THE ACC PROCESS

The Accident Compensation Corporation (ACC) provides comprehensive, no-fault personal injury cover for all New Zealand residents and visitors to New Zealand. This means that if your injury and surgery is accepted by ACC, then the costs of your care and recovery will be covered by ACC, regardless of whether you have health insurance.

After an injury, an ACC claim will lodged by your initial treating health practitioner – usually your family doctor, physio or urgent care clinic. 

Costs

Once ACC accepts this claim, initial treatment and investigations are covered although some may require a partial payment.  When you see Dr Coleman, the costs of your assessment are completely covered by ACC, as are the costs of any special investigations (MRI scans and CT scans) that he requests.

Surgery

If you have decide to proceed with surgery, a further request has to be made to ACC to fund your surgery. It is important to know that although ACC have confirmed that they will cover your initial injury and your specialist review, you will not automatically get your request for surgery approved. Once the request has been processed, you will receive an approval or decline from ACC in the mail. The usual timeframe is around two to four weeks for simple requests but can be eight to ten weeks in more complex requests.  Some surgeries do not require this process and can be booked for surgery without approval. These include ACL ruptures, acute clavicle fractures and removal of metalware previously inserted under ACC funding.

If your surgery is approved, you can simply contact our office to schedule your operation.

If ACC declines your application for surgery, we will send you a letter outlining your options. You can lodge an appeal against the ACC decision, use health insurance if you have it, self-fund, or be referred to the public health system. ACC will fund one extra clinic visit even if your surgery has been declined so you can book a further appointment to discuss if you wish.

An ACC appeal takes approximately 3 months to complete. If you have private health insurance and do not wish to wait for the ACC appeal result, it is also possible to proceed with surgery using your insurance and appeal the ACC decision at the same time. Please contact your insurance company in this case, as they will be able to guide you with this process. To lodge an appeal, you need to contact ACC directly.

If you do not have health insurance and wish to appeal the ACC decision, we recommend using an ACC appeals lawyer or advocate to help you through the process and represent you at the appeal hearing.

If you wish to be referred to the local public hospital, please contact us and we can arrange the referral.