, transport costs and other reasonable expenses associated with a hearing.

    Note:
    The maximum amount that a reviewer can award in relation to a review hearing is governed by the Review Costs and Appeals Regulations 2002 (external link).

    Related legislation

    Accident Compensation (AC) Act 2001

    Last updated: 20 June 2008