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.
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:
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.
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, eg 'open wound’, 'contusion', 'sprain', – not just the symptoms
- the body site, eg 'blister of toe' – not just 'blister'
- the body side, eg '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, eg 'fell off a bike', 'cut from a knife', or the series of events that caused the injury, eg '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.
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.
If you're unable to work electronically, you can order paper forms through the online resource ordering system.
Paper forms should be scanned and sent individually to:
If you're in Northland, Auckland, Waikato or Bay of Plenty:
ACC, Claims Assessment and Client Support
PO Box 952
Waikato Mail Centre
If you're in Taranaki, Manawatu-Whanganui, Hawke's Bay, Wellington or the South Island:
ACC, Claims Assessment and Client Support
PO Box 408
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.
Use the correct read codeChoose the read code that best applies to your patient’s injury.
Using the right injury read code
Find out if your patient works for an Accredited EmployerAccredited 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 AC 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, call our provider contact centre.
Phone 0800 222 070
Find out if the patient's condition has come on gradually because of workA 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 be considered as gradual process as the condition must have been present for a longer period.
Find out if the patient has an injury caused by treatmentA 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.
Get patient declaration and consentYour patient or an authorised representative must sign the patient declaration or you must specifically document their declaration in your records. This gives consent for you to lodge the claim and lets us collect information about their injury from you and any other health providers.
If you're lodging the claim:
- manually, both you and the patient must sign every form you're submitting
- online or via a PMS, print the completed forms for them to sign. Keep these hard copies at your practice as a record
- via telehealth, record patient consent in their clinical record. There's more guidance on our COVID-19 webpage.
Telehealth criteria during the COVID-19 response
- 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
Medical certificate and return to workA 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 and return to work
If your patient is fully unfit for work
There are only a few instances when your patient will be fully unfit for work. These include:
- when the risks of returning to work are excessive and the work environment poses a risk of serious harm to your patient or someone else
- when the patient can't travel to and from work - even with assistance
- when the patient has total inability to work, eg they're admitted to hospital.
If they're fit for some work
If your patient can do some tasks or parts of their job, state on the ACC18 that they're fit for selected duties and outline the activities and type of work they can do with their injury.
This also applies to patients who are fully unfit for a few days and then fit for selected work.
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.
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, eg 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.
Sensitive claims can be lodged by:
- medical practitioners, using the ACC45
- registered or contracted counsellors under the Integrated Services for Sensitive Claims (ISSC) contract, using the client engagement form.
ISSC providers can access the client engagement form through MyACC:
Find Support has more information for people who have experience sexual abuse or assault.
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.
Treatment injury claims can be lodged by completing an ACC2152 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.
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.
The ACC42 is a paper form and can be ordered through the online resource ordering system or via phone:
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
- 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.
If you need help, contact our eBusiness team: