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

    Any health providers registered with us can lodge a claim. But in some cases, your patient will need to be referred to another health provider before we determine cover. We base this on:

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

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

    Injuries we cover

    How to lodge a claim

    1. Choose online or manual

      The best way to lodge a patient's claim is to set up your practice management system, or use our system. You can then fill in most of the forms electronically and submit forms as often as you need. 

      Getting set up online

      You can still send claim forms manually by post. Call our provider order line to order ACC45 claim forms: 

      Phone 0800 802 444

      To lodge a claim manually, send all relevant forms to your nearest ACC branch:

      Find a branch
    2. Use the correct read code

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

      Using the right injury read code
    3. 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 injuries and claims. Ask your patient if they work for an AE, if they’re unsure, call our provider contact centre.

      Phone 0800 222 070

    4. Know the type of claim you're lodging

      Different types of claims have different processes.

      Check the type of claim you're lodging
    5. Provide patient notes

      Add all of your patient notes on the patient’s injury to the ACC45. If you have your patient notes in a separate document, you can send it to us through Healthlink.

      Sending patient notes
    6. Issuing a medical certificate

      If you’re a GP or nurse practitioner, you can issue a medical certificate when you fill in the ACC45 form. If you’ve already lodged an ACC45, fill in the ACC18 form.

      Issuing medical certificates and return to work
    7. Request support for your patient

      If your patient needs other support, such as equipment or help around the house, you can indicate this when you fill in the ACC45 or the ACC18 form. You can also ask them to complete the ACC1 form. You can lodge this at the same time as the ACC45 or at a later date.

      ACC1 Request for assistance form
    8. Make sure your patient signs the patient declaration

      Your patient or an authorised representative needs to sign the patient declaration. This gives consent for you to lodge the claim on their behalf and lets us collect information about their injury from you and any other health providers.

      If you’re lodging the claim:
      - manually, they must sign every form you're submitting.
      - online, print the completed forms for them to sign. Keep these hard copies at your practice as a record.

    Information we need to make a decision about a claim

    We need specific information to make a decision about a claim.

    Injury diagnosis

    The description should include a:

    • specific injury, eg 'open wound, contusion, sprain', etc – not just 'injury'
    • body site, eg 'blister of toe' – not just 'blister'.

    What to do:

    • In the diagnosis field, select conditions that fit these requirements as closely as possible 
    • If your choices don’t include the right injury or body site, please provide additional information in the injury description or comments field  
    • If you're lodging a claim with multiple injuries, please list the most significant injury first.

    Accident description

    The description should:

    • Include a brief summary of the accident, what happened, and the mechanism of injury, eg 'Fell off the bike onto the left arm while travelling to work' 
    • It's useful to include a specific location as well, eg 'Centennial Highway southbound, 70 meters from the Hutt Road intersection in Wellington'.

    What to do:

    You can use the cause of accident, injury description or comments fields for this information.
    Note: these fields may be called different things in different software products.

    Lodging a claim if your patient works for an Accredited Employer

    1. Fill in all the required forms for that claim like normal
    2. Send all forms and invoices to the Accredited Employer (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.

    Check the type of claim you're lodging

    Depending on the type of injury your patient has, you may need to lodge a different type of claim.

    Lodging a general injury claim

    Use the ACC45 for all injury claims except for dental injuries.

    Lodging a sensitive claim

    Sensitive claims are for mental or physical injuries caused by some criminal acts, eg injuries caused by sexual violence.

    Types of crimes that are covered as a sensitive claim

    Only medical practitioners and registered or contracted counsellors can lodge sensitive claims. If you're:

    • a medical practitioner or registered counsellor, use the ACC45 form.
    • under the Integrated Services for Sensitive Claims (ISSC) contract, use the client engagement form.

    ISSC providers can access the client engagement form through MyACC:

    Log in to MyACC for ISSC providers

    We'll often ask for more information to help us make a decision. It is important you tell your patient the next steps after lodging a sensitive claim.

    Lodging a claim for an injury caused by treatment

    If your patient has an injury caused by treatment from a registered health professional, it’s a treatment injury claimThis includes treatment for injuries we're already covering that cause further injury.
    1. Fill in the ACC45 like you would for a general claim.
    2. Tick the ‘Treatment Injury’ box on the ACC45. (If you have an older version of the ACC45 this is the ‘Medical Misadventure’ box).
    3. Complete an ACC2152 form.

      ACC2152 Treatment injury claim form
    4. Provide relevant patient notes and records. This will help us get all the information we need and make a decision quicker.

    Find information about what can be accepted as a treatment injury claim and what information we need.

    Treatment injury claim lodgement guide

    It can take from a few days to nine months to investigate a treatment injury claim and make a decision. We’ll contact the patient if we can’t make a decision within two months.

    Lodging a claim for an injury 12 months after it happened

    If you’re lodging a claim for a patient more than 12 months after their injury:

    1. Fill out the ACC45 like you would for a general claim.
    2. Provide patient notes from the time of the injury if you can.
    3. Provide information about the history of the injury.

    If we need more details about the injury we'll get in touch. We'll contact the patient to get any patient notes from other providers they may have seen.

    Lodging a claim for a condition that has come on gradually because of work

    If you think that over time your patient’s work has caused their illness or injury, it’s a gradual process injury.

    1. Fill out the ACC45 the same as for a general claim.
    2. Tick the ‘Gradual process’ box on the ACC45.
    3. We’ll need time to investigate the claim. Let your patient know we’ll be in touch to find out more.

    Lodging a claim for a dental Injury

    If you’re a dentist, use the ACC42 Dental injury form for your claims. Call our Dental stationary line to order ACC42 forms:

    Phone: 0800 802 444

    If you’re another kind of treatment provider treating a dental injury, use the ACC45 as normal.

    After you've lodged the claim

    We make a decision on cover within 24 hours of receiving a claim. Cover decisions for complicated claims are likely to take longer.

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

    Treatment should begin within a year of lodging a claim. There is then a year to provide treatment from when the first session takes place.

    If a patient needs further treatment, you'll need to seek prior approval.

    Getting prior approval for further treatment for allied health providers

    Contact us

    If you need help, contact our eBusiness team:

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

    Last published: 21 December 2020