ACC - What it Does Cover and What it Doesn't Cover

14 August 2015

Many of us treat ACC like a Tax.  While it is compulsory it is, however, insurance.  But what exactly does it cover and more importantly what doesn’t it?  

ACC will pay for treatment for accident related injuries.  You may be surprised by your ACC history as many of us don’t even know if a treatment was paid by ACC. One of our clients recently asked to see their ACC history believing he’d never made a claim as he’d never been “Off work on ACC”.  He was 40 and had over 80 treatment claims recorded as being covered by ACC.    

ACC also pays up to 80% of the income that a person was earning prior to any injuries that stop them from physically being able to work.  

 ACC will not pay for any investigations or treatments for what they consider to be related to illness -  no matter how severe they are.  So a person who has a more severe illness such as Cancer may have a lot less cover compared to someone with a less severe condition like a broken leg but was related to an injury. 

ACC will not pay out on any condition they classify as “degenerative”.  A common example may be an old sporting injury that eventually requires a joint replacement.  However it’s not required for some years (mayby decades) during which time there are signs of degeneration.  ACC could (and indeed this is becoming more and more common) decline to cover the treatment believing it to be more degenerative than injury related.  This means that claiming when you are older has a higher chance of being declined due to some element of wear and tear is likely to be involved.

 If a claim is not covered by ACC then you have the following options:

  • Fund the treatment yourself
  • Fund the time off work yourself
  • Go on to the Sickness benefit
  • Use the Public System
  • No treatment
  • Have private health and/or income protection insurance

We have a fantastic public health which is funded by the Government.  The amount of money that is pumped in to our health system is a huge part of our GDP.  Yet it is still severely stretched due to the growing demand placed on it.  ACC shares this burden but only in the accident related area.    

If you are off for a long period of time it is most likely going to be due to an illness and not an injury.  If someone is reliant only on ACC as their “insurance” then they are exposed to a substantial financial risk.  Our recommendation for those in paid employment is to have private Income protection insurance.  While this also pays out for accidental related injuries it pays out for any condition that stops you from working due to sickness or that may be disputed by ACC.  

We also believe that medical insurance is becoming an essential element of any insurance package.  While our public system is great it is too stretched to deal with all requirements in a timely manner and the longer we have to wait for our care and treatment the more risk we put on ourselves for our recovery.  



Published In Whakatane Beacon

This post was written by

Trish Marsden - who has written 96 posts

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