We know that some of our community feel apprehensive about accessing ACC following an injury. We have been in contact with ACC to have the process explained further and give some clarity around what they do.
When an accident claim is received they first assess if this is a true accident by itself, or whether it was secondary to another underlying health condition. From there the accident is allocated into one or more of four tiers, which will relate to how much care and support you will need to recover.
- Enabled Recovery – Provider care (only requiring Osteo/Physio etc)
- Assistive Recovery – Transitional care (from a specialist or hospital to only needing Osteo/Physio etc)
- Support Recovery – Needing further care, such as surgery and access to home help and work support, as well as other therapies.
- Partner Recovery – Long term injury with impact to life, requiring long term/life long care and support.
Most injuries are usually under tier 1 & 2 which are looked after by a team rather than a specific case manager, where as tiers 3 & 4 do have case managers.
One thing we asked about was the fact that people were concerned that they may have to call back and explain their situation multiple times, as nobody appreciates having to re-explain a difficult situation. They have assured us that every phone call received is typed up at the time to assist with any other call backs. We also asked whether there are any ‘red flags’ in the system when they see a patient is requesting ACC help but have Ehlers-Danlos Syndromes. They relayed that there are no such red flags and that every case is assessed on that specific accident. It is up to the medical professional who completes the ACC form on your behalf to include all information relevant to the injury.
We wanted to make sure that our community felt comfortable accessing ACC when they truly needed it and this was what my meeting was to ascertain. If you find yourself in a situation where you have been denied cover and you believe you are entitled to this there are a couple of options.
First and foremost, call ACC and speak to a case manager about your case, and get an understanding of why they believe you are no longer entitled to care under their service for this incident.
Secondly, talk to the health professional you are currently accessing. They should be looking after your care and will be able to advocate for you if they believe you are still entitled to care under ACC for this incident.
Thirdly, there is a third party navigation service called Way Finders that you can contact. They will review your case from a neutral standpoint and be able to assess it to see if you are entitled to care under ACC for this incident. This can be found here www.wayfinders.org.nz or by calling 0800 273 037. We are starting the conversation with Way Finders to ensure they have information on EDS and hope to continue a relationship to keep this conversation open.
Below is a break down of the Tiers from ACC in more detail.
Clients primarily manage their own recovery. They’ll use a self-service website to request support or equipment, find out about their payments and report on recovery progress. There’ll be a team of people available if the client needs to speak to us and we’ll follow up if we see things are not going as planned.
- Clients can get help faster by ordering their own equipment or support service
- Clients can play a greater part in their own recovery by taking action when they need something
- A team of people will be ready to provide support if the client needs to talk to us.
Clients primarily manage their own recovery. One of our team will contact them if there’s something specific to discuss and we’ll be available if the client need to talk to us. Clients have a contact number to a team and do not have a dedicated recovery coordinator.
- We’ll contact the client and employer at times when it is critical to them, eg when they’re preparing to return to work
- A team of people will be ready to provide support if the client needs to talk to us
- We’ll have all the information about the claim available to us so the client won’t need to repeat their information. This includes information notes about previous conversations
- Clients can do a lot themselves, eg order equipment or taxis, and check payments.
Clients with more complex needs have a dedicated ACC contact who works with them and their employers during their recovery.
- We provide the right level of support to meet the client’s specific needs
- The client would have a single point of contact when the client has more complex needs.
Clients and employers with complex and long-term needs build a relationship with a dedicated ACC contact and work together to help the client to manage their injury or recovery.
- Working with a Recovery Coordinator who has more specialist knowledge
- A high-level of support from us
- A dedicated person who gets to know the client and understands their needs.