If you are involved in an accident and sustain an injury that is no-one’s fault, the New Zealand government’s personal injury scheme, the Accident Compensation Corporation (ACC), can help pay for:

  • medical bills;
  • treatment; and
  • can help cover your income if you cannot work.

This article will explain when the ACC will cover you and when you will be entitled to a refund.

When Does ACC Cover You?

An accident means a specific event where:

  • your body is subject to an external force; or
  • you move suddenly to avoid an external force. 

The term ‘accident’ also includes:

  • breathing in or swallowing a gas, liquid or object on a specific occasion;
  • burns (but not usually sunburn); and
  • absorbing chemicals through your skin for up to one month.

Whilst ACC generally does not cover conditions that are caused gradually, rather than a one-off event, it will cover your injury if it is the result of something harmful that you are exposed to at work over a period of time, such as:

  • hearing loss; or 
  • asbestos.

However, you will have to show that your work environment caused the injury.

You will be able to claim a refund if you are a New Zealand citizen, resident or temporary visitor and your accident happened in New Zealand. ACC doesn’t cover accidents that occur outside of New Zealand, even if you are a New Zealand citizen or resident. 

Most claims for a refund involve physical injuries caused by an accident which is no one’s fault. Some non-physical injuries, such as shock or stress, are covered too. If someone else’s actions caused your accident, this would not be covered by ACC. Instead, you may be able to sue them in court for compensation.

ACC will not pay for treatments or services for:

  • pre-existing medical conditions;
  • injuries that are unrelated to the injury you wish to claim for; or
  • if you deliberately injured yourself.

Injuries That You Can Claim For

The vast majority of injuries occur at home and in the community, whilst others happen at work, on the road, or when playing sport. Common examples include:

  • falling off a ladder;
  • twisting your knee playing sport; and
  • car accident injuries.

Injuries That You Cannot Claim For

Your injury must be the result of an accident. ACC does not cover:

  • illness or contagious diseases, like flu or measles;
  • stress or other mental health issues unless they are linked to the injury that you are claiming for;
  • sunburn and other skin conditions due to rain, cold or wind;
  • hernias; and
  • conditions related to ageing, like arthritis or back pain.

How Do I Get an ACC Refund?

You must complete an ACC 45 Injury Claim Form within 12 months after your accident. Your doctor, physio or another healthcare professional must also complete the form, and they will usually send it to ACC. 

ACC will make a decision about your claim within 21 days for a standard claim, or two months for complicated claims. This might include work-related injuries that develop over time or mental injuries caused by sexual abuse.

What Costs Are Covered?

If your claim is successful, you can seek assistance with:

  • payment for medical fees, rehabilitation and treatment, including at a hospital and visits to GPs, physios and other specialist treatment providers; 
  • weekly compensation for loss of earnings if you’re unable to work; and 
  • lump-sum compensation for permanent disabilities.

Each of these are called entitlements.

ACC can refuse you entitlements in certain circumstances, including if you refuse to have medical treatment for your injury. They may also suspend or stop your entitlement if they’re not satisfied that you’re entitled to carry on receiving it.  

ACC will cover your treatment if it is:

  • necessary to restore your health;
  • performed at an appropriate place and only as often as required;
  • carried out by a suitably qualified health provider; and 
  • only provided after ACC has approved your claim (except for emergency treatment). 

If you are unable to earn money as a result of your injury, ACC entitlements include weekly payments for loss of income. Whether you are an employee, self-employed, or if you have recently stopped work, ACC will pay you 80 percent of your pre-injury weekly earnings (up to a maximum amount). This may be reduced if you receive another form of income during the period that you’re unable to work.

Generally, the ACC will pay you weekly compensation until you are able to return to work. If this is not possible, the ACC will carry out an assessment to determine whether you are capable of working in your job again. After this, they will pay you weekly compensation for a further three months only. 

Key Takeaways

ACC refunds can provide crucial financial assistance towards medical bills and treatment if you have had an accident whilst in New Zealand and have sustained a physical injury as a result. It can also help to cover your income if you can’t work. To make a claim, you should seek assistance from your medical professional within 12 months of your accident. If you have any questions about ACC refunds, contact LegalVision’s employment lawyers on 0800 005 570 or fill out the form on this page.

FAQs

What is the ACC?

ACC stands for the Accident Compensation Corporation, which is an organisation that can help pay for medical bills, medical treatment, and can help cover your income if you can not work.

What injuries does the ACC cover?

The ACC covers the vast majority of injuries occurring at home and in the community, whilst others happen at work, on the road, or when playing sport. 

What can the ACC pay for?

If your ACC claim is successful, you can seek assistance with payment for medical fees, weekly compensation for loss of earnings, and lump-sum compensation for permanent disabilities.

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