How to challenge a denial of ACC
What can I do if I'm unhappy about a decision by ACC?
If your claim for Accident Compensation has been denied, or if you're unhappy with an aspect of the decision granting your claim, you can apply for a formal review of the decision. ACC must tell you, at the appropriate time, about your right to have a review.
You must follow this review procedure, as you cannot use any other remedy in court or in the Disputes Tribunal. There is, however, a right of appeal to the courts after you have been through the review process.
The laws that govern accident compensation (including the review procedure) are contained in the INJURY PREVENTION, REHABILITATION, AND COMPENSATION ACT 2001, most of which came into force on 1 April 2002. The new Act has not changed the essentials of the scheme, but among other things it does provide for a new Code of ACC Claimants' Rights to be drawn up and adopted.
As well as using the formal review procedure, you can also complain at any stage about anything to do with the management of your claim to the ACC Complaints Investigator: see below.
Talk to your ACC Case Manager first
If you're unhappy with an ACC decision, the fastest and most effective way of getting the decision changed is likely to be to raise the matter with the ACC staff member dealing with your claim. It may be that your challenge to the decision will be upheld by an internal review without a formal review being necessary.
If you think that your rights under the Code of ACC Claimants' Rights have been breached â€“ for example, if you haven't been treated with dignity and respect â€“ you have a specific right to complain under that Code. You can complain either to the person you've been dealing with (or his or her manager) or to ACC's complaints service (see below). For more information on your rights under the Code, see the related article How to claim accident compensation.
What decisions can I challenge?
You can challenge many aspects of a decision, including:
- whether you're covered or not
- whether you'll be provided with any entitlements
- which entitlements you'll be provided with
- the level of entitlements
- any preliminary decisions that are necessary for the above decisions to be made
You can also apply for a review:
- if ACC take an unreasonably long time in dealing with your claim, or
- if you've complained to ACC that they've breached your rights under the Code of ACC Claimants' Rights and you're unhappy with ACC's response to your complaint (for more on this new Code, which was still in draft form as of June 2002, see How to claim accident compensation)
How do I apply for a review?
You should apply for a review in writing, using the special form that ACC provides for this purpose.
Is there a time limit for lodging my review application?
You must apply for the review within three months after the decision. But ACC must accept a late application if there are extenuating circumstances â€“ for example, if you were so traumatised by the injury that you weren't able to think about applying for a review.
Who conducts the review?
ACC uses Dispute Resolution Services Ltd (DRSL) to carry out its reviews. DRSL was formed as an independent subsidiary company of ACC out of ACC's old review section.
Dispute Resolution Services begins by assigning a review support officer to your case. The support officer will make all the arrangements for your hearing, including arranging for a professional reviewer to conduct the hearing. The support officer is the person you should contact if you have any questions or concerns about your case. DRSL have published a booklet, "It's Your Review", that explains the review procedure.
The review hearing
A review hearing must be held unless all the parties agree otherwise.
The hearing must take place within three months from the date of your application for review. If it does not, then it is deemed that a decision has been made in your favour.
Reviewers are required to act independently. They must also comply with the principles of natural justice and act in a "timely manner".
The reviewer looks at the matters afresh, on the basis of the information provided at the review. He or she must also ignore the insurer's policy and procedure and decide the question on its substantive merits.
At the hearing sworn evidence may be introduced, and the reviewer makes findings of fact. Dispute Resolution Services advises that if you wish to present written evidence at the hearing (such as bills, letters and doctor's reports) you should send them to the ACC case manager, the DRSL review office and the other parties to the hearing as soon as possible before the hearing.
Hearings usually last up to an hour, although more complicated cases may last longer.
Who can attend the review hearing?
As well as you and ACC, all those directly affected by the decision are entitled to attend - for example, if the decision relates to workplace injury, your employer may attend.
All those attending, including you, have the right to bring a representative to speak on their behalf, such as a lawyer or a union official. You're free to bring a member of your family or whanau to your hearing as a support person.
What powers does the reviewer have?
The reviewer may do any of the following:
- dismiss your application for review
- modify ACC's decision
- quash ACC's decision and either substitute the reviewer's own decision or require ACC to make a new decision in accordance with the reviewer's directions
- if the review is of an unreasonable delay by ACC in making a decision, either
- direct ACC to decide your claim within a set time, or
- make the decision for ACC
The reviewer's decision must be made within 28 days after the hearing. (If there wasn't a hearing, the decision must be within 28 days after a day agreed on by all parties for this purpose.)
Who pays for the review?
ACC must pay the costs of providing the review.
You're responsible for meeting your own costs (for example, hiring a lawyer and travel), with the following exceptions:
- If the reviewer finds that the decision was wrong, wholly or partly, he or she must order ACC to contribute towards your costs (within set limits).
- Even when the reviewer decides ACC's decision was correct, the reviewer can order ACC to contribute towards your costs if he or she thinks that you acted reasonably in applying for the review.
Any costs and expenses that you are awarded must be paid within 28 days.
The maximum costs that you may be awarded are relatively low and are unlikely to meet your legal costs if you hire a lawyer. However, you may be eligible for civil legal aid: see How to obtain civil legal aid.
Can I appeal the reviewer's decision?
Yes, you have a right of appeal to the District Court (unless the review was of a breach of the Code of ACC Claimants' Rights). You must file your appeal within 28 days of receiving the reviewer's decision. There is a narrow discretion for the court to allow late appeals, but you shouldn't rely on this.
You can appeal to the High Court from the District Court's decision, but only on a question of law.
Making a complaint
As well as the formal review procedure, ACC provides a procedure for making complaints. A complaint might be about ACC's policies or practices, or about a decision on a claim you've brought, or about a breach of your rights under the Code of ACC Claimants' Rights (for the Code, see How to claim accident compensation).
Complaints are made to the ACC Complaints Investigator. While the Complaints Investigator's office is part of ACC, it is supposed to deal with complaints impartially and independently. It will investigate your complaint, and check that you've received service of a proper standard and that you've received everything that you're entitled to. It will attempt to resolve the matter and, if necessary, it can also make recommendations to ACC about its policies or about problems with the ACC laws.
You can complain about an ACC decision even if you've also applied for the decision to be formally reviewed. (If you and ACC both agree, the review can be delayed until your complaint is dealt with.)
How do I contact the Complaints Investigator?
If you're not happy with the response of the local ACC office to your complaint, you can complain to the ACC Complaints Investigator in one of the following ways:
- Write to or fax the Complaints Investigator's office at:
- Freepost 264
PO Box 242
Fax: (04) 918 7580, or
- Freepost 264
PO Box 90341
Fax: (09) 915 8317
- Freepost 264
- Phone them by ringing 0800 650 222 (weekdays 8 am to 5 pm)
- Email them at: email@example.com
- You may wish to use the skills of a lawyer at a review hearing so that the best possible case is presented. If you decide to appeal the reviewer's decision to the court, you should hire a lawyer.