Getting a decision on your patient's claim

In most cases, we approve claims without further information. Sometimes we’ll ask for more information or look at evidence before we make our decision. 

On this page

    What we look at when making a decision

    Using evidence to help with a decision

    We've consulted and worked with health professionals to create cover and funding guides. We back up all our decisions and guidelines with the latest evidence-based healthcare (EBH) research. You can find these in our resource hub.

    View our criteria for cover in the resource hub

    View our research in the resource hub

    If we need more advice

    In some cases, we may need medical, legal or technical advice within ACC to help us make our decision. We may also ask for independent medical advice.

    How long it takes to make a decision

    The time it takes to make a decision on your patient's claim depends on their type of injury. If we need more information or independent medical advice, it could affect how long it takes us to make a decision.

    If we approve your patient's claim

    Once we approve your patient's claim, we'll send them a letter confirming our decision and the ways we can help.

    If we decline your patient's claim

    If we don’t cover your patient's claim, we'll send you a copy of their decision letter explaining why. We'll also call your patient to tell them our decision and what they should do next.

    If you have new information about your patient's injury

    If you have new information that supports your patient's claim, we can reconsider our decision. We'll review the information and send a new decision letter to your patient.

    If your patient doesn't agree with our decision

    If your patient doesn’t agree with our decision, they can lodge an independent review. They'll have received some information with their decline letter to explain how to do this.

    Find out more about the review process

    Contact us

    If you have any questions, contact us:

    Phone 0800 222 070 (Monday to Friday, 8am to 6pm)

    Last published: 14 March 2024