New ACC data show the scale of New Zealand's injury burden. In 2025, injuries from sport and recreation alone generated more than 480,000 claims, 2.5 million days of weekly compensation and an estimated $1 billion in lost productivity. Across the five largest winter sports alone, ACC accepted more than 162,000 claims, with what they refer to as "sprains and strains" being the most commonly recorded injuries. These figures are significant, but they do genuinely reflect the types of injuries that we see in our clinics?

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Almost everyone we see at Axis arrives with a sprain or strain code, no matter what their problem is. Following their specialist assessment, it is clear that most have a more specific or different diagnosis. For example, a "knee sprain" may prove to be an anterior cruciate ligament rupture, meniscal tear or patella dislocation. A "shoulder sprain" may be a rotator cuff tear or instability injury.

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Occasionally, the symptoms are primarily related to osteoarthritis overuse or another condition that was not caused by an accident.

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This mismatch is pretty understandable. Most claims are lodged by a patient's doctor or physiotherapists during the first consultation, before imaging, specialist assessment or a clear clinical picture is available. A further issue is that many clinicians are only allowed to use sprain or strain codes, even when they know that this underestimates the problem. While a broad code allows treatment to begin, it can later create confusion about which injury ACC has accepted, what treatment relates to that injury and whether future care will be funded. It also means that statistics based on initial codes almost certainly do not accurately describe the injuries patients ultimately prove to have.

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Why the diagnosis must be updated

When our assessment identifies a different diagnosis, we are required to notify ACC and request that the injury code is changed. This is not optional. The claim must reflect the injury the patient actually has.

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In most cases, this is beneficial for our patients. An accurate diagnosis guides rehabilitation and provides a clearer record if further treatment is required. An accurate diagnosis also can give the patient future protection. Consider someone whose knee injury is initially recorded as a sprain, but is subsequently confirmed as a traumatic meniscal tear. It is well known that a meniscal injury is associated with an increased risk of future knee osteoarthritis. If the meniscal tear diagnosis is accepted by ACC, that diagnosis may remain relevant if related problems develop years later.

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It is important to highlight that cover and entitlement are not the same thing. Cover means ACC has accepted that a particular injury occurred. Entitlement is the subsequent decision about whether ACC will fund a specific treatment, rehabilitation service, operation or period away from work. Having cover for a knee sprain does not guarantee that ACC will continue to pay for ongoing treatment.

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When symptoms are not caused by an accident

In some cases, updating the diagnosis can also show that ACC may not be the appropriate funder, or can create uncertainty. Some patients, originally coded with a sprain or strain have symptoms that are better explained by osteoarthritis, tendon pathology, overuse or another gradual-onset condition. These are genuine health problems that will generally still require treatment, but ACC generally covers injuries caused by accidents rather than illness, ageing or gradual degeneration. An exception may apply when a gradual process condition is caused by the person's work and meets ACC's specific criteria. ACC explains what injuries it covers here.

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This distinction can be difficult when a claim has already been accepted and treatment has started. It is better to address the uncertainty early than to discover it when the patient later requests surgery, extended rehabilitation or weekly compensation.

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Our role

It is important to stress that we are here for our patients, but that we have contractual responsibilities to ACC. Our role is not to determine or enforce ACC cover. Our responsibility is to assess the patient, establish the most likely diagnosis and recommend appropriate treatment. ACC makes the final decision about cover and entitlement. When the diagnosis or its relationship to an accident is uncertain, we can explain our clinical reasoning and liaise with ACC. Where there is disagreement, we can help the patient and their referrer understand the issue and provide the clinical information ACC needs to make its decision.

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There recently released figures show that injuries have a major impact on New Zealanders, their whanau, workplaces and the wider community. Better diagnosis coding will make those statistics more reliable, but its greatest value is at an individual level. Patients deserve to know what injury they have, what ACC has accepted and whether the treatment being recommended is likely to be covered.

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