Claims and How To Make Them
CLAIMING EARNINGS OR LUMP SUM PAYOUTS
FOR INJURY'S SUSTAINED UNDER
THE NEW ZEALAND
ACCIDENT COMPENSATION ACT 2001
Here is the web address for the full Act 2001
The following is what will happen but be prepared for heartache and delay tactics from ACC. They are a conglomerate and an Insurance Company although owned by the Taxpayers, they do in some instances fail badly in keeping to the rules and regulations of the ACT 2001.
Section 1. How To Make The Claim
This Section and the other sections apply to New Zealand ONLY.
For other Countries see Section at the end of this page.
1.1
Has your Injury been accepted by THE ACCIDENT COMPENSATION COMMISSION
as a work related injury and the date it was accepted. As per Parts One and Two of the
ACCIDENT COMPENSATION COMMISSION ACT 2001.
1.2
Has your GP put in a Accident Compensation Commission ACT 2001 - Claim Form 45, for you?
**This is so important for you, as you will see pursuant to Section (2) and (3) further on in this
claims guide.
1.3
If so have you been given a Case Manager? (Here there are good ones, bad ones
and some are absolute shockers).
1.4
Were you working at the time of your injury? This is important as to whether you get a weekly
income or not. This is covered in Part Two of the Accident Compensation Commission ACT 2001.
1.5
If the answer to Q3, is NO then you may not eligible for weekly income.
1.6
Find an Advocate: To try and take on Accident Compensation Commission , unless you
know the Accident Compensation Commission ACT 2001 well and have some legal knowledge
it can be a daunting task, and you may end up wirth nothing. There is a provision within the
Accident Compensation Commission ACT 2001, you may if ou wish represent yourself,
but be "WARNED" you will need the skin of a Rhinoceros.
1.7
Your Advocate should be one who has a varied and good reputation for going up
against the Accident Compensation Commission.
1.8
Check the Advocate out by looking up on the Internet, his/her history, recommendations check out
through The Community Law Centre, does he charge as most of the work he does for you under the
Accident Compensation Commission ACT 2001 and they pay him.
1.9
The difference comes if you are paid a Lump Sum. Then the Advocate takes a percentage.
Most are around 20 - 25% but there are those who take 50% of your pay-out.
Section 2: Required Documentation
NOTE: KEEP COPIES OF EVERYTHING YOU SEND TO YOUR ADVOCATE or
ACC especially ACC.
They have a habit of losing paperwork a way of delay.
2.1
Documentation is the most important, as ACC will knock back your claim, if all the
documentation is not made available. So follow the check list below.
2.2
Documentation you will require is as follows:
2.2.1
Copies of the hospital records pertaining to the accident.
2.2.2
Doctor's, Surgeon's, Specialist's reports.
2.2.3
If an Occupational Therapist's or Physiotherapists were involved in your treatment
reports from them they are necessary.
2.2.4
Request through ACC a copy of your full file. If you have had any claims prior to your
accident you need all that as they will try to blame your accident on anythig prior or that it
"EXASERBATED” the injury.
2.2.5
ACC have a Handbook on the way claims are made and what they pay out on.
You can find those items here:-
a) Accident Compensation Commission Handbook Pertaining to
Treatment of an injury in line with the AMA 4.
https://www.acc.co.nz/assets/provider/fe092baf01/acc716-ama4-handbook.pdf
b) Guide to Assessment Services Accident Compensation Commission
ACT 2001.
https://www.acc.co.nz/assets/contracts/imp-schedule.pdf
NOTE: KEEP THESE TWO DOCUMENTS AS YOU MAY NEED THEM LATER.
The AMA 4 Book, your Advocate will have a copy of this Manuel. Trying to find pertinent sections that the ACC handbook refers to online is quite difficult. The AMA 4 is also expensive, varies from $180.00USD, Second Hand to $320.00USD New. The DSM V which also may be used for Mental injuries or claims also varies, from $390.00USD Second Hand to $645.00USD New.
Section 3: Required Documentation and Accident Compensation Commission's Idiosyncrasies
3.1
"Unfortunately," is probably the Accident Compensation Commission's favourite word and they will without
hesitation if not everything is supplied this word is their get out of jail word !!!!
3.2
Once you have this information, a word of advice here, if you request all the above mentioned information, it
will speed up the process faster and the Accident Compensation Commission, hates it when they do not have
an avenue for delay. This is speaking from experience.
3.3
Take all the above Documentation to your Advocate, as he will then submit the Respective Accident
Compensation Commission Claim Form for your injury that is, Claim for Weekly Earnings
( Make sure you haveat 12 months of earnings eg: previous year's tax return, letter from your employer
and so on).
3.4
If your claim is accepted for Weekly Earnings, the payments in most cases will be backdated to the date of
your accepted injury pursuant to Section (1), of the Accident Compensation Commission Act 2001.
3.5
If you have received any income from WINZ (Work and Income New Zealand), during the period of your
accepted injury date (pursuant to Section 1). That amount will been deducted in accordance with the
Accident Compensation Commission ACT 2001 in the relevant sections applicable.
3.6
If as pursuant to Sections (1) and Section (4) of this Guide you will be able to under the Accident
Compensation Commission ACT 2001 ,have the choice of Weekly Payments or Lump Sum, but not both.
Your Advocate will explain the rules pertaining to this. As the Accident Compensation Commission ACT 2001,
has strict guidelines as to dates etc., who can claim weekly earnings and who may be eligible for a Lump
Sum. This is where your Advocate will be able to advise what you can claim under the Accident Compensation
Commission ACT 2001.
Section 4: LUMP SUMS
4.1
If you are elegible for a Lump Sum the Accident Compensation Commission will send you to an Assessor or
Specialist, depending on the type of injury you have incured. The Accident Compensation Commission will
forward all relevant information to the Assessor, with specific questions they want answered in accordance
with their Handbook and the AMA 4 pursuant to the relevant parts of the Accident Compensation Commission
ACT 2001.
4.2
At the assessment you are permitted to have a support person/s with you provided you notify the Assessor of
such beforehand. (7-14 days is a guide)
4.3
A good idea is also to have a list of questions to ask the assessor. If there is anything you do not understand
ask questions. Your Advocate will receive a copy of the documentation sent to the assessor as well as yourself
if you request such copy. You should also request a copy of the questions to be asked during the assessment.
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The above is only a guide to the Accident Compensation Corporation ACT 2001. The links set out within this guide are
the best way to fully gain an idea of what is required and how things work when making a claim under the Accident
Compensation Corporation ACT 2001. A good Advocate is a good start and even better a good Case Manager will
make things a lot easier.
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5.1
We have not shown anything under the heading of Reviews as this is an intense and can be a
soul-destroying exercise.
5.2
A Review or an Appeal is when the Accident Compensation Commission use their two favourite words
"Unfortunately" or "EXASERBATED” is where you need a very good Advocate.
5.3
Under the Accident Compensation Commission ACT 2001, if your reviews or Appeals fail you have the
right to take the case to the District Court. The Accident Compensation Commission Act 2001, sets out the
procedures for this but your Advocate or your self may represent your case before a Judge.
Australia: Workers Compensation Law - SAFE WORK
https://www.safeworkaustralia.gov.au/workers-compensation
USA: The Federal Employees' Compensation Act (FECA)
https://www.doi.gov/workerscompensation
United Kingdom: Employers’ Liability and Workers’ Compensation:
England and Wales.
https://orca.cf.ac.uk/26855/1/Lewis%202012.pdf
It was difficult to find anything on Scotland and Ireland or whether they come under the England & Wales criteria.
The Table of How Your Claim is Processed
DO THE PAPERWORK MAKE IT EASY NOT A TASK
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