ACC

Accident Compensation Commission (ACC)

When someone is injured in an accident, the personal consequences can range from inconvenient to devastating. An ankle sprained during an indoor netball game may mean an early end to the season, whereas the loss of a limb in a car accident may mean the end of a career. New Zealand's accident compensation scheme (ACC) aims to help people who suffer accidental injuries. This includes trying to prevent injuries happening, making rehabilitation available to those who are injured, and providing compensation to them for their losses.

What is the accident compensation scheme?

New Zealand's accident compensation scheme provides 24-hour, no-fault insurance cover for personal injury to New Zealand citizens, residents and temporary visitors to New Zealand. In return for giving no-fault accident cover, the ACC scheme takes away the right to sue for personal injuries covered by the scheme (except for exemplary damages).

Entitlements

The compensation, rehabilitation and other assistance payable to injured claimants are called entitlements.

The main ACC entitlements are:

  • rehabilitation (which includes treatment, vocational rehabilitation and social rehabilitation)
  • weekly compensation, including first week compensation
  • lump sum compensation for permanent “impairment” (disability)
  • support for family members after a fatal injury.

In determining whether a particular injury is covered by ACC, a two-step test must be used. The two questions to ask are:

  • Is there a personal injury as defined in the Act? (for information see “Personal injury” in this chapter)
  • Are the circumstances of the injury covered by the ACC scheme? (for information see “Circumstances covered by ACC” in this chapter).

Personal injury

What is a personal injury?

Accident Compensation Act 2001, s 26

Personal injury is defined as one of the following:

  • the death of a person
  • physical injuries suffered by a person, including, for example, a strain, fracture, wound, laceration or a sprain
  • mental injury suffered by a person because of his or her physical injuries (for information see “What is a mental injury?” in this chapter)
  • mental injury caused by sudden traumatic events at work (for information see “What is a mental injury?” in this chapter)
  • mental injury suffered by a person that is caused by certain criminal acts (mainly sexual crimes) (for information see “What is a mental injury caused by certain criminal acts?” in this chapter)
  • damage (other than wear and tear) to false teeth (dentures) or artificial limbs (prostheses, which does not include hearing aids, spectacles, or contact lenses).

What is not a personal injury?

Personal injury does not include:

  • injury caused wholly or substantially by a gradual process, disease, or infection, unless it is personal injury that is:
  • work-related (for information see “Is it a work-related gradual process, disease or infection?” in this chapter)
  • a treatment injury (for information see “Personal injury caused by treatment (treatment injuries)” in this chapter)
  • consequential on personal injury for which the person has cover
  • consequential on treatment given for personal injury for which the person has cover.
  • a heart attack or a stroke, unless it is personal injury that is:
  • a treatment injury (for information see “Personal injury caused by treatment (treatment injuries)” in this chapter)
  • work-related and caused by physical effort or physical strain, in performing his or her employment, that is abnormal in application or excessive in intensity for the person.
  • non-traumatic hernias (for example, from coughing or sneezing, or not directly as the result of trauma)
  • personal injury caused wholly or substantially by the ageing process
  • personal injury to teeth or dentures caused by the natural use of those teeth and dentures.

What is a mental injury?

Accident Compensation Act 2001, s 27

A mental injury is a form of personal injury and is defined as a clinically significant behavioural, cognitive, or psychological dysfunction.

Examples of mental injuries that are covered include depression caused by a physical injury that restricts movement and enjoyment of life, or a panic disorder caused by scarring and disfiguration from a serious car accident, which prevents the person going out in public. Because the injury must be “clinically significant”, it doesn't include short-term emotional effects like anger, fear and embarrassment.

Mental injury caused simply by the experience of being in an accident or witnessing other traumatic events isn't covered. To be covered, the mental injury must have been caused by physical injuries suffered in the accident or event.

There's no cover for mental injury resulting from physical injuries suffered by another person.

Except for mental injuries caused by sexual crimes (for information see “What is a mental injury caused by certain criminal acts?” in this chapter), only mental injuries that arise because of physical injuries are included in the definition of personal injury. A mental injury, such as psychiatric harm arising from witnessing or learning about horrific events, or experiencing work stress, is not included the definition of personal injury.

However, a mental injury caused by a sudden traumatic event at work is covered, if the event happened after 1 October 2008 (an example would be a train driver who unavoidably runs over and kills someone lying on train tracks). To be included in the definition, this kind of mental injury must be:

  • the result of a single work-related event
  • which the claimant sees or hears directly
  • and which could reasonably be expected to cause mental injuries to people generally.

What is a mental injury caused by certain criminal acts?

Accident Compensation Act 2001, s 21

These are mental injuries that are caused by behaviour of a type described in particular sections of the Crimes Act 1961. These are mostly sexual crimes; for example, sexual violation (rape) and indecent assault. There does not need to be a physical injury for a mental injury of this type to be covered. However, there must be a diagnosed mental injury, such as depression or an anxiety disorder. ACC will not provide counselling and other entitlements simply on the basis that a sexual crime has occurred.

 

 

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