Entitlements

Contributed by Morgan Speight and current to 1 July 2023

Ambulance and emergency care

Taking an ambulance to the hospital

If you are injured and need to get to a hospital quickly, you may need to call an ambulance. ACC will usually cover the costs associated with the ambulance ride. However there are some situations where you may need to meet the costs yourself.

You may be asked to pay the costs of emergency transport if you needed an ambulance because of health reasons, rather than because of an accident, because it is not covered by the agreement that ACC has with the ambulance services. You may also be asked to cover the costs of the transport if you were injured more than 24 hours before you called for an ambulance. You will also be asked to cover the costs for ambulance transportation in non-emergency situations, unless ACC has given its prior approval.

ACC will usually cover the costs of using an ambulance service if:

• It is an emergency situation; and
• You call within first 24 hours of being injured; and
• The injury was not caused by a non-injury problem; and
• ACC has an agreement with the emergency transport service provider (ACC has agreements with most emergency ambulance services, including St John).

Taking an ambulance home

ACC does not cover the costs of being taken home by an ambulance, however the costs may be met by your District Health Board if the Health Board orders the transport. However, if you ask for the ambulance to take you home, the private hire charges will apply.

Reimbursement of prescription costs

If you are prescribed medication to help you recover or rehabilitate from your injury, ACC may be able to help with the costs of the prescription.

What prescription costs can ACC cover?

ACC can help with the costs of your prescription if your claim has been accepted by ACC and if the prescribed medication is:

• Needed to help treat the injury;
• Classified as a prescription medication; a restricted medication; a pharmacy only medication; or a controlled drug;
• Prescribed by a treatment provider;
• Purchased from a licenced New Zealand pharmacy (this will include online pharmacies such as Pharmacy Direct and Allergy Pharmacy);

When won't ACC be able to help?

ACC won't be able to reimburse costs for a prescription for something that is:

• • Not a prescription medication
  • Restricted medication
  • Pharmacy only medication
  • A controlled drug
  • Medicines that you have purchased without a prescription;
  • Administrative charges that you may be charged by your doctor or pharmacy;
  • Medicines purchased from a pharmacy that is not a New Zealand licensed pharmacy (this will include online pharmacies. To check that your online pharmacy is licenced to operate in New Zealand you can ring the Ministry of Health on (04) 496 25 79, or email pharmacylicence@moh.govt.nz)

Can ACC help with a non-subsidised medication?

If you would like ACC to contribute towards the cost of a non-subsidised medication, your doctor or specialist must get funding approval from ACC first. A non-subsidised medication will include any medication that is not fully paid for by the Pharmaceutical Management Agency (PHARMAC),

How to apply for funding for a non-subsidised medication

To apply for funding approval you will need to ask your doctor or specialist to complete and send in a request for pharmaceutical funding.

Your doctor or specialist will need to explain on the form:

• How the medication will help to treat your injury, and why a subsidised medication is not suitable;
• What your rehabilitation goals are, and how they will be met;
• What previous medications you have taken, and a list of your current medications..

How is an application for funding for a non-subsidised medication assessed?

Once your doctor or specialist has filled out the form, it will be reviewed by your claims manager who will assess whether it is appropriate to fund your non-subsidised medication.

The claims manager will take into account:

• What your doctor or specialist said in the form;
• Best practice literature;
• Your rehabilitation progress so far;
• Whether it is appropriate to fund the non-subsidised medication.

ACC will write to you to tell you:

• That your claim has been accepted; and
  • How long ACC will cover the medication costs;
  • How much of the costs ACC will cover; OR
• That your claim has been denied and
  • Why the claim was denied.

Limits on ACC's prescription funding

ACC will only approve medication funding for a limited amount of time, and will not always be able to cover the full cost of the medication. If the cost of the medication is higher than what ACC can pay, you may need to cover the rest of the costs of the medication after ACC's contribution.

ACC will consider renewing it's decision if you submit a new application to them.

Before agreeing to pay for medicine costs ACC will check:

• Information about your injury and current condition or conditions;
• Any assessments provided by your doctor or treatment provider;
• Other information about the pharmaceuticals and how they are helping you to recover from your injury;
• How you have rehabilitated to date.

How can your prescription costs be reimbursed?

Your prescription costs can be reimbursed in two ways:

1. ACC can pay your pharmacy directly for any costs that it approves funding for. You will not have to claim back any prescription costs. You will need to talk to your case manager about setting up direct pharmacy billing for this option.
2. You can claim back some of the prescription costs and be personally reimbursed into your bank account.
   1. Fill out a Request for Reimbursement of Pharmaceutical Costs form;
   2. Make sure that you include the following information:
      1. Each pharmaceutical/medication name;
      2. The cost for each of these;
      3. The injury that each pharmaceutical/medication was provided for;
      4. Your bank account number;
   3. You will also need to include all pharmacy receipts and invoices for the pharmaceuticals and medications that you are claiming a reimbursement for.
      1. ACC will need the original receipts and invoices from the pharmacy.
      2. If you do not have these anymore, you will need to obtain duplicates from the pharmacy.
      3. You may send ACC a scanned copy of the original receipts and invoices, however, if you choose to do this, you will need to keep the originals for six months.
      4. The receipt must show:
         1. Your name;
         2. The name of the pharmacy;
         3. The name of the pharmaceutical or pharmaceuticals;
         4. The name of the person who prescribed the medication/pharmaceuticals;
         5. The prescription number; and
         6. the amount that was charged for the medication/pharmaceuticals
      5. ACC cannot accept the following as receipts:
         1. Till receipts;
         2. Eftpos/credit card receipts;
         3. Pharmacy statements;
         4. Labels from the box or container for the medication;
         5. Faxed or photocopied invoices.

What if you disagree with a decision that ACC makes?

If ACC makes a decision regarding your application for medication funding, you can apply to have that decision reviewed.

Weekly compensation

Weekly compensation is used to cover lost earnings if you cannot work because of an injury. ACC will be able to cover your lost earnings up to 80% of what you were earning before you were injured, however there is a weekly maximum ($2,257.17 as at 1 July 2023). In order to qualify for weekly compensation, you must not be able to return to your job because of your injury.

Where were you injured?

If you were injured at work, your employer is required to pay your first week of compensation. If you have more than one job when you are injured, the job that you were injured at has the responsibility of paying you that first week of compensation.

If you are not injured at work, then you will not be eligible for the first week of compensation.

If you need to be out of work for more than one week, ACC will pay the rest of your weekly compensation.

What was your employment status when you were injured?

To qualify for weekly compensation, you need to be one of the following immediately before you were injured:

• Working as
  • An employee; or
  • A self-employed person; or
  • A shareholder employee; or
• Recently stopped working and;
  • Your final pay covers the period since stopping work; or
  • You were injured within 28 days of stopping work and had arranged to return to work, or start a new job within 3 months (or 12 months if you are a seasonal worker); or
  • You were injured whilst on parental leave.

If you were on parental leave when you were injured, your entitlement will not start until you would otherwise have needed to go back to work at the end of that parental leave. This means that if you recovered from your injury before the end of the parental leave period, you would not qualify for weekly compensation from ACC.

When does your entitlement to weekly compensation begin?

The test used to determine when your entitlement begins will be different based on whether you:

• Had stopped working for a short period of time; or
• If you had bought the right to weekly compensation; or
• If you were under 18 at the time of your injury, or if you were in full time study that you began when you were under 18 years old ("potential earner").

How long will your weekly compensation last?

ACC will not usually allow weekly compensation to continue forever, even if your injury means that you will never be able to return to the job that you had before you were injured. ACC will sometimes pay weekly compensation indefinitely if you suffer from a serious brain or spinal injury.

Once you complete vocational rehabilitation, you will be assessed using a "vocational independence" test which will look at whether you are capable of working a full time job, and what kind of job you would be able to do based on your experience, education, or training, and will take into account whether you are suited for the job based on things like the sort of income you had before you were injured.

If the assessment tells ACC that you have vocational independence, then your weekly compensation will have to stop after three months from that assessment being made. If you are not able to find a new job before the end of those three months, then you will still be able to receive an income, however it will not be available through ACC and you will need to apply for a benefit through Work and Income.

What Happens To KiwiSaver?

Your weekly entitlement payments from ACC can contribute towards your KiwiSaver account if you want to continue to add to it whilst you are injured; however these contributions are not automatic. You will need to opt in to KiwiSaver contributions again as ACC entitlements are considered a different source of income, in the same way as if you had changed jobs. You will need to fill in this form and send it in to the address listed on the form before ACC can make these contributions to your KiwiSaver account.

Because you will need to opt back into KiwiSaver contributions, you will be able to decide what percentage of your entitlement you wish to contribute to your account, so you will not have to make the same level of contributions as you were making when you were able to work.

What if your injury gets worse after your entitlement stops?

If you think that your condition has gotten worse and means that you have lost your vocational independence again, then you can reapply to ACC and ask them to cover your payments instead of Work and Income. If you reapply with ACC they will reassess whether the condition has gotten worse and whether or not it meets the test for impacting your vocational independence.

Single lump sum payments

This is a one-off, non-taxable payment that you can get in addition to weekly payments from ACC. This payment is only for people who are permanently impaired by their injuries, rather than people who are expected to recover from their injuries and return to ordinary life.

Requirements:

• You are impaired; and
• You were injured after 31 March 2002; and
• You are assessed by ACC; and
• You were alive for the assessment; and
• You had been impaired for at least 28 days; and
• A doctor assessed you as being at least 10% impaired by your injury.

What is an "impairment"?

For the purposes of this assessment, an "impairment" is a loss, loss of use, or derangement of a body part, organ system or organ function. It does not cover pain, suffering, or loss of enjoyment of life.

If the injury occurred before 1 April 2002

If your injury occurred before 1 April 2002, then you will not qualify for the lump sum payment. Instead, you will need to be assessed under the old entitlements, and ACC will decide whether or not you qualify for the scheme that was used at the time of your injury which was a weekly independence allowance.

How to start the process

The assessment can take place if either:

• Your condition has stabilised and you are likely to be permanently impaired; or
• If your condition has not stabilised but it is likely that you will be permanently impaired; or

In order for ACC to start the process of assessing you for a single lump sum payment, your doctor will need to provide a medical certificate that you fall into one of the above categories. ACC will pay for the medical certificate, and any other reasonable costs that are associated with getting it (this may include things like transport costs).

If you have a mental injury

If you have a mental injury resulting from a physical injury, ACC cannot assess you for a lump sum payment until you are over 16 years old, unless there are exceptional circumstances which mean that you should be assessed earlier. The medical certificate from your doctor will also need to tell ACC that the permanent injury was caused by the mental injury that you have.

How you are assessed

You will be assessed by an independent medical professional or doctor who will determine whether or not your injury will have a permanent effect on you. This medical professional will be chosen by ACC. The doctor will decide how much your injury impairs you, their decision will be a percentage of how much of your body is impaired by the injury. The percentage is calculated using a formula that all doctors must use. The doctor will do a formal assessment of you and your injury. In order for this to happen, the doctor will have to do this in person. ACC will pay for this assessment.

What happens after the assessment?

Following their assessment, the doctor will write a report to your case manager which will be very detailed and talk about everything that was said at the meeting, as well as your medical records and any lab findings that are relevant to the injury. This is so that ACC knows the extent of your injury, the effect that it has on you, and everything that was used to assess you and the impairment that you have. The report will also include the actual percentage that the doctor decided on.

How does the doctor decide on the impairment percentage?

The percentage of impairment that the doctor will give you is worked out using a detailed assessment that every doctor has to follow. The percentage that is given will tell ACC exactly how much you are entitled to receive as your lump sum payment. To qualify for a lump sum payment, then you will need to be assessed as being at least 10% impaired.

Can you challenge the assessment?

The assessment can be challenged once every 12 months. Because the assessment may include the doctor having to make a judgment call about a part of your impairment, they might not give the same percentage as another qualified professional, and you might disagree with the percentage that is given.

You can ask to be sent a copy of the report that the medical professional sends to ACC to find out how and why they made the decision that they did. This can help you to understand why they made their decision, and can help you decide whether or not you want to challenge the outcome.

It is important to remember that you can only ask to have your case re-assessed once every 12 months.

How to challenge the assessment:

If you disagree with the assessment or the decision about whether or not you are entitled to a lump sum payment, you can ask for a review of the decision.

To successfully challenge a decision at review or appeal, you need to be able to show that:

• The medical professional who made the decision either
  • did not look at something that was important; or
  • missed a step in the decision making process; and
• That an expert thinks that the decision that did not follow the specified guidelines.

A reviewer or the Court will not always decide that the decision was wrong just because a different doctor thinks you are more impaired. However, it can be helpful to have an expert who thinks you are more impaired because it could show that the original decision left out something important, or didn't follow the process that they were supposed to.

If you disagree with the assessment or the decision about whether or not you are entitled to a lump sum payment, you can ask for a review of the decision.

Treatment

ACC covers a number of different types of treatment including physical rehabilitation, cognitive rehabilitation and examinations that are required to obtain a medical certificate.

Examples of treatments include:

• Emergency treatment (sometimes called 'acute treatment')
• Treatments in a hospital
• Visits to a GP or physiotherapist
• Visits to a specialist (such as a surgeon)

How does ACC decide if specific treatment is covered?

ACC is required to pay for the costs of your treatment if it is:

• To help you to restore your health as much as possible;
• Necessary, appropriate, and of the required quality;
• Given at appropriate places and times;
• The type of treatment that the treatment provider giving it to you usually gives;
• Given by someone who is qualified to give the treatment;
• Given by a person who normally provides that kind of treatment;

In most circumstance treatment should only be provided after ACC has given permission, unless in special circumstances. ACC does not need to have given permission before you receive emergency treatment.

In deciding whether or not the treatment meets the above requirements, ACC will take into account:

• The nature and severity of your injury;
• How the injury is generally treated in New Zealand;
• What other treatment options there are;
• The costs compared with the likely benefits of the treatment.

What does ACC cover?

ACC can assist with the payment for the following treatments and services:

• Acupuncture treatment;
• Audiology services;
• Chiropractic treatment;
• Counselling services;
• Dental treatment and services;
• General practitioner (GP) services;
• Hand therapy treatment;
• Hospital treatment (including surgery);
• Medical specialist services;
• Nurse services;
• Occupational therapy services;
• Osteopath treatment;
• Pharmaceutical treatment (medication);
• Physiotherapy treatment;
• Podiatry treatment;
• Radiology services (including MRI and X-rays);
• Speech therapy services.

ACC provides a full list of treatments that it covers, as well as the amount that it can contribute towards the cost of each of those treatments.

Does ACC cover other services?

ACC may be able to cover you for some or all of the costs associated with your treatment such as

• Accommodation;
• Transport to and from the treatment;
• Medication;
• Laboratory tests.

What ACC doesn't cover

Most of the costs associated with your treatment will be covered by ACC. However, if there is a surcharge associated with the treatment provider (such as your doctor or physiotherapist) ACC cannot reimburse you for that charge.

How to apply for cover

If you haven't yet applied for cover for your ACC injury then you will need to make an application.

If your ACC claim has been accepted, and you need treatment, you should start by talking to your health professional. They can help to decide what kind of treatment you will need. Your health professional will be able to tell you whether the treatment that you need can be done without ACC having approved it, or if you will have to wait for ACC to approve the treatment before you go through with it. The health professional will be able to apply for the costs from ACC. Under this process you may be required to fill in a form for your doctor.

If you need to be reimbursed for your treatment you will need to fill in and send a form to ACC requesting the funds. You will need to attach all of the invoices and receipts relating to the payment of your treatment along with the form.

If you want to be reimbursed for your prescription you will need to fill in the Prescription Reimbursement Form. For all other reimbursements, fill in the general Request for Assistance form. You should also keep a copy of all of your invoices and receipts for your own records.

How will ACC let you know whether your claim is accepted?

Once ACC has made a decision about whether or not it can cover your treatment, it will get in touch with you to let you know about its decision. You will usually be informed through a letter, however, in some circumstances ACC may let you know over the phone.

Individual rehabilitation plan

You and your ACC case manager are responsible for preparing your individual rehabilitation plan. An individual rehabilitation plan is usually put together for injuries that are serious or complicated, and are expected to take more than 13 weeks to recover from.

The goal of this plan is to:

• Act as a roadmap to help you see what you need to do to return to everyday life, or work;
• Identify your needs and goals for returning to work, and for your everyday life;
  • This should be a particular goal or goals such as "to return to work in 2 months";
• Identify what assessments you need;
• Identify the treatment that ACC will fund to meet your needs and help you to achieve identified goals;
• Identify the vocational rehabilitation services that ACC will fund to meet your needs and help you to achieve identified goals;
• Identify the social rehabilitation services that ACC will fund to meet your needs and help you to achieve identified goals;
• Set a date when you hope to become independent and
  • be able to return to work full-time;
  • return to your normal social activities;
  • no longer need home help;
• Set a date for the next meeting to assess your progress;
• Be active and ongoing until you can return to work or independence.

Who prepares a Rehabilitation Plan?

Your ACC case manager will prepare the plan but should consult you in putting it together. You have the right to negotiate the contents of the plan with ACC. Other people who may participate include:

• A support person may come with you;
• Your GP;
• Your employer (if you were employed at the time of the injury).

Who pays for the Rehabilitation Plan?

If there are costs associated with the development of the Rehabilitation plan, ACC is required to cover them. ACC is also responsible for paying for any assessments that the Rehabilitation Plan requires.

What support does the Rehabilitation Plan cover?

• Vocational rehabilitation;
• Surgery;
• Counselling;
• Travel and accommodation costs associated with treatment;
• Childcare;
• Attendant care;
• Equipment to help you;
• Home modifications.

How a Rehabilitation Plan works

The steps that are involved with making and following an Individual Rehabilitation Plan are:

• You and your case manager will create and agree to a Rehabilitation Plan;
• You will need to complete the assessments set out in the Rehabilitation Plan.
• After the assessments the plan may need to be adjusted based on what happens at the assessments.
• You will need to complete the treatments and activities that are laid out in the Rehabilitation Plan, this may include;
  • Having surgery,
  • Undergoing treatment;
  • Completing rehabilitation activities.

What if your situation changes?

If your situation changes it is important to talk to your ACC case manager as it may mean that the Individual Rehabilitation Plan needs to be changed. It is important to make sure that your Rehabilitation Plan is helping you to get back your independence.

What happens once you finish the Rehabilitation Plan?

Once you have completed all of the assessments and activities outlined in the plan ACC may ask that you be reassessed. The reassessment will be to make sure that you are rehabilitated and ready to return to normal life. If you are not rehabilitated as far as possible, you may need to make a new Rehabilitation Plan.

Participation in the Rehabilitation Plan:

It is important that you complete all of the steps outlined in the Rehabilitation Plan as it is there to help you recover as much as possible from your injury. If you fail to complete the plan and refuse to participate, ACC may make a decision to stop providing you with entitlements that you are receiving such as weekly compensation.

If you are not happy with the Rehabilitation Plan

Because making a Rehabilitation Plan involves some negotiation, you may disagree with the final contents of the plan. You may also be unhappy with the decisions that ACC makes about finalising the plan, or because of steps taken by ACC if you do not participate in the plan. You are entitled to ask for a mediation or apply to have a decision reviewed if you disagree with ACC.

Social Rehabilitation

This kind of rehabilitation is designed to help you to restore your independence as much as possible. It is to help with regaining your independence in your everyday life, outside of your working life (work related independence is covered under vocational independence).

What help can ACC provide?

Social rehabilitation means that, if it will help to restore your independence, ACC may provide help with:

• Getting aids and appliances;
• Attendant care;
• Childcare;
• Education support including
  • Resource preparation,
  • Planning,
• Home help (domestic services) including
  • Cleaning,
  • Laundry,
  • Shopping,
• Home modification, including
  • Removing barriers,
  • Adding features to your home,
• Training for independence, including
  • Helping you learn how to use aids and appliances,
• Transport costs or assistance including;
  • Modifying a vehicle;
  • Purchasing a vehicle;
  • Public transport costs.

ACC can also make a decision about whether it will cover other kinds of social rehabilitation that will help you to be independent in the following areas:

• Cognitive tasks of daily living;
• Communication;
• Domestic activities;
• Educational participation;
• Financial management;
• Health care;
• Hygiene;
• Mobility;
• Motivation;
• Safety management;
• Sexuality (such as helping overcome sexual dysfunction).

What kind of help you will be able to get will depend on your individual circumstances and needs.

Eligibility

You will need to be assessed (and sometimes reassessed) to ensure that the assistance that you receive is:

• Required because of your injury;
• To restore your independence;
• Necessary;
• Appropriate;
• Of appropriate quality;

The kinds of social rehabilitation that you receive should be provided for in your Individual Rehabilitation Plan agreed between both you and ACC.

Asking for assistance

There are a number of ways to request assistance:

• Talk to your ACC case manager,
• Complete the Request for Assistance Form listing details of the help that you need,
• Attach any medical certificates, accounts, receipts, or any other proof that you have to support your claim for home help in the Request for Assistance Form.
• You can also request assistance by asking your case manager for specific assistance.

When will you know if your request is accepted?

ACC will let you know whether or not they have accepted your request for assistance. You should hear back within 21 days. If you do not hear from them, you should consider getting in touch and following up the application.

Who provides the assistance?

Assistance can be provided by any agency or individual (including a friend or family member), although ACC recommends that you use an agency they have a contract with. There are advantages and disadvantages associated with each type of care provider. For more information about selecting a care provider, talk to your case manager or read through this booklet.

If you wish to use an agency that does not already have an agreement with ACC, it is important to be aware that there may be extra costs and tax obligations. You should consider talking to your ACC case manager and an accountant if you are thinking about using an agency that does not have a contract with ACC.

Eligibility for home help

You may be eligible for home help such as assistance with cooking, cleaning and shopping when a personal injury stops you from being able to do them yourself. Home help will be available for you for as long as ACC believes that you need it, this will depend on your individual circumstances and needs. ACC will make assessments throughout your recovery to decide how long you are likely to need the help.

ACC will consider

• Whether you can no longer perform domestic activities because of your injury
• Whether your family needs help with domestic activities because of the extra demands of your injury
• How much of the domestic chores you carried out before your injuries, and how much you can still do after your injury
• The number of household family members and how much help they need
• How much of the domestic activities were carried out by other family members before you were injured
• How much of the domestic activities other family members might reasonably be expected to carry out after the injury

The help that you will be able to get will depend on your individual circumstances.

Eligibility for childcare

You may be eligible for childcare assistance if your personal injury means that you can no longer provide that care yourself. Childcare help will be available for you for as long as ACC believes that you need it. This will depend on your individual circumstances and needs. ACC will make assessments throughout your recovery to decide how long you are likely to need the help.

ACC will consider:

• How much childcare you were responsible for before you were injured;
• How much childcare other people in the household provided before you were injured;
• Who else might reasonably be expected to provide childcare since your injury.

The child or children that the care is for must be under 14 years old, or under 18 years old if they have a physical or mental condition that means that they need care.

The child or children must also be either:

• Your biological child;
• Your adopted child;
• The child of your partner or spouse, that you act as a parent for;
• A child who usually lives with you, that you raise as your own child and that you parent. (This may include a foster child or a whangai child);

It is important to be aware that childcare assistance will not cover any arrangements for care that you had in place before your injury. This means that ACC will not pay for childcare arrangements that your children were enrolled in before you were injured. ACC will only cover childcare that is necessary because your injury stops you from providing the kind of childcare that you did before the injury happened.

Eligibility for attendant care

You may be eligible for attendant care assistance if you need help performing tasks because of your injury. This might include help with personal care, daily living and protecting you from further injuring yourself. The assistance will be available to you for as long as ACC believes that you need it, which will depend on your individual circumstances and needs, ACC will make assessments throughout your recovery to decide how long you will need the help, and whether your needs have changed.

When deciding about eligibility and what kind of assistance you can get, ACC will consider:

• The nature and extent of your injury, and how much the injury gets in the way of your ability to care for yourself;
• How much other family members might reasonably be expected to attend to your personal care;
• Whether attendant care might help you to attend work or education;
• What kind of rehabilitation outcome you could achieve using attendant care;
• How much attendant care you would need to give family a break from helping care for you.

The kind of assistance that you get, and the amount of help that you qualify for will depend on your individual needs and circumstances, and may change throughout the recovery process.

Personal aids and equipment:

You may be eligible for special equipment that will help you to become independent in your daily life as quickly as possible. Once you have applied for cover for equipment, ACC will arrange for someone to meet you and assess your needs. They will discuss with you the different ways that your needs can be met, and whether getting special equipment is the best way to help you recover from your injury.

ACC can help you by providing equipment such as

• A wheelchair or walking frame;
• A shower tool or seat;
• Special kitchen utensils;
• Reading aids;
• A Braille device;
• Special telephone;
• Modifications to your workplace.

ACC may also be able pay for batteries or other consumables that the special equipment needs to work properly.

ACC will not be able to cover you for equipment that is:

• Similar to something that you already have, unless your equipment is no longer suitable;
• Similar to something that you already had which was suitable, but was disposed of after your injury;
• Is more expensive than another piece of equipment that is suitable for your needs;
• Needs to be replaced because you didn't look after it;
• Needs to be replaced because you used it incorrectly.

The equipment and cover that you will qualify for will depend on your individual needs and circumstances.

Most of the equipment that ACC provides is owned by ACC. You will be able to use it for as long as you need it, and once you no longer need it, ACC will arrange for it to be returned.

Special equipment will usually take around 5 working days to be delivered to you, however this may vary depending on whether you need it urgently, or if the equipment needs to be specially designed to suit you.

Vocational rehabilitation

Vocational rehabilitation is assistance from ACC that is designed to help to restore your independence in your working life. The purpose of this kind of rehabilitation assistance is to help you to:

• Keep your current employment;
• Find employment that is suitable and appropriate for you, based on your training and experience;
• Regain, or acquire the capacity to work full time (at least 30 hours per week) in work that is suitable based on your training and experience.

Eligibility

Vocational rehabilitation is usually only available to people who were working at the time of their injury.

ACC will provide you with some kind of rehabilitation if you have been approved for cover and:

• Are unable to work in the job that you had before your injury, and are therefore entitled to weekly compensation;
• Are likely to have to stop work if you do not receive vocational rehabilitation, and you are entitled to weekly compensation;
• Were injured whilst on parental leave.

Vocational rehabilitation is always included in an Individual Rehabilitation Plan, which should set out the path that is the most appropriate in your circumstances.

ACC will need to determine whether or not it is reasonable to expect you to return to the job that you had before you were injured. If not, ACC is required to identify which of the following options is the most appropriate:

• Finding a different job with the same employer; or
• Finding the same type of work with a different employer; or
• Finding a different job with a different employer, that uses your existing skills; or
• ACC providing extra help for you to use your skills to find work.

When will you know whether you are eligible?

ACC will let you know whether or not they have accepted your request for assistance. You should hear back within 21 days. ACC or someone associated with ACC may contact you within the first week to discuss appropriate services and assistance with you.

If you do not hear from them, you should consider getting in touch and following up the application.

If you are returning to your current work

• A professional, non-ACC assessor will conduct a workplace assessment to determine how much of your old job you can still do;
• The assessor will report back to your case owner and help them decide what rehabilitation you will need.

This assessment will help to determine what kind of assistance will best help you to rehabilitate you as much as possible.

If you are not likely to return to your current work

If your injury means that you are unlikely to be able to return to the job that you had before you were injured, your case owner will organise:

• An occupational assessment to identify:
  • Your skills,
  • Suitable work options,
• A medical assessment to find out which of the suitable work options would be suited to your medical needs.

These assessments will help to determine what kind of assistance you will need to rehabilitate as much as possible.

Vocational rehabilitation - help available.

Vocational rehabilitation can include help such as:

• Transport to and from work;
• Special equipment in the workplace;
• Occupational assessments;
• Medical assessments;
• Helping you prepare to look for a job;
• Programmes to build your abilities and confidence.

The kind of help that ACC will provide you with will depend on your individual needs and circumstances; as well as the most appropriate rehabilitation path. For example:

• If the rehabilitation plan is aimed at keeping you in the job that you had before you were injured then you may receive:
  • A workplace assessment,
  • Short term transport assistance,
  • Special equipment at work.
• If you cannot return to the job you had before your injury, you will have an occupational assessment to identify skills and work options. Work options will take into account everything, including how much you were earning before you were injured.

How does ACC decide what cover you will get?

You ACC case owner will discuss your needs and circumstances will you. If it is appropriate, the case owner will also talk to your employer and your doctor. Everyone who is consulted by the case owner will help to decide the kinds of assistance that will best meet your needs.

Once your case owner has decided what they think is the best kind of assistance to provide you with, and you agree with them, your rehabilitation plan will be updated to include

• The agreed kind of assistance that you will receive;
• When your assistance will begin;
• The date that you are expected to be rehabilitated by.

How long does vocational rehabilitation last?

ACC will provide you with vocational rehabilitation until:

• You are able to return to the job that you had before you were injured; or
• You find a new job; or
• You are not able to return to your old job, but you are able to work full-time in a job that you are suited to, based on your training and experience (called 'vocational independence'); or

The maximum period of time that ACC will usually fund vocational rehabilitation is three years.

Stopping entitlement

If ACC is not satisfied based on the information that it has that you are entitled to receive an entitlement, your entitlement may be:

• Suspended; or
• Cancelled; or
• Declined.

If ACC intends to do this, they must give written notice of this, and set out a reasonable amount of time before they suspend, cancel or decline the entitlement.

When can ACC decline to provide entitlements?

ACC can choose not to give you entitlements whilst you are:

• Unreasonably refusing/failing to comply with any requirement that the Accident Compensation Act sets out that relates to your claim; or
• Unreasonably refusing/failing to undergo medical or surgical treatment that you are entitled to receive; or
• Unreasonably refusing/failing to agree to, or comply with, an individual rehabilitation plan.

Entitlements can also be refused if you:

• Have been awarded damages in a civil court (in some situations);
• Have deliberately injured yourself, or the fatal injury was caused by suicide;
• Are in prison;
• Are convicted of murder;
• Were injured committing a serious crime.

If you were injured whilst committing a crime

If you were injured whilst committing a crime you will only qualify for the following entitlements:

• Treatment; and
• Any elective surgery needed to enable you to return to work

You will not automatically not qualify for other entitlements if:

• You were injured whilst committing a crime with the maximum sentence being at least 2 years imprisonment; and
• The injury would be covered by ACC; and
• You are sentenced to either home detention or imprisonment.

If you meet all three requirements then you will automatically not qualify for any entitlements except for treatment and elective surgery to enable you to return to work.

The Minister for ACC can decide, in exceptional circumstances, to override the disentitlement. If this happens then you will be able to access entitlements that would have been available had the above three requirements not been present.

Deliberate self-inflicted injury

Entitlements will not usually be paid for a self-inflicted injury or suicide.

In order to qualify for ACC entitlements, a claimant will need to show that the fatal injury was the result of a mental injury that would be covered by the ACC scheme. The mental injury must be one that ACC would ordinarily cover.

It can be difficult to show that the deceased was suffering from a covered mental injury unless ACC had already recognised the injury and was providing cover for it before the fatal injury occurred.