ACC
The Accident Compensation Corporation, commonly known as ACC, is a Crown Entity set up under the Accident Compensation Act 2001 (the Act).
ACC is responsible for providing a form of accident insurance for all personal injuries. ACC’s main purpose is to promote injury prevention measures, and to provide rehabilitation and fair compensation to those who are eligible under the Act.
An ACC Review Specialist has responsibility for any case on behalf of ACC. While ACC appears as a party to every case (except for cases involving Accredited Employers), ACC is simply the respondent to the review process, and is a party to be treated in the same manner as the Applicant.
ACC may, in appropriate circumstances, instruct external counsel (a lawyer) to act for them.
ACC Scheme
The ACC scheme is a ‘no fault’ system. This means that a person will be entitled to Cover for a Personal Injury caused by an accident, irrespective of how the accident occurred or who may have caused it. In exchange, individuals are no longer permitted to sue others for compensation in the courts following an injury caused by an accident. This is often referred to as the social compact – in exchange for obtaining access to ACC, we give up access to the courts in terms of a claim in tort (ie a claim that the person responsible for the accident was negligent and therefore should compensate the injured person).
ACC Decision
This is the decision made by ACC in relation to Cover, an Entitlement, lodgment of a Late Review, or a complaint under the ACC Code of ACC Claimants’ Rights. It is this decision which can be subject to review by an ICRA reviewer.
ACC Decision Date
This is the date of the ACC Decision. In a decision relating to Cover or an Entitlement (the most common types of ACC decision), the ACC Decision Date is the date of the letter where ACC told the applicant that their application for cover or entitlement was declined. An applicant is entitled to an independent review of that decision to decline the claim. An application for review must be lodged within three months of the ACC decision date: see Lodgment Date.
ACC Navigation Services
ACC funds two independent agencies to provide free advice services for individuals dealing with ACC, including applicants for independent reviews.
These agencies are Way Finders and Workplace Injury Advocacy Service.
Accredited Employers and AEP
Accredited employers are part of what is called the Accredited Employers Programme (AEP).
An accredited employer is an employer who has entered into an agreement with ACC that is known as an accreditation agreement.
Under that agreement, the accredited employer is permitted to provide, at their own cost, Entitlements in relation to work-related personal injuries suffered by their employees during a claim management period. In other words, the accredited employer stands in the shoes of ACC.
An accreditation agreement may provide that:
the employer is liable for some or all of the cost of providing entitlements in relation to work-related personal injuries suffered by the employer’s employees in that employer’s employment; and in return, ACC will charge the employer reduced levies in relation to those work-related personal injuries on the basis set out in the framework; and
some decisions of an employer in relation to a work-related personal injury that are made under an accreditation agreement are, for the purposes of the Act, to be regarded as decisions of ACC.
Act
Where reference is made to the Act, this is generally to the Accident Compensation Act 2001. Be aware that some cases will be under an earlier version of the legislation, the Accident Compensation Act 1982. This should be clear from the case and is important because, in particular, the reviewer is required to hold Warrant (under the 1982 Act) to proceed with any cases under that earlier Act.
Adjournment
When a Hearing date and time has been scheduled, we say that it has been ‘set down’. Once a hearing has been set down, either party may apply for that hearing to be postponed. If the Reviewer agrees to the postponement, this is known as an adjournment.
In exceptional circumstances, an adjournment may also be initiated by a Reviewer, for example if they are incapacitated and unable to attend.
An adjournment may only be granted by the reviewer if there are reasonable grounds for requiring it, and all adjournments must be recorded in a Minute setting out the reasons for that adjournment.
Advocate/Representative
An advocate or representative is someone who represents a party to the review.
Advocates may be legally qualified but there is no requirement for them to have any qualification. In practice, many advocates working in the ACC space are what are called lay advocates (as opposed to legal advocates).
A party is entitled to be represented by their advocate of choice, whether a legal or lay advocate.
Agreement to Mediate
The Applicant and ACC may agree to mediate their dispute. Before doing so, they must sign an agreement to mediate. By signing that agreement, they agree to participate in a Mediation and confirm that they have read, understood and agree to conduct themselves in accordance with the Mediation Protocol. There are also key provisions in relation to confidentiality, indemnities, costs, and outcomes in the Agreement to Mediate.
Appeal
Parties who disagree with the review Decision can appeal to the District Court in most cases. This must be done within 28 days of the review decision being issued. The District Court may accept late appeals, but only if there are special circumstances.
A party cannot appeal a review decision on a decision by ACC on a complaint raised under the Code of ACC Claimants’ Rights. However, that party can appeal the related costs decision.
Information on how to appeal is set out in the notice attached to all decisions.
Applicant
The applicant is the person who has applied to ACC for a review of an ACC Decision.
The applicant may engage an Advocate/Representative to represent them during the Review process. An applicant may also be supported (or directed to) the ACC Navigation Services. They may also request
Cultural Support.
Application for Review
If an applicant wants a Review of an ACC Decision, they must complete an application for review and give it to ACC (this is often referred to as ‘lodging the review application’). The application for review will identify the ACC decision that the applicant wants to be reviewed. Sometimes an application for review will be made on the standard ACC33 form. However, an application for review can take any format so long as it is in writing and, for example, could be made by email.
The date of the application for review is called the Lodgment Date.
Authority to Act
If the applicant has an Advocate/Representative acting for them, they need to confirm this in writing by providing an Authority to Act.
Case Management Conference (CMC)
Once the review process is underway, the first step will be a case management conference (CMC). This is an important part of the process.
The primary reasons for the CMC are:
- to ensure that both parties are fully prepared for the review Hearing;
- to ensure that the necessary Evidence is provided well in advance of the review hearing;
- to avoid any last minute issues that might result in an Adjournment;
- to explore the possibility of Settlement;
- and/or Mediation; and
- to make any necessary Procedural Directions.
The CMC will typically take place by telephone or by video conference and will be led by the Reviewer. Before the CMC, the ICRA case manager will be responsible for sending the parties all the information they need to be able to join the CMC and to ensure they are prepared to participate effectively and confidently.
Claim Number
A Claim Number is the unique identifier assigned by ACC to the specific accident in relation to which the applicant is claiming cover and/or entitlements.
The Claim Number is different to the Review Number or an ICRA Reference Number.
Multiple Entitlements may be sought in relation to any given claim, depending on the individual’s variable needs. As a result, there may be more than one Review Number relating to any given Claim Number.
Code of ACC Claimants’ Rights
The Code sets out how ACC works with those who make claims. The purpose of the Code is to foster positive relationships between ACC and its clients. In essence, it sets out an ACC client’s rights and ACC’s responsibilities. It also contains details of how ACC must investigate any complaint made against it because of a breach of the Code, and what remedies are available (for example, an apology from ACC to the applicant).
The Code does not relate to Entitlements. Instead, it is better thought of as a code of conduct. An applicant can apply for a Review of a decision under the Code.
Confidentiality Agreement for Non-Parties
This agreement must be signed by any non-party (ie someone other than ACC or the applicant, this may be an Advocate/Representative or a Support Person) before they attend a Mediation. It confirms their agreement to maintain confidentiality in terms of the mediation process. The parties themselves will sign an Agreement to Mediate which includes comparable confidentiality provisions.
Conciliation
There are many different approaches to Mediation, including what may sometimes be referred to as ‘conciliation’.
When someone refers to conciliation, they are talking about an ‘evaluative’ form of mediation. Put simply, it is a mediation process where the Mediator will be more direct and ‘evaluative’ in terms of how they facilitate the conversation between the parties. However, this does not mean that the mediator will tell the parties what they have to do; any Settlement between the parties will be theirs and theirs alone.
Typically, given the nature of the disputes arising from decisions taken by ACC and in light of the relatively limited time available to a mediator to work with the parties, ACC mediations will be more evaluative in nature. However, all ICRA mediators are skilled professionals who will draw on a wide range of techniques and skills to best assist the parties so that they experience a positive and constructive mediation session, with the end goal of helping the parties to reach a final settlement of the issues in dispute.
Costs
If the Reviewer makes a Decision (including a Ruling or a Withdrawal decision), the reviewer will usually be able to make a direction requiring ACC to pay costs to the applicant. The type of costs that an applicant can claim, and the amount of those costs, are limited by the Accident Compensation (w and Appeals) Regulations 2002.
If there is a withdrawal decision that occurs before a Hearing is held, and the withdrawal occurs because ACC has revised the ACC Decision in favour of the applicant, then the reviewer cannot make a direction requiring ACC to pay costs. Instead, ACC is required to pay those costs directly.
Cover
Cover is granted for a particular injury or condition (a Personal Injury) where that injury or condition comes within the scope of the Act. Section 20 of the Act is the gateway provision which sets out the circumstances in which there is cover under the legislative scheme.
Cover is different to an Entitlement. Cover is the first step, ie with no cover there can be no entitlement. However, cover does not guarantee an entitlement.
You may be interested to note that cover extends to visitors to New Zealand (although non-residents are eligible only for limited benefits). Cover also extends to New Zealanders abroad (although the Act prevents double recovery).
Cultural Support
Cultural support is available and funded by ACC for Applicants who are Māori. ICRA provides Māori cultural support through Tūhono
ICRA also provides translation and interpretation services (in relation to all languages) for ACC applicants.
Decision
A decision is the formal record of the Reviewer’s substantive findings, ie the decision the reviewer reaches on the ACC Decision that was referred for Review. A decision must also be issued if the review is withdrawn: see Withdrawal
By contrast if a reviewer makes a decision that they do not have Jurisdiction, that decision is formally recorded in a Ruling.
In making their decision, a reviewer may do one of three things:
- dismiss the application for review with the result that ACC’s original decision stands;
- modify ACC’s decision; or
- quash ACC’s In doing so, the reviewer can overturn ACC’s decision or direct ACC to make a new decision.
Decision Due Date
In most cases, the review Decision is due 28 calendar days after the review Hearing has been closed (the Act refers to a hearing being ‘finished’ so you may see both terms used).
Usually, a hearing is closed after the hearing itself has finished (ie, the day the parties met to discuss the substantive issues). However, in some cases the Reviewer may ask the parties to provide further Submissions or Evidence after the hearing. In that case, we would say that the hearing has not finished, and the 28-day time will run from the provision of those further submissions or evidence. Procedural Directions will be given by the reviewer during the course of the hearing to this effect where appropriate. Those directions will be set out in a Minute.
It should be noted that the 28-day timeframe for issuing a decision applies to reviews proceeding under the 2001 Act. For reviews under the 1982 Act, there is no applicable timeframe. However, we would typically expect decisions to be delivered within that same timeframe where possible to ensure a time efficient process.
Entitlement
There are many different forms of entitlements that an Applicant can receive under the Act. These include, for example (this is a non-exhaustive list), weekly compensation, lump sum payments, payment of certain treatment costs (for example payment for GP visits or for surgery), provision of aids and appliances, childcare payments and home help payments, housing modifications, support for vocational rehabilitation, and transport for independence.
To receive an entitlement, the applicant must have Cover and meet the eligibility requirements set out under the relevant provisions in the Act.
Evidence
During the Hearing, the parties will present evidence to the Reviewer. The reviewer considers the evidence and will make their Decision based on that evidence. Evidence might include the results of medical scans and imaging (eg, x-ray reports), letters or emails from doctors and other specialists containing their opinions on the issues (ie, medical opinions), copies of doctors’ notes, or even letters of support from an applicant’s family or employer.
The reviewer has the power to decide what evidence is admissible (that is, what evidence the reviewer is willing to consider).
Hearing
The hearing is an opportunity for both parties to comment on their Submissions and put forward their case to the Reviewer.
For most reviews, there will be a review hearing. However, it is possible to have a review decided just on the documents – this is known as a hearing ‘on the papers’. Review hearings will usually take place by video conference although in some cases an applicant may request an in-person hearing.
ICRA Reference Number
The ICRA Reference Number is the unique identifier which is allocated by ICRA to each case which is sent to us for review. It will be in the form of ICRYY-MMXXXXX (eg ICR20-0701678).
This is different to the Claim Number or the Review Number. These numbers are allocated by ACC.
Jurisdiction
Jurisdiction refers to the origins of a decision maker’s authority. In the ACC context, a Reviewer only has jurisdiction to decide things they have expressly been granted jurisdiction to decide under the Act. A reviewer is not permitted to exceed that jurisdiction by making a Decision which does not fall within the type provided for in the Act. For example, if an Applicant applies for a Review of an ACC Decision that relates to weekly compensation, the reviewer does not have jurisdiction to consider issues relating to funding for surgery (which is a different type of Entitlement to weekly compensation).
If a reviewer does not have jurisdiction, they may issue a Ruling as to jurisdiction confirming that position. A ruling must be issued (rather than a Decision) because, where they have no jurisdiction to decide the matter, they also have no jurisdiction to make a decision.
Sometimes a reviewer will consider a jurisdiction issue and, having found that they do have jurisdiction, go on to make a decision about the ACC decision in question (this is often referred to as making a ‘substantive decision’). In this case, the reviewer will issue a Decision that addresses both the jurisdiction and substantive issues.
Late Review
An Applicant has three months from the date of the ACC Decision to lodge an Application for Review. ACC must accept a late application if there are ‘extenuating circumstances’ that apply that meant the applicant had trouble making the application for review within the three-month timeframe. Examples of extenuating circumstances might be where the applicant was so affected by the injury they suffered, that they were not able to consider their review rights.
A decision to accept or decline a late review is itself a reviewable decision (in other words, an applicant can apply for a Review of a decision not to accept a late review).
Lodgment Date
The lodgment date is the date that the Applicant lodged the Application for Review with ACC. The lodgment date must be within three months of the ACC Decision Date.
An applicant can apply to lodge a Late Review (ie outside of the three months). ACC must make a decision whether to accept that late review. That decision itself may also be the subject of independent review.
Mediation
Mediation is a consensual, confidential and relatively informal negotiation process in which parties to a dispute use the services of a skilled and independent Mediator to assist them to define the issues in dispute, to develop and explore settlement options, to assess the implications of settlement options and to negotiate a mutually acceptable Settlement of that dispute which meets their interests and needs.
The objective of mediation is to enable and empower the parties to negotiate and resolve the dispute promptly, cost effectively and confidentially rather than to have a decision imposed upon them by a reviewer or a judge. The process enables the parties to negotiate flexible and creative solutions which need not conform to strict legal rights or general community standards.
Ultimately, mediation puts the power back in the hands of the parties to the dispute.
There may or may not be a mediation in relation to any given review process. It should be discussed with the parties during the Case Management Conference (CMC) but may also be an option at any time.
All mediations result in an Outcome Notice being issued.
It should be noted that ACC, at times, refers to this as ‘Dispute Resolution Services’.
Mediator
A mediator is an independent person who assists the parties to define and understand the issues, and facilitates a discussion between them with a view to helping them find a resolution to the dispute of their own making. In other words, the mediator will not make a decision for the parties. This process is called Mediation.
Minute
A minute is a formal record of the Procedural Directions relevant to any review, and any relevant circumstances that led to those directions being made.
A reviewer must issue a minute each time they make a timetabling or procedural decision. For example, a minute must be issued after:
- Case Management Conference (CMC);
- an application by a party (eg for an Adjournment); or
- any other event which gives rise to an amendment to the Procedural
Part-heard hearing
From time to time a Hearing will be adjourned part heard to allow the parties to obtain and/or provide further information (Submissions or Evidence) to the Reviewer. The hearing may be reconvened at a later date or a reviewer may simply direct that further information/submissions are provided in writing, following which the hearing will be formally closed.
Relevant information and any Procedural Directions arising from the part-heard hearing would be recorded in a Minute.
Personal Injury
Personal injury is a defined term under the Act – see section 26.
Procedural Directions
Procedural directions are instructions that the Reviewer gives to the parties about various matters relating to how the Hearing will be conducted. The most common procedural directions are timetabling directions – for example, setting down the date of the Hearing, or specifying a date by which Submissions or Evidence must be provided.
Review
A review is the overall process carried out by a Reviewer. The end result of a review is a Decision.
Review Number
As a rule of thumb, a review number is the unique identifier assigned by ACC when an Applicant has sought Cover and/or an Entitlement, ACC has declined that cover and/or entitlement, and the applicant has subsequently requested a review of the ACC Decision to decline the cover and/or entitlement. It is the action of requesting a review of an ACC decision that triggers the review number to be assigned by ACC. The review number would normally relate to a Claim Number, and often there may be multiple entitlements declined by ACC, resulting in multiple review numbers, should the applicant want each entitlement declination to be reviewed.
In some cases, a review number will not be relevant to any claim number. For example, the review may be concerning a ‘W8 – Code of ACC Claimants Rights’ issue, which may not include a claim number as there may be no specific incident or accident in relation to which the applicant is bringing the review. The applicant has the right to bring the review if they feel mistreated, regardless of any financial incentive or coverable incident.
Note, the Review Number is different to the Claim Number or an ICRA Reference Number.
Reviewer
The reviewer is an independent professional who has medico-legal experience. They are responsible for the overall conduct of the Review.
A reviewer will facilitate any Case Management Conference (CMC) and the Hearing, and is responsible for giving appropriate Procedural Directions, issuing Minutes , Rulings, and any Decision.
The reviewer will consider all Submissions and Evidence submitted to them during the review process and make a fresh decision.
Ruling
A reviewer may issue a ruling (as opposed to a Decision) if they do not have Jurisdiction under the Act.
Settlement
A settlement is a resolution of the dispute between the parties which is reached by consent. This may be the result of a Mediation process or direct negotiation between the parties. Either way, full settlement will bring a review process to an end in the form of a Withdrawal. Partial settlement is also possible with some issues resolved and the remaining issues proceeding to a full Review and Decision.
Submissions
The parties will be given an opportunity to (a) file written submissions prior to the hearing; and (b) make oral submissions during the course of the hearing. Submissions have two purposes. They should introduce and explain the party’s argument, and they should also be aimed at persuading the Reviewer that the party’s case should succeed. The submissions set out the argument as to why that party is correct and should include references to the relevant Evidence relied on to argue the case.
Support Person
A party may also wish to have a support person with them, whether to attend a Case Management Conference (CMC), Mediation, or Hearing.
The sole role of a support person is to provide reassurance and emotional support for a party. A support person must not intervene or participate in the process in any other capacity whatsoever (unless the person is providing Cultural Support
