ACC may be able to help you if you have an injury claim covered by ACC and need surgical treatment to recover from the injury.
What help can I get?
Your doctor decides whether your need for surgery is either:
- urgent, and you require immediate surgical treatment that a public hospital can provide, or
- non-urgent (elective), and refers you to a specialist who will advise if you need surgical treatment, including what type of surgery and how you can access it.
Costs for urgent surgery in a public hospital are covered in bulk payments made by ACC to the Ministry of Health under an annual agreement for public health acute services. If your claim for injury is subsequently declined, the district health board will recover costs from its general funding.
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 two options – Elective Surgery Contracts or Regulations.
Elective Surgery Contracts option
You will not pay for your surgery. It is likely, but not guaranteed, that you can use the specialist of your choice and be admitted to a hospital of your choice.
ACC pays for your treatment costs and will try to arrange your surgery, with a contacted provider, within six months of your assessment. However, we will 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.
Regulations option
You may choose a surgeon, hospital, including a private hospital, and when you have your treatment. You can also choose other services, such as a single room.
ACC pays 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 will contribute towards your share of treatment costs.
What do I need to do to get help?
- Talk to ACC about what kind of help we may be able to provide.
- Discuss options for surgical treatment (Elective Surgery Contracts or Regulations as above) with your specialist before he or she applies to ACC for funding approval.
Note:
ACC’s written consent is required before any elective surgery can be done.
How am I eligible?
The request for funding for your elective surgery must meet criteria including:
- your claim for personal injury has been accepted for cover by ACC
- ACC has 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 ACC has accepted cover
- the specialist surgery will help you return to work or regain your independence.
ACC will also consider any general risks associated with the surgery when considering your application.
Important:
Please contact us to confirm if you are eligible, or to identify other ways in which we can help. See Contact ACC Claims for our contact information.
How long might ACC take to determine if I am eligible?
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.
Please contact us if you have not heard from us within a reasonable period of time. See Contact ACC Claims for our contact information.
What happens next?
After we have considered your specialist’s report and any other relevant medical information, we will make a decision about what help we can give you for elective surgery. We will contact you to let you know the decision.
If we decline your claim, we will 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.
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?
Related legislation
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)