What if I have problems with a claim?

Have a complaint?

You can make a complaint at any stage if you are unhappy about anything to do with ACC’s management of your claim.

What can I make a complaint about?

ACC is bound by the Code of ACC Claimants’ Rights. The purpose of this Code is to protect your rights as a client, to make sure that ACC offers the highest possible level of customer service and resolves your issues fairly and quickly.

Accredited employers and people acting as agents of ACC, or on behalf of ACC, must also comply with this Code.

Note:

  • This Code does not apply to complaints relating to ACC dealings with a client prior to 1February2003.
  • Treatment services are not covered by this Code. These are covered by the Code of Health and Disability Services Consumers’ Rights.

Where can I get a copy of the ACC Code?

For a copy of the Code of ACC Claimants’ Rights, either:

We can also provide interpreters for over 30 different languages.

Who can make a complaint?

Anybody who is unhappy with the management of their claim or feels their rights under the ACC Code of Claimants’ Rights (PDF17K) have been breached can make a complaint.

What do I need to do to make a complaint?

You have a number of options available to resolve an issue.

First and foremost, we recommend that you talk directly to the person involved about the issue. This is often the simplest way to sort out a problem. You are welcome to involve a support person (eg friend or family member) if you think that would help.

If you are unable to resolve the issue this way, or do not feel comfortable approaching them, you can:

  1. Talk to the person’s team leader or branch manager. If you are unable to resolve the issue you or ACC can request mediation. If you think mediation would be a good idea, talk it over with the ACC person involved or their manager. If both you and ACC agree to mediation, then ACC will contact the mediator to make arrangements to suit everyone.
  2. Make a formal complaint:

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.

As mentioned above, either party can suggest mediation. If it is agreed, we will contact the mediator to make arrangements.

Next steps

If the Customer Support Service is unable to resolve your issue within the agreed timeframe or you want to make a formal complaint about ACC, then you can contact the Office of the Complaints Investigator.

Note:
You have the right to request that your complaint be forwarded to the Office of Complaints Investigator at any time, without trying to resolve it with those concerned.

Other options

You can also raise your concerns with other organisations outside of ACC. These organisations are all independent of ACC.

For concerns regarding your privacy, contact:
    Office of the Privacy Commissioner
    Call: 0800803909
    Website: www.privacy.org.nz (external link)
If you feel you have been treated unfairly by a government agency, contact:
If you are unhappy about a health or disability service you have received, or the conduct of a treatment provider, contact:
    The Health and Disability Commissioner
    Call: 0800112233
    Website: www.hdc.org.nz (external link)

What happens next?

If …

then…

you have resolved the issue by talking to the staff member or manager involved

no further action is taken.

ACC may send you a letter stating the agreed resolution.

you requested mediation

ACC will contact a mediator who will make arrangements for a meeting to suit everyone.
The mediator is a professionally qualified independent person whose role is to help both you and ACC reach an agreement on the issue that meet’s everyone’s needs.
Note:
Mediation doesn’t affect any other rights or entitlements you may have, for example the right to lodge a formal complaint or review.

you made a complaint with Customer Support Service by telephone or in writing

the Customer Support Service will:
  • contact you within two working days of receiving your complaint, and
  • try to resolve your issue with the people concerned within four working days of receipt of the complaint.

the Customer Support Service cannot resolve your complaint within four working days

your complaint will be forwarded to the Office of Complaints Investigator.
The Office of Complaints Investigator may:
  • contact you to try and resolve your concerns
  • arrange a facilitated meeting between you and branch staff and
  • Send you a letter if they have been involved in facilitating a resolution, or
  • conduct an investigation and provide a written decision.

you made a formal complaint directly to the Office of Complaints Investigator

the Office of Complaints Investigator will either:
  • contact you to try and resolve your concerns
  • arrange a facilitated meeting between you and branch staff and
  • Send you a letter if they have been involved in facilitating a resolution, or
  • conduct an investigation and provide a written decision.

your complaint is lodged with:

  • Office of the Ombudsmen
  • Office of the Privacy Commissioner
  • Health and Disability Commissioner
contact the appropriate office about the next steps in dealing with your complaint.

Important:
You have the right to ask for a review of any claim decision made by ACC. You can also appeal a decision made by the reviewer, unless the decision was made under the Code of ACC Claimants’ Rights (PDF17K).

See:

Related legislation

Accident Compensation (AC) Act 2001

Injury Prevention, Rehabilitation, and Compensation (Code of ACC Claimants’ Rights) Notice 2002 (PDF17K).

Last updated: 25March2010