Lodging a claim for a patient

As a registered provider, you can lodge claims on behalf of your patient if you think they have an injury we cover. You'll need to check you're lodging the right type of claim, and following the right process.

It’s best to complete the forms with your patient during their first visit.

On this page

    Check you can lodge a claim

    Most treatment providers, registered health professionals, and locums at a practice registered with us can lodge a claim.

    We base this on:

    • what kind of provider you are, eg physio, general practitioner (GP)
    • the type of injury you're treating
    • your scope of practice.

    You’ll also need to check if your patient’s injury is one that we cover.

    Injuries we cover

    Understanding claims and cover

    Who can lodge claims for different injuries

    Depending on the type of health provider you are, you can only lodge claims for specific types of injuries on behalf of your patient.

    Find which provider type can lodge claims for which injuries, and the relevant read code:

    Using the right read code to lodge and update claims

    Information you'll need

    Information about your patient

    You'll need to know their full name, date of birth, and postal address. Where possible it’s helpful to include the patient's National Health Index number (NHI number) and mobile phone contact.

    It's also helpful to verify the information with the patient, such as the spelling of their names. Supplying accurate information means we can quickly let the patient know we've accepted their claim, potentially within hours of the claim being made.

    For work injuries, it's useful to ensure employer details are current so the employer notification letter goes to the correct place.

    Information about the injury

    For us to cover a claim there must be both an injury and an accident, and the two must have a link. We also need to know when and where the accident took place.

    When lodging a claim for a physical injury, you must identify:

    • the specific injury, for example, 'open wound’, 'contusion', 'sprain', – not just the symptoms
    • the body site, for example, 'blister of toe' – not just 'blister'
    • the body side, for example, 'left leg'.

    The accident that caused the injury

    When lodging a claim, you must be able to identify the cause of the injury. This includes:

    • the mechanism of the injury, for example, 'fell off a bike', 'cut from a knife', or the series of events that caused the injury, for example, 'digging in the garden'
    • the patient's employment history if it's a gradual process injury or disease.

    Where the accident took place

    If the accident occurred outside of New Zealand to a citizen or resident, we may still be able to provide support. In these instances, we'll follow up with the patient directly to understand the circumstances.

    It's important that the location and country of the accident are consistent. We'll verify the information with the client if there are any inconsistencies before we can accept their claim.

    When the accident happened

    When lodging a claim, you must identify the time and date of the accident.

    We'll consider claims lodged 12 months after the accident, but we'll need more information. This excludes sensitive claims.

    Delayed lodgment

    How to lodge a claim

    The best and most efficient way to lodge a patient's claim is to use a practice management system (PMS) or our online system.

    Getting set up online

    If you're unable to work electronically, you can order paper forms through the online resource ordering system.

    Order online resources

    Paper forms should be scanned and sent individually to:

    Email hamilton.registration@acc.co.nz

    If you're in Northland, Auckland, Waikato or Bay of Plenty:

    ACC, Claims Assessment and Client Support
    PO Box 952
    Waikato Mail Centre
    Hamilton 3240

    If you're in Taranaki, Manawatu-Whanganui, Hawke's Bay, Wellington or the South Island:

    ACC, Claims Assessment and Client Support
    PO Box 408
    Dunedin 9054

    Completing an ACC45 form

    All providers, other than dentists, must use an ACC45 to lodge a claim. Electronic and manual forms cover the same information.

    Completing an ACC42 for dentists

    1. Use the correct read code

      Choose the read code that best applies to your patient’s injury.

      Using the right injury read code
    2. Find out if your patient works for an Accredited Employer

      Accredited Employers (AE) 'stand in the shoes of ACC' and manage their own employee's workplace claims. In these instances, complete the ACC45 as usual and send all forms and invoices to the AE contact or their third-party administrator (TPA).

      If you lodge the claim with us instead of the AE or TPA, there may be a delay in accepting your patient's cover. There may also be a delay in payment of your invoices.

      If you have an issue with a claim already submitted, call the AE or TPA.

      If your patient is unsure if they work for an AE, check our list of Accredited Employers or call our provider contact centre.

      Find an Accredited Employer

      Phone 0800 222 070

    3. Find out if the patient's condition has come on gradually because of work

      A gradual process injury is when your patient's work has caused their illness or injury over time. Only medical practitioners can lodge these claims.

      In these instances, tick the 'gradual process' box on the ACC45. We'll need time to investigate the claim. Let your patient know we'll be in touch to find out more about their employment and work history.

      Acute injuries can't be considered as gradual process as the condition must have been present for a longer period.

      Learn about work related gradual process injuries
    4. Find out if the patient has an injury caused by treatment

      A treatment injury claim is when your patient has an injury caused by treatment from a registered health professional.

      In these instances, tick the 'is this claim for treatment injury' box on the ACC45. There are a few additional steps you'll need to take if your patient has a treatment injury claim.

      Treatment injuries

    Get patient declaration and consent

    Your patient or authorised representative must confirm their consent for you to lodge the clam, and it must be recorded. This lets us collect information about their injury from you and any other health providers.

    You can do this electronically by reading the following statements to the patient and recording the response in their clinical record:

    ACC may collect, use and disclose personal and health information for its lawful functions in connection with the Accident Compensation Act 2001. This includes obtaining relevant medical or other records about you and sharing relevant information with third parties to manage claims and entitlements; and / or where permitted or required by law. Providing information to ACC is voluntary. However, if relevant information is not provided, ACC may not be able to determine whether you are eligible for cover or for particular entitlements. You have the right to access and request correction of your personal and health information.

    Further details of how and why ACC collect, use, store and disclose information can be found on ACC’s website under ‘Privacy’: acc.co.nz/privacy

    • Do you authorise your records to be collected by ACC and used and disclosed for the purposes I have read out to you?
    • Do you declare that you have provided true and correct information and you’ll tell ACC If your situation changes?
    • Do you authorise me as your (name of health profession: GP, physiotherapist, etc) to lodge your claim with ACC?
    1. Request support for your patient

      If your patient needs other supports, such as equipment or help around the home, you can indicate this when you fill in the ACC45 by ticking the 'Rehabilitation assistance required' box.

      You can also ask the patient to complete the ACC1 form. You can lodge this at the same time as the ACC45, or later as needed.

      ACC1 Request for assistance form
    2. Medical certificate and return to work

      A medical practitioner or nurse practitioner can issue a medical certificate as part of the initial ACC45 injury claim, which covers your patient for up to the first 14 days.

      The ACC18 can be used to certify beyond the first 14 days. An ACC45 and an ACC18 medical certificate both be submitted at the initial consultation.

      Issuing medical certificates
    3. Use the right ACC provider number

      When you have multiple numbers, use the number associated with the practice where you're submitting the request. This information helps to ensure privacy.

    Information for specific injury types

    For more complex claims, we need additional information with the ACC45.

    Delayed lodgement

    If you're lodging a claim for a patient 12 months or more after the date of the accident, excluding sensitive claims, you need to include:

    • any supporting clinical records
    • details of other healthcare services who have provided treatment.

    Lodging a sensitive claim

    Sensitive claims are for mental or physical injuries caused by some criminal acts, for example, injuries caused by sexual violence. Lodgement of these claims may be many years after the event and the event doesn't need to be reported to the police or other authority.

    Types of crimes that are covered as a sensitive claim

    Sensitive claims can be lodged by:

    • medical practitioners, nurse practitioners and nurses, using the ACC45
    • registered or contracted counsellors, which include psychologists, psychotherapists, psychiatrists and social workers, under the Integrated Services for Sensitive Claims (ISSC) contract, using the client engagement form.

    ISSC providers can access the client engagement form through MyACC:

    Log in to MyACC for ISSC providers

    Find Support has more information for people who have experience sexual abuse or assault.

    Find Support

    There are three main ways a person might be eligible for ACC-funded support for mental injury. Read our quick guide to learn more.

    Complex cover mental injury quick guide

    What information to include on the ACC45

    To lodge a sensitive claim:

    • use the Read code SN571 (Sexual Abuse), or use 'Z' and add any other relevant injury codes as needed
    • write 'sensitive claim' in the accident description field. There's no need to describe what happened.

    Our integrated service for sensitive claims (ISSC) providers will work with your patient through the supported assessment process if they want to progress with a formal mental injury claim.

    Lodging a treatment injury claim

    Treatment injuries are caused by treatment from a registered health professional. This includes treatment for injuries we're already covering that cause further injury.

    Treatment injury claim lodgement guide

    Treatment injury claims can be lodged by completing an ACC2152 form in addition to an ACC claim lodgement form, eg ACC45, ACC46, or ACC42.

    ACC2152 Treatment injury claim form

    In these instances, provide relevant patient notes and records. This will help us get all the information we need and make a decision faster.

    We can contribute to the administrative costs of lodging a treatment injury claim, eg recovering medical records. We'll pay you if all the claim forms are filled out, even if we deny the claim.

    Paying you for your services

    Lodging a maternal birth injury claim

    ACC now accepts claims for specific maternal birth injuries which happened on or after 12.00am on 1 October 2022.

    These claims are made using the ACC45 form, but should include the following details to ensure faster processing:

    • the date of injury as the date the birth occured
    • the correct read, SNOMED or ICD10 code
    • 'MBI' or 'maternal birth injury' in the Additional Injury Comments field in Part D
    • midwives can leave Part E blank. This section can only be completed by doctors and nurse practitioners. The form can be processed without this information.

    Sample ACC45 form for a maternal birth injury

    Accidental death

    Accidental death claims are commonly lodged by District Health Boards (DHBs), the funeral director, Victim Support, or lawyers. In some instances, medical practitioners attending the event may use the ACC45.

    If you're involved in an accidental death claim, please note the physical injury and state specifically the person is deceased because of the injury or injuries. This information allows us to accept the claim and ensures that we don't send any correspondence addressed to the deceased person.

    Completing an ACC42 form – dentists

    The ACC42 is a paper form and can be ordered through the online resource ordering system or via phone:

    Ecos website

    Phone 0800 802 444

    If you're submitting an ACC42, make sure you fully complete the injury diagnosis and pre-accident condition section. This includes information about:

    • the teeth number involved and the teeth injury classification
    • soft tissue
    • prothesis
    • jaw/alveolus/temporomandibular joint (TMJ).

    It's also useful if you supply any other relevant clinical information. This information helps us make timely cover decisions.

    The ACC42 form must include your unique ACC provider or locum number. Where you have multiple numbers, use the number associated with the practice where you are submitting the request. This information helps to ensure privacy.

    After you've lodged the claim

    Once we receive a claim, we'll check that it meets cover criteria. Straightforward online claims are automated, and a decision can often be made on the same day as receiving a claim. In these instances, your patient may receive a text message on the cover decision.

    The easiest way for providers to check the status of the claim is to use your PMS or our online system. Cover decisions for complex, manual, and non-acute dental claims are likely to take longer.

    We'll contact you if we need more information about the claim.

    Contact us

    If you need help, contact our eBusiness team:

    Phone 0800 222 994
    Email ebusinessinfo@acc.co.nz

    Last published: 15 December 2023