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How do I make a claim?

Injury in New Zealand

If you’re injured in New Zealand, even if you’re visiting from overseas, ACC can help with treatment and other support.

What do I need to do?

  1. If you or someone you care for is injured, get treatment as soon as possible. Don’t wait until you feel better, as this can often make the injury worse and your recovery longer.
    The Accident Compensation (AC) Act 2001 lists the health professionals whose treatment ACC can contribute towards. We have a of them, go to:
    approved treatment providers
    .
      1. Your health professional, eg doctor, physiotherapist, dentist, nurse, will help you fill out an ACC claim form and send it to us.
        Usually you’ll need to pay at least part of the cost of this first visit to a health professional; they can claim the rest back if your claim is accepted. If you’re asked to pay the full amount, keep the receipt, because you may be able to claim some of the money back if we accept your claim.
        If you need to take time off work because of your injury, discuss this with your doctor or nurse practitioner. They’ll complete a medical certificate for you, if they confirm that you do need time off work.
          1. When we receive your claim form, we’ll contact you by phone or letter to let you know if your claim is accepted.

          What if I am taken to hospital?

          1. When you’re admitted to hospital, they’ll send a claim form to ACC on your behalf.
          2. When we receive your claim form, we’ll contact you by phone or letter to let you know if your claim is accepted.

          If you were taken to hospital by an emergency service within 24 hours of being injured, ACC may cover the transport costs. For more information, go to:
          Ambulance and emergency care

          Serious injury

          If you have suffered a serious injury that results in significant permanent disability or loss of function, we’ll assign you to a support coordinator in the National Serious Injury Service.

          What information do you need from me?

          To help us decide if your injury is covered, you must supply on your ACC claim form the following information:

          • your surname and first name
          • your home address
          • telephone number
          • date of birth
          • date of accident
          • description of accident
          • whether a motor vehicle was involved
          • whether the accident occurred at work
          • your employment status at the time of the accident, ie not working, employee, self-employed or other (such as shareholder employee, contracted employee or commission-only salesperson)
          • your employer’s name and address
          • your signature, or that of your legal guardian or representative, and date signed
          • diagnosis of your injury (the health professional will enter this information)
          • what affect the injury has on your ability to work (if applicable, your health professional will complete this)
          • your health professional’s signature and date signed.

          If we need you to supply further information, we’ll send the form or a letter to you with a request for the missing information.

          Your role in the claim decision-making process

          Remember that you have a role in the decision-making process. Giving us as much information as you can about your situation, and attending meetings and assessments when asked, helps us to make a timely decision on cover and what other help to give you. You can nominate and authorise someone to represent you at meetings or in communications with ACC.

          Consent from you to collect information

          After we have made an initial decision to cover your claim, we may need to get further information about you from other sources, such as medical details from treatment providers. We cannot collect this information without your authority and the lack of information may impact on our ability to make a decision on your entitlement to other ways we can help you.

          To obtain your authority, we’ll send you a form to complete and sign, and we’ll discuss any concerns with you.

          How do you decide if I’m covered?

          When we receive your claim, we register it and give it a unique claim number. Most claims are assessed at the registration centre and either accepted or declined based on individual circumstances and the criteria listed in Am I covered?

          As a guide, we’ll consider questions such as:

          We’ll contact you by phone or letter to let you know the decision on your claim. If we can cover your claim, we’ll advise what assistance you’re entitled to, eg a number of subsidised visits to a physiotherapist for treatment of a sprain. We may also ask you to contact your ACC client services contact or case coordinator to discuss what assistance is available.

          One of our client services staff will be on hand to help if your injury needs treatment and/or assessment over a period of time, or if significant contact with us is required to help you access the right assistance.

          If we can’t help you, we’ll tell you why. It may be because your injury is:

          • a non-work related disease or infection, including conditions you may have been born with
          • a non-work related gradual process
          • due to the ageing process.

          In some cases we decline cover if you fail to respond to us with further information when we ask for it. If you disagree with our decision, you can ask for a review. For more information, go to:
          Get a decision we made reviewed

          How long might you take to decide?

          The majority of claims are assessed at the registration centre within 21 days of being lodged.

          Sometimes a decision on a claim cannot be made within 21 days because we require additional information. If that happens in your case, we’ll extend the timeframe for making a decision up to a maximum of four months from the date the claim was lodged. You’ll be told about the extension as soon as possible.

          Some claims require more investigation or assessment by a specialist unit within ACC, eg:

          • work related mental injury, where a person suffers a clinically significant mental injury caused by a traumatic work related event
          • mental injury as a result of sexual abuse
          • physical injury suffered in the course of medical treatment
          • death caused by an accident
          • if your injury is work-related gradual process.

          What happens next?

          Seek further treatment as required

          If you need further treatment, eg counselling, surgery or medical treatment, talk to your health professional first. They’ll work out what treatment you need and, if necessary, apply to us for help meeting the costs. For more information go to:
          Treatment costs

          Other types of help we can give

          For all other types of help, talk to us about your needs. We can give you more information about our services, including how to apply. For example:

          If you …

          then we may be able to help with…

          need extra help while you recover from your injury

          can’t work while you recover because of your injury

          compensation for lost salary or wages.

          have a long term impairment

          lump sum payment or independence allowance

          Note:
          Because no two injuries are the same, the type of assistance we can offer varies depending on individual circumstances. It’s important to talk to us to check if you’re eligible for particular services.
          Contact us

          Find out more at:
          What support can I get?

          What if I have a work-related injury?

          Employees

          You may want to use a provider recommended to you by your employer and who is familiar with your workplace’s activities. The health provider will help you complete an ACC45 claim form and forward it to us.

          We’ll advise you and your employer if your injury is classified as work-related or not. For work-related injuries where you are eligible for compensation for loss of earnings, the first week of earnings will be paid by your employer. The second and subsequent weeks are ACC’s responsibility.

          If your employer is an accredited employer and your claim is accepted as a work-related injury, your employer or their claims administrator will provide the same help as ACC would if we were managing your claim.

          Self-employed

          All self-employed people are required to have injury cover with ACC. You can make a claim for some work-related conditions, however, if you need time off work, you cannot receive weekly compensation for the first week. After this, if you are eligible, your weekly compensation payments will begin as soon as we receive all the information needed to calculate it.

          If you have ACC CoverPlus Extra cover, your weekly compensation will already have been calculated as part of the application process. Otherwise, standard ACC CoverPlus cover provides for weekly compensation based on 80% of your past year’s earnings.

          ACC CoverPlus Extra

          ACC CoverPlus

          Volunteer work

          If you are injured while doing voluntary work, it’s classified as a non-work injury and your claim will be considered as such.

          If you are in paid employment and have to take more than a week off work because of an accident you had doing volunteer work, you may be eligible for weekly compensation. As with other non-work injuries, the first week is not paid by either your employer or us.

          If you are not in paid employment, you are not entitled to weekly compensation because you have not ‘lost’ any weekly income.

          What if I have a non-work related injury?

          If you are in paid employment and have to take more than a week off work because of an accident you had whilst not at work, eg a fall at home, you may be eligible for weekly compensation. The first week is not paid by either your employer or ACC. If you are eligible, the second and subsequent weeks will be paid by ACC.

          More information

          Contact us

          What support can I get?

          Related legislation

          Accident Compensation (AC) Act 2001

          Accident Compensation Act 2001 section 20: Cover for personal injury suffered in New Zealand (external website)

          Accident Compensation Act 2001 section 25: Accident (external website)

          Reviewed: 6 September 2016