ACC may be able to help you if you have an injury claim covered by us and need surgical treatment to recover from the injury.
Your doctor decides whether your need for surgery is:
- urgent, and you require immediate surgical treatment that a public hospital can provide
- non-urgent (elective), and refers you to a specialist who’ll advise if you need surgical treatment, including what type of surgery and how you can access it.
ACC covers costs for related urgent surgery in a public hospital in bulk payments made to the Ministry of Health under an annual agreement for public health acute services.
The rest of this section deals with elective (non-urgent) surgical treatment for an injury.
If your specialist identifies that you need elective surgery, you can choose from:
You’ll not pay for your surgery. You may be able to use the specialist of your choice and be admitted to a hospital of your choice.
ACC’s written approval is required before we’ll fund any elective surgery. Your specialist will submit a surgery request to us, and we’ll inform you of the decision.
If we approve your surgery, we pay for your treatment costs and will try to arrange your surgery, with a contacted provider, within six months of your assessment. However, we’ll not pay for any special requests, such as a single hospital room or television. You may also need to pay a refundable deposit for equipment, such as crutches.
2. Regulations option
You may choose a surgeon and hospital, including a private hospital, when you have your treatment. You can also choose other services, such as a single room.
ACC’s written approval is required before we’ll fund any elective surgery. Your specialist will submit a surgery request to us, and we will inform you of the decision.
If we approve your surgery, we pay a percentage of the cost of the surgical procedure and you pay the balance. Your specialist will tell you how much your contribution is likely to be. If you have private health insurance, it is important to check with your insurer and establish how much they’ll contribute towards your share of treatment costs.
- Talk to us about what kind of help we may be able to provide
- Discuss the above options for surgical treatment with your specialist before they apply to ACC for funding approval. ACC’s written approval is required before we’ll fund any elective surgery.
The request for funding for your elective surgery must meet certain criteria:
- your claim for personal injury has been accepted for cover by ACC
- we have received a full and complete assessment report and treatment plan from your specialist
- you need the surgery as a result of the personal injury for which we have accepted cover
- the specialist surgery will help you return to work or regain your independence.
We’ll also consider any general risks associated with the surgery when considering your application.
Contact us to confirm if you are eligible, or to identify other ways in which we can help.
ACC regards 21 days as a reasonable timeframe for the majority of decisions regarding surgery, but if the surgery is complex and/or we need other information or additional medical information, it may take slightly longer.
Contact us if you have not heard from us within a reasonable period of time.
After we’ve considered your specialist’s report and any other relevant medical information, we’ll make a decision about what help we can give you for elective surgery. We’ll contact you to let you know the decision.
If we decline your claim, we’ll tell you why.
The waiting time for option one, Elective Surgery Contracts, depends on your specialist’s report. You can expect your surgery to be within six months.
If you chose option two, Regulations, your specialist will advise when you will receive surgery.
You may also be eligible for other types of assistance. See What support can I get? for more information.
If you are unhappy with the decision, you can ask for it to be reviewed. See What if I have problems with a claim?
Accident Compensation Act 2001:
- Schedule 1, Clauses 1 to 6 (external website)
Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Regulations 2003
- Regulation 18: Elective surgery costs (external website)
Updated: 14 April 2015
Reviewed: 31 March 2015