How we assess claims

We’re using a new system that allows us to identify and fast-track the acceptance of straightforward claims. Complex claims are reviewed and assessed by staff.

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    A new way of assessing claims

    From September 2018, we’re using a new system that will help identify and accept straightforward claims. Complex claims will be identified, and a staff member will review and assess the claim. The system won’t decline any claims.

    Each injury in the new system will have a score based on analysis of 12 million previous, anonymised ACC claims. This score is the probability that a person assessing a claim would accept the claim. You’ll see this score on your claim information.

    Explaining your claim information

    Before this change, our staff would review every claim. By using a system to fast-track straightforward claims, our staff have more time to spend on claims that need a review or assessment. This also creates a greater level of consistency in the decision-making process.

    Straightforward claims will be fast-tracked

    Each year, we receive an average of 2.1 million claims.

    Of the 2.1 million claims we receive each year, 1.8 million are easily identified as fitting within the rules of the Accident Compensation Act 2001. We approve these claims without the need for further information or investigation.

    We're using the new system to identify and fast-track the acceptance of straightforward claims. These are claims where it’s clear an accident has caused the injury.

    It helps us to make decisions quicker so that you can get help faster. If we have your mobile number or email address, you may receive information telling you what’s happening with your claim much sooner.

    For example, while John was out walking his dog he tripped and sprained his ankle. He went to his doctor who submitted a claim to ACC. We received the claim and made an immediate decision. John receives a text message letting him know his claim is accepted. John can take his claim number to his physiotherapist and start treatment as soon as he can.

    Before, John would have had to wait a week for a letter in the mail with information about his claim.

    Complex claims will be reviewed and assessed by staff

    When claims are identified as complex, a staff member will review and assess the claim. Types of complex claims include:

    • sensitive claims
    • accidental death
    • dental
    • hearing loss
    • gradual process
    • serious injuries
    • claims relating to injuries that could involve multiple causes.

    For example, Jane fell off a cliff when tramping. She has sustained multiple injuries, including a blow to the abdomen which has caused a hernia. The emergency department at the hospital has lodged a claim with ACC. Hernias are not often caused by an external force and generally not covered by ACC. The claim is identified as complex and a staff member will assess whether treatment of the hernia is covered.

    Review of claims by staff is dependent on the diagnosis and details of injuries. In this example, Jane's injury is one that needs further investigation and a staff member will review her case.

    Last published: 12 June 2019