The ACC Scheme. 1 The Injury Prevention, Rehabilitation, and Compensation Act 2001 sets the framework for New Zealand s accident compensation scheme.

Transcription

1 The ACC Scheme 1 The Injury Prevention, Rehabilitation, and Compensation Act 2001 sets the framework for New Zealand s accident compensation scheme. 2 The ACC scheme provides comprehensive, 24-hour, no-fault cover and entitlements for all New Zealand citizens, residents, and temporary visitors to New Zealand who suffer a personal injury. In return, people do not have the right to sue for personal injury, other than for exemplary damages. 3 The ACC scheme is administered by the Accident Compensation Corporation (ACC) a Crown Agent under the Crown Entities Act 2004, with the Department of Labour as its official monitoring agency. What does ACC cover? 4 Establishing cover under the ACC Scheme hinges on three criteria ascertaining that a person has sustained a personal injury, the cause of that personal injury, and where the injury was sustained. 5 ACC generally covers the treatment of personal injury that is, a physical or mental injury caused by a physical injury, a mental injury caused by sexual assault or abuse or work-related mental injury. 6 Personal injury does not include emotional effects such as hurt feelings, stress or loss of enjoyment (unless it s the result of a mental injury covered by the scheme). 7 If it is established that a claimant has sustained a personal injury, ACC only provide cover for a personal injury caused by one of the following: accident at work, home, or on the road work-related gradual process, disease or infection treatment injuries sexual assault or abuse work-related mental injury Who does ACC cover? 8 ACC provides cover for those people suffer a personal injury in New Zealand, whether they are earning or not. A person may also be covered when they are injured overseas if they are considered to be ordinarily resident. A person is ordinarily resident in New Zealand if they: are a New Zealand citizen hold a residence permit for New Zealand

2 hold a returning resident s visa or residence visa allowing them to lawfully return or come to New Zealand are exempt from any requirement to hold a permit under the Immigration Act 1987 are a spouse, child or dependant, who generally accompanies a person who fits one of the above criteria. 9 The person must also have New Zealand as their permanent place of residence. Whether or not the person also has a home outside NZ is not relevant for this definition. 10 Overseas visitors to New Zealand may also be covered by ACC, if they meet ACC s cover criteria. What are ACC claimants entitled to? 11 Once cover has been established, the Injury Prevention, Rehabilitation, and Compensation Act 2001 (IPRC Act) includes a range of entitlements to rehabilitate or compensate claimants who have suffered personal injury covered by the Scheme. Entitlements include: rehabilitation, which may involve treatment, social and vocational rehabilitation, lifetime rehabilitation planning, and associated ancillary services weekly compensation lump sum compensation for permanent impairment or an independence allowance for impairment in respect of injuries suffered before 1 April 2002 death benefits for surviving dependents. Rehabilitation 12 The aim of rehabilitation is to assist in restoring to the maximum practicable extent a claimant s health, independence and participation in society. Treatment 13 Treatment aims to restore the claimant s health. It includes: physical rehabilitation cognitive rehabilitation examinations or assessments for the purpose of providing a certificate to ACC (such as a medical certificate for time off work). 14 ACC provides treatment through: paying treatment providers for claimants treatment visit/consultations and procedures, according to the Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment)

3 providing bulk funding to the Crown for hospital emergency departments, acute inpatient and follow-up medical outpatient services. Treatment is paid for via the Public Health Acute Services Service Agreement. An amount for this is negotiated annually between the Minister of Health and the Minister for ACC. funding other treatment services (such as elective surgery), usually through ACC contracting with private and public providers. Social rehabilitation 15 Social rehabilitation, paid for by ACC through contracts, aims to restore a claimant s functional independence and is provided through entitlements, such as: aids and appliances e.g. wheelchairs and walking frames home help, child care and attendant care modifications to the home transport for independence, such as modifying and purchasing vehicles training for independence programmes community nursing. Vocational rehabilitation 16 The IPRC Act aims to help claimants to maintain or obtain employment, or regain or acquire vocational independence. 17 Where possible, research suggests that it is best for claimants to stay in the job they held before their injury. ACC therefore provides for: occupational assessments to review the working environment and ways to help a claimant to do all or some of their work tasks as their injury improves engaging the claimant s employer in rehabilitation equipment to help a claimant at work help with pain management. 18 In some cases, employment maintenance programmes may be provided before the claimant returns to work, and while they are undergoing rehabilitation. 19 Employers are expected to take all practical steps to help an injured employee in their vocational rehabilitation whether or not the injury is work related.

4 20 ACC is required to assist claimants who are unable to return to their preinjury job. The programmes include an initial occupational assessment, which identifies the types of work that may be suitable for them, and an initial medical assessment, which assesses whether those types of work are medically sustainable and if any further rehabilitation is required. 21 Following rehabilitation, ACC may require claimants to have their vocational independence assessed by an occupational and a medical assessor. These assessments aim to ensure that vocational rehabilitation, identified in the claimant s individual rehabilitation plan, has addressed any injury-related barrier to employment or vocational independence. The assessments contribute in determining whether the claimant can undertake work to which they are suited by reason of education, experience or training for 35 hours per week or more. A person may achieve Vocational Independence as a result of this process which means that weekly compensation will be withdrawn after three months. Ancillary services 22 Ancillary services help claimants to access treatment and social or vocational rehabilitation. They include: emergency transport by ambulance transport to treatment (except where transport is the responsibility of district health boards) transport required to obtain certain types of vocational and social rehabilitation travel for escorts and support people in specific situations payment for pharmaceuticals prescribed for ACC-covered injuries. help with accommodation for claimants, escorts and/or a support person in certain situations. What is compensated? Weekly compensation entitlements earnings-related compensation 23 Claimants may be eligible for weekly compensation for earnings lost, up to 80% of pre-injury earnings, as a result of their injury. The calculation to determine the amount paid is prescribed by ACC legislation. To be eligible for weekly compensation the claimant must have been in employment and receiving earnings immediately before the injury occurred. Provision for a minimum and maximum amount of weekly compensation is also included. Lump-sum compensation entitlements compensation for permanent impairment 24 Lump-sum payments have replaced the Independence Allowance for injuries that occur on or after 1 April Claimants injured before then can still

5 25 Lump-sum compensation is only payable if the claimant is assessed as having a whole person impairment of 10% or more, which may include pain, and mental and behavioural disorders caused by personal injury. Payment levels, graduated to reflect the level of impairment, are adjusted according to changes in the Consumer Price Index. 26 Claimants not eligible for lump-sum compensation can still be considered for the Independence Allowance. Death benefits compensation to surviving spouses and dependents 27 An accepted fatal claim (a claim for entitlements arising from fatal injuries) may qualify for: a funeral grant survivors grants for surviving spouses, children and other dependants weekly compensation for surviving spouses, children and other dependants (where the claimant was an earner). Surviving spouses can apply to ACC to convert their entitlement to a single amount. The Maximum amount payable is 80% of the deceased s assessed earnings. childcare for the claimant s children. Who pays for the ACC scheme? 28 Funding for the costs incurred by the scheme are managed through six separate Accounts. ACC s Accounts (except the Non-Earners and Treatment Injury Accounts) are funded through levies set by the Government to meet the costs of providing rehabilitation services and compensation. ACC levies are assessed to ensure that sufficient levies are collected in a levy year to fund the current and estimated future cost of claims made as a result of injuries that occur during the levy year i.e. fully funded. The six separate Accounts are maintained for specific purposes:

6 Explanation of the ACC Accounts Account Funder Cover Entitlements Work Account (formerly Employers Account and Self- Employed Work Account) Employers, selfemployed, private domestic workers, and shareholder employees based on the earnings Work injuries to employees and selfemployed that happen on or after 1 July 2000 of their employees Net levy income: 639 Claims liability: 1,267 Residual Claims Account Net levy income: 315 Claims liability: 2,767 Earners Account Net levy income: 905 Claims liability: 2,453 Motor Vehicle Account Net levy income: 590 Claims liability: 3,964 Treatment Injury (formerly Medical Misadventure Account) Net levy income: 121 Claims liability: 886 Employers based on the liable earnings of their employees; Self -Employed based on their earnings Earners and selfemployed based on their earnings Motor vehicle owners and users through an annual vehicle levy collected through registration and an excise on petrol Currently from earners (via the Earners levy) and the Government Work injuries to earners with exposure before 1 July 1999 and non-work injuries to earners that occurred before 1 July 1992 Non-work injuries to earners and selfemployed occurring outside the workplace for those in paid work on or after 1 July 1997 All injuries involving moving vehicles on public roads since 1 July 1992 Injuries resulting from all adverse medical and treatment events as of 1 July 2005; injuries resulting from medical error and medical mishap after 1 July 1992 and before 1 July 2005 Compensation for Loss of income, medical treatment, rehabilitation, lump sums, death entitlements, elective surgery, dental treatment, and transport costs Non-Earners Account Net levy income: 719 Claims liability: 2,398 Government Injuries to people not in paid employment Medical treatment, rehabilitation, lump sums, death entitlements, elective surgery, dental treatment, and transport costs