In New Zealand, we are fortunate to have the Accident Compensation Corporation (ACC). This unique scheme provides insurance-like cover for people who have been injured in an accident. ACC helps to fund treatments such as GP and specialist visits, physiotherapy, imaging (such as X-rays and MRIs) and sometimes surgery.
ACC is designed to support people who have suffered an acute injury - that is, an injury that happens at a particular time and place, such as twisting your knee while playing sport or breaking a bone after a fall.
Over recent years, ACC has experienced major cost pressures. More and more treatments are being claimed under the scheme, including conditions that were never intended to be covered. This has led to cost blowouts in the scheme.
If this continues, the scheme may not be financially sustainable in the future. To ensure ACC is there for future generations, it needs to return to its original purpose; covering genuine accidents and acute injuries, not long-term medical problems or conditions that arise gradually.
ACC does not cover health problems that develop gradually over time, such as arthritis, or overuse injuries.
Sometimes, though, it can be tricky to separate the two. For example, someone may suffer an accident that injures their knee, but they may also have underlying arthritis. In these situations, it is not always clear how much of their current problem is due to the accident and how much relates to the pre-existing condition.
When you lodge a claim with ACC, you are essentially asking for support because of an accident. ACC accepts most claims, often based on the description provided at the time. However, when you see a specialist, part of our role is to carefully review your history and examine you to determine what has caused your pain or injury.
If your problem is mostly the result of an underlying medical condition (like arthritis) rather than a new accident, it may not be covered by ACC. In those cases, treatment may need to be funded privately or through another pathway.
As specialists, our priority is to try to help you. In almost all cases this means we can work your case up to a point where we have a clear diagnosis and therefore the ability to tell you what your treatment options are.
However, we are contractually obliged to provide ACC with a clear explanation about your problem, and this includes commenting on injury causation. This can sometimes mean telling you that your situation is not an ACC-covered injury, even if you have already had some treatment accepted.
We know this can be disappointing or confusing. Our aim is not to deny care, but to make sure the system is fair, accurate, and sustainable for everyone who needs it. We remain committed to helping you find the best treatment pathway - whether through ACC, your GP, private options or other services.
