How to get the best out of your ACC claim

How to get the best out of your ACC claim

ACC covers injury caused by accident and provides support for incapacity resulting from those injuries. In simpler terms, ACC takes responsibility for injury caused by accident and offers a range of assistance for issues directly linked to those injuries. Sometimes the injury that ACC has acknowledged as causing the problem, doesn’t align to the request for assistance they receive. For example, if your original injury was recorded as a 'sprain' and 4 months later you need surgery, the surgery may very well be declined because 'sprains' don't usually require surgery.

ACC works like any other insurance company and makes decisions based on the information that they have at hand. Sometimes things go wrong for people because the information right at the start of someone’s accident has not been recorded clearly or fully.

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Right at the start – when the claim is lodged

1. When you first see the person lodging the claim on your behalf, make sure that the accident description - the way you hurt yourself - is a full and accurate description of what really happened. If you fell on your outstretched arm and took the full weight onto that body part because you were carrying something in the other arm, make sure the accident description outlines that and doesn’t just say ‘fall on arm’. It may affect the way that your claim is considered in the future if the accident is not described in full at the start.
2. Make sure that the correct body site is listed on the form. If it was your left elbow and left index finger, make sure it doesn’t just say ‘arm’.
3. If your diagnosis changes from the simple initial diagnosis at the start of the accident to something more complex later on, request that your GP updates your injury diagnosis and informs ACC that your injury caused by accident has changed as new medical information has come to light. For example, let’s say you fell and hurt your knee. The claim may be lodged as ‘right knee sprain’. However, a week later when the injury is reassessed after the swelling has gone down you are told you have damaged your medial ligament by the health professional who is assessing you. Be sure to get your claim updated to reflect the new diagnosis.

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Your medical notes and record-keeping

You have the right is ensure that your medical notes are a true and accurate reflection of you and your situation. Although it may feel awkward at first, ask to read your notes at your GP, physiotherapist, or relevant health professional visit, and ensure that your information is correct. As ACC is collecting these notes to make big decisions, it is important that they are accurate and clearly explain the link between your accident and your current need. These are your notes after all.

If you can, keep copies of relevant information. This can be helpful if ACC is struggling to obtain relevant notes from organisations such as hospitals. It may be quicker for you to provide ACC with the information that you have to hand than wait for ACC to collect it.

You may need to see a specialist when your injury is not resolving or if you need further treatment. Sometimes, specialist consultation notes can be brief and may not fully explain the reasons behind their treatment recommendations. It is important to stress that the injury diagnosis and the link to your accident is clearly explained by your treating specialist, as ACC will make significant decisions based on these notes. Ask for a copy of the consultation notes and aways be ready to ask for further clarification if you feel that something was missed from your consultation.

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Dealing with ACC

When dealing with ACC, use the MyACC app when you can but also don’t hesitate to use email and keep a folder going with all copies so you can hold ACC to account for timeframes and any expectation setting.

If ACC makes any decision affecting you and something on your claim, make sure to get this in writing. ACC calls this document the ‘decision letter’.

If you do not understand any decision issued, or you wish to ask for a re consideration of a decision issued, ask ACC for a copy of the document they call the ‘internal guidance document’ which was written to accompany the decision. These are not routinely provided to people. Staff members shouldn't make complex decisions alone. The internal guidance document will include input from either a clinical advisor, a technical advisor, or both. They will explain the medical or legal reasons behind ACC's decision-making. This internal guidance document can assist you and others such as Way Finders when it comes to fully understanding the reason behind a decision and what your likely next steps could be if you should choose to challenge it.

If there is no internal guidance document, ask ACC if hotline guidance was sought to assist with the decision-making process. This is a phone call to an internal staff member/subject expert. This conversation will be documented, and you can ask for a copy of this hotline conversation.

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Be honest about what is happening

Don’t keep things to yourself hoping they will get better. From an ACC perspective, if it is not written down, it did not happen. Talk to your health providers about your situation and how and why your accident and injury have impacted your life, in regard to home life or at work. This information can then be used to support requests for assistance.

Remember your claim is exactly that, your claim. It is not ACC’s claim. If you've had an injury from an accident that ACC has accepted, their role is to help you access your entitlements under the Accident Compensation Act.

You have rights under the ACC claimant code of rights, and obligations under the same code to ensure that your claim runs smoothly, and that you can get on with the business of recovery. There are systems in place to assist you when things don’t go quite to plan.

Get in touch with us if you have more questions about any problems that you may be facing.