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Accident Insurance - facts for injured people

ACC covers ALL personal injuries, including work injuries, for accidents that occur on, or after, 1 July 2000. Under recently enacted amendments to the Accident Insurance Act. 1998, competitive provision of workplace accident insurance has been removed and instead the entire scheme will be delivered through ACC. The following pages tell injured people, including employees, of their rights and what to do if injured.

Cover and Entitlement

The Accident Insurance Act 1998 continues to provide cover for people who suffer personal injury. This means you continue to be covered for any injury resulting from

  • an accident, or
  • work-related gradual process or disease or infection, or
  • mental injuries resulting from sexual abuse.

Even if the injury is your fault or someone else's, you are still covered for injury by accident. You may also be covered for "medical misadventure" if you suffer personal injury while being treated by a registered health professional.

You are entitled to:

  • a contribution to the cost of your medical treatment and to rehabilitation
  •  
  • at least 80% of your weekly earnings for the time your doctor says you must be off work.

These entitlements are specified in the Accident Insurance Act 1998 and related regulations and have not changed.

What to do if Injured

If you are hurt at work, or think you have developed an infection or gradual process injury as a result of your work, you should seek medical attention from a qualified treatment provider.

You should also immediately report your accident or ailment to your employer or workplace supervisor.

If you have a personal injury outside of work, far example, while playing sport or undertaking home repairs, you should seek immediate first aid from a treatment provider.

Treatment providers can be a range of health professionals from nurses doctors, physiotherapists through to acupuncturists - check with the professional concerned to see if they are the right person to treat your injury.Filling in the Claim Form

You will need to register a claim for your personal injury and it is usual for your treatment provider to assist you in this process.

When you fill in the form there is a question which asks your ethnic background. This is important information for service improvement, however you don't have to answer this question - you may choose whether you fill it in or not. You can also choose to block out or score over the ethnicity information where a copy of the form is being released to your employer.

You will be asked to sign the form. The signed form enables the collection and release of information about you to the extent that it is needed to prevent future injuries, determine cover and/or assess your entitlement to compensation, rehabilitation assistance, medical treatment and/or the appropriate level of care and personal attention you should receive.

Some of the information you supply is health information and the collection, use, and disclosure of this information is subject to the Health Information Privacy Code. Further, under the Privacy Act you are entitled to access all health and personal information held about you.

The Regulator (part of the Department of Labour) also collects comprehensive personal injury statistics and other information to establish and maintain a complete claims database. A number of organizations and individuals can apply for access to this information, according to standards and access protocols maintained by the Regulator. In general, information from the database con be used only in a way where it is not possible to personally identify you.

Treatment

If your accident insurance claim is accepted, you have the right to medical treatment and rehabilitation that enables you to lead as normal a life as possible.

Your first visit for medical treatment may be to any appropriate treatment provider or, for more serious injuries, to a public hospital.

If a treatment provider cannot give you the treatment you need, they must refer you to someone who can.

ACC, or your employer's insurer in the case of an ongoing claim, or your accredited employer, must contribute to your medical expenses and transport casts. (see section on Your Employer')

An ongoing claim refers to a claim that relates to a work injury that you incurred between 1 July 1999 and 30 June 2000.

Compensation

If you need time off work to recover from your injury, your employer or ACC must pay far at least 80% of your weekly earnings. Your employer must pay you that income for your first week off work. ACC pays after the first week except for

  • ongoing claims where the registered insurer pays, or
  • if your employer is accredited, in which case they will continue to pay you after the first week.

Before paying you, your employer may require a medical certificate as proof of your injury and incapacity. If you need more than a week off work, you must have a medical certificate from a doctor. Your employer or ACC is entitled to choose and pay for a doctor to provide the certificate.

Rehabilitation and Return to Independence

It's important that you try to return to independence while you are recovering from an injury. If you are in employment, the longer you are off work the harder it is to get ] back to suitable employment. You may be entitled to vocational and/or social rehabilitation which will help you bock to work or independence. Far mare information about this, contact ACC.

Employees

What to do if the work-related injury happened previously

If your injury happened at work between 1 July 1999 and 30 June 2000 then your employer's insurer at that time will manage that injury, regardless of whether you have registered the injury previously or not. You need to register work-related gradual process or disease or infection in the usual manner (see Questions and Answers).

You need to talk to your employer about the date of the accident, and who the insurer was and relay that information to the treatment provider. The date of your injury is critical to your employer and to the treatment provider. The employer's previous insurer must provide you with the same statutory entitlements.

That insurer can choose to transfer its obligations to ACC or any other registered insurer; this transfer has occurred for @Work Insurance who has transferred its obligations to ACC. Your employer will know if this has happened - ask your employer if you are in doubt.

Your Employer

Your employer is automatically covered by ACC for every employee on the payroll from 1 July 2000.

However your employer may be part of an accredited employer or partnership programme with ACC which allows for "self management" of your workplace injury for a specified period. In this circumstance, your accredited employer must:

  • advise you of accreditation including claims processes administrators, etc
  •  
  • promptly process your claim
  • provide all statutory entitlements for your work-related personal injury
  • keep you fully and regularly informed of what is happening
  • inform you of your review or appeal rights 
  •  
  • keep records of your injury.

Your employer may also use someone else to provide claim and case management services, on their behalf.

If your employer is accredited they have satisfied ACC that they meet certain requirements such as demonstrated commitment to injury prevention and awareness and importance of rehabilitation, and are actively involved in these activities.

Reporting Serious Work Injuries

Your employer must report any serious injury accidents to the Department of Labour's Occupational Safety and Health Service.

Information about all accidents must be recorded in the employer's accident register and steps must be taken to prevent the accident happening again.

Remember your employer has legal obligations to keep your workplace safe.

If you're unhappy because...

  • your claim is not accepted, you may apply to ACC or the registered insurer or the accredited employer for a review of any of their decisions
  • your employer is pressuring you to be dishonest about an injury, contact the Department of Labour Industrial Relations service. The Industrial Relations Info-Line is 0800 800 863.

Challenging a Claim Decision

Apply in writing on a form provided by the ACC or the registered insurer or your accredited employer within three months of getting the decision. The ACC or the registered insurer appoints a reviewer who must act independently when conducting a review. In the case of an accredited employer, the review process is run by ACC. The ACC or the registered insurer or your accredited employer will have to pay all the costs of the reviewer in conducting the review. You are entitled to attend. The reviewer must make a decision within 28 days and give you a decision in writing as soon as possible. If a review decision is not in your favour, you may file a notice of appeal in a District Court. If you think the District Court decision is wrong in law, you can make further legal appeals. You may wish to obtain your own advice from your legal adviser.
 

Questions and Answers


Who covers me for injuries?

As of 1 July 2000, ACC covers you for all injuries by accident, that occur on, or after, that date.
 

What if my injury is work-related?

ACC covers you for work injuries that occur an, or after, 1 July 2000.

What does it mean if my employer is an accredited employer?

Your employer has a risk-sharing arrangement with ACC which allows them to self-manage workplace injuries. Your employer must promptly process your claim, and provide all statutory entitlements, according to the accident insurance legislation.
 

What if I had a work-related injury prior to 1 July 2000?

If you had a work-related injury between 1 July 1999 and 30 June 2000, your employer's previous insurer provides cover - regardless of whether you registered the injury prior to 1 July 2000 or not. The registered insurer can choose to transfer its obligation to ACC or any other registered insurer, eg. this transfer has occurred for @Work who have transferred their obligations to ACC. Your employer will know if this has happened - ask your employer if you are in doubt.
 

What if my work related injury is work-related gradual process or disease or infection?

Under the legislation, for work-related gradual process or disease or infection, the date that you suffered your personal injury is the earlier of:

  • the date that you first went to see a doctor about the injury; or
  • the date that the injury resulted in incapacity.

If you suffered your personal injury between 1 July 1999 and 30 June 2000 you must register the claim with the registered insurer your employer had at that time.

If you suffered your personal injury after 1 July 2000 then you register your claim with ACC.

Disclaimer:

This information is a plain language guide to accident insurance legislation. For any legal or financial purposes, the legislation takes precedence over the contents of this webpage.

For more information about accident insurance, contact your local ACC branch or visit the Department of Labour website www.tocover.govt.nz