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
- Patient notes
- Information we have after talking to your patient
- Information from your patient's employer if it's a work-related injury
- The patient's relevant claim history
- Medical information from other health providers.
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.
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.
If you have any questions, contact us: