ACC can fund counselling services if you have suffered a mental injury as the direct result of a personal injury.
What help can I get?
The mental injury, as the direct result of a personal injury, may relate to either a physical injury (see definition in Am I covered?) or sexual abuse or assault that is covered by ACC.
Mental injury means a mental health condition that results in your having significant difficulty functioning as you normally would, including the way you behave, think and act.
Example:
You become a paraplegic (both your legs are paralysed) as a result of a fall from a horse. Following the accident, you develop depression because you can no longer participate in activities you enjoyed before the injury.
Your mental injury (depression) will need to be diagnosed by a psychiatrist and, if it is considered a direct result of the physical injury, you may be eligible for counselling that will be paid for by ACC.
Important:
In practice, the conclusion reached will vary from case to case, depending on the particular facts of the case and the psychiatric advice received. Each case needs to be carefully considered on its own merits.
See Injury from sexual abuse or assault for more information about counselling available for sexual abuse claims.
What do I need to do to get help?
After your mental injury is accepted for cover, ACC may decide that counselling is the most appropriate treatment option for you at this time. You are also able to request counselling in discussion with your ACC client services contact. In either case, ACC will refer you to an ACC-contracted psychiatrist first for an assessment.
See Injury from sexual abuse or assault for more information about counselling available for sexual abuse claims.
How am I eligible?
Unless your cover is for a mental injury as a result of sexual abuse or assault, you must have a physical injury that is covered by ACC to be eligible for counselling. That means you have had a claim for a physical injury accepted by ACC. See Injury from sexual abuse or assault for more information.
You must then be assessed as having a mental injury that is directly related to the physical injury. The psychiatrist will send a full assessment report to ACC.
The assessment report should:
- confirm the mental injury is directly related to the physical injury suffered
- advise the most appropriate treatment option
- address any rehabilitation issues
- advise of any pre-existing psychological issues.
Your ACC client services contact will then liaise with an ACC medical advisor, and perhaps your doctor, to establish your clinical condition before making a referral for treatment.
Important:
The help you will get depends on your individual circumstances. 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?
After cover for your claim is accepted, ACC regards 21 days as a reasonable timeframe for the majority of decisions about what assistance you may be entitled to.
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?
When ACC has approved your referral for counselling sessions, your ACC client services contact will talk to you about an appropriate counsellor for you to see. You must visit an ACC-registered counsellor and we will provide a list of counsellors in your area. Or, you can download a list of ACC-registered counsellors in your area from our website.
The number of sessions approved is included in your individual plan, which you sign with your ACC client services contact and the counsellor. ACC will arrange to pay part of the cost of your sessions direct to the counsellor. You will be required to pay something yourself, and you will need to discuss the details with the counsellor you choose to see.
Counselling must be face to face. ACC will not pay for missed sessions, other than one emergency session, if necessary, that may be done by phone.
If you need further counselling sessions after the initial sessions are complete, the counsellor will need to provide a comprehensive report to ACC:
- recommending that more sessions are required, and
- advising that the sessions continue to relate to your covered injury claim.
ACC will then refer to the recommendations in your initial psychiatric assessment report and discuss that report, and the counsellor’s report, with an ACC medical advisor. The medical advisor will recommend the most appropriate treatment or action. This could be to:
- arrange a further medical review or psychiatric assessment
- refer you to another treatment provider
- approve further counselling sessions.
You will be advised about our decision as soon as possible.
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 (AC) Act 2001
- Section 27: Mental injury (external website)
- Schedule 3: Cover for mental injury caused by certain acts dealt with in Crimes Act 1961 (external website)
Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Regulations 2003
- Regulation 9: Counsellors’ costs (external website)
Published: 20 June 2008