Claims approval process: documents released

Te tukanga whakamana kerēme: kua puta ngā tuhinga

We've published key documents detailing our new claims approval process.

We’ve published some key documents about our new claims approval process. This process will reduce the time it takes for clients to find out what’s happening with their claim.

The new process will be introduced in mid-September. It will identify and almost instantly accept straightforward claims, when it is obvious an injury was caused by an accident.

The process can only approve claims, it cannot decline them. Any claim not immediately accepted will be reviewed by one of our claims assessors in the same way all claims are currently considered.

We’re publishing how we’re using data to accept claims

Chief Operating Officer Mike Tully says transparency was behind the decision to publish key documents on how claims data will be used to accept claims.

“We recognise the use of data is an area of considerable public interest. So we’ve sought external expert advice that our new process is accurate, and meets the Principles for Safe and Effective Use of Data and Analytics. These principles were developed by Statistics New Zealand and the Privacy Commissioner.

“Throughout the system’s development, we’ve also been updating the Minister for ACC, the Privacy Commissioner, the Human Rights Commission, and the Government Chief Data Steward.

“I’m pleased to say we’ve received positive feedback about our approach, including from the Centre for Law and Policy in Emerging Technologies at Otago University.

“Clients can be confident their data is being used appropriately and for a good purpose. Faster claim decisions will put many clients in a better position as they start their recovery.”

Making decisions more quickly, so you can get help faster

Mike Tully says claims assessors currently manually handle around two million claims a year. Around 96 per cent of those claims are straightforward and are approved without the need for further information or investigation.

“From next month, our new process will identify and approve these straightforward claims where it’s clear an accident caused the injury.

“We will also be able to automatically generate text messages to let clients know what’s happening with their claim while they wait for their letter.

“The new system uses a statistical model that takes data from 12 million anonymised claims lodged between 2010 and 2016, to determine the probability that a given claim will be accepted.

No change to how we make decisions

“How we make cover decisions for claims remains unchanged. All claims will still be assessed against Accident Compensation Act 2001 criteria, as they are now, and less straight-forward claims that don’t meet the criteria for fast-tracking will still be reviewed by a claims assessor.

 “This means our people will have more time to focus on higher-value tasks like supporting clients through complex claims, and being there for them during their recovery.”

Claims approval - technical summary

Claims approval - privacy impact assessment

Claims model - Deloitte report

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