The Accident Compensation Corporation (ACC) scheme is not limited to New Zealand citizens or permanent residents. If you are injured in New Zealand, you are covered — regardless of your nationality, visa status, or how long you have been in the country.
Under section 20 of the Accident Compensation Act 2001, a person has cover for personal injury suffered in New Zealand. This includes tourists, visitors, international students, temporary workers, and anyone else physically present in New Zealand when the injury occurs.
There are some exclusions for visitors while travelling to, around, and from New Zealand, set out in section 23 of the Accident Compensation Act 2001.
If you are ordinarily resident in New Zealand, you may also have cover for personal injuries suffered outside New Zealand. Under section 22 of the Accident Compensation Act 2001, cover extends to ordinarily resident New Zealanders who are injured overseas, subject to certain conditions. However, the scope of this overseas cover has been the subject of recent litigation, particularly in relation to whether the physical injury causing a subsequent mental injury must itself have occurred in New Zealand.
Before the Accident Compensation Corporation (ACC) will provide cover, you must show that your injury was caused by an “accident” as defined in the legislation. This is a legal definition — not the everyday meaning of the word.
Under section 25 of the Accident Compensation Act 2001, an “accident” means:
The Accident Compensation Act 2001 explicitly states: “The fact that a person has suffered a personal injury is not of itself to be construed as an indication or presumption that it was caused by an accident.” This means that just because you have an injury does not automatically prove it was caused by an accident. You must establish the causal link between the accident and your injury — and this is where many claims fail.
Under section 26 of the Accident Compensation Act 2001, “personal injury” includes several categories of harm. Each has its own requirements and limitations.
The most common type of cover is for physical injuries caused by an accident as defined in section 25 of the Accident Compensation Act 2001. This covers injuries such as broken bones, sprains, cuts, and other physical harm resulting from a specific event involving external force.
Personal injuries caused by a work-related gradual process, disease, or infection are covered under section 30 of the Accident Compensation Act 2001. To qualify, the task, property, or exposure that caused the injury must have been a substantial cause of the injury, and it must be shown that people in the same type of employment are significantly more likely to develop that condition than people who are not in that employment.
Under section 32 of the Accident Compensation Act 2001, a “treatment injury” is a personal injury suffered by a person seeking or receiving treatment from a health professional. The injury must have been caused by the treatment, and it must not be a necessary part or ordinary consequence of that treatment, taking into account all the circumstances including the person’s underlying health condition and the clinical knowledge at the time.
Treatment injury does not include injuries that result from a person unreasonably withholding or delaying their consent to treatment. The fact that treatment did not achieve the desired result does not, of itself, constitute a treatment injury.
Under section 26(1)(c) of the Accident Compensation Act 2001, personal injury includes mental injury suffered because of physical injuries suffered by the claimant. This means that if you suffer a physical injury and develop a mental health condition as a direct result — such as post-traumatic stress disorder (PTSD), depression, or anxiety — that mental injury may be covered.
However, “pure” mental injury (mental harm without any underlying physical injury) is not generally covered unless it falls within the specific categories for mental injury caused by certain criminal acts under section 21 of the Accident Compensation Act 2001, or for work-related mental injury under section 21B of the Accident Compensation Act 2001.
Under section 26(1)(e) of the Accident Compensation Act 2001, personal injury includes damage (other than wear and tear) to dentures or prostheses that replace a part of the human body. However, section 26(6) of the Accident Compensation Act 2001 explicitly provides that prostheses does not include hearing aids, spectacles, or contact lenses. Damage to these items is not covered.
New Zealand’s accident compensation scheme is often described as “no-fault.” This is misleading. While you do not need to prove that someone else was at fault for your injury, you must still prove “causation” — that is, that your injury was caused by an accident, a gradual process, or treatment. This requirement applies to every single claim.
The Forster, Barraclough, and Mijatov report “Solving the Problem: Causation, transparency and access to justice in New Zealand’s personal injury system” (2017) found that the Accident Compensation Corporation (ACC) applies causation in a narrow, technical, and legalistic way that frequently requires claimants to obtain legal advice, representation, and complex medical evidence — all at their own expense.
The leading authority on causation in Accident Compensation Corporation (ACC) cases is the Court of Appeal decision in Accident Compensation Corporation v Ambros [2007] NZCA 304. In that case, the Court of Appeal drew a critical distinction between legal causation and medical or scientific causation.
The Court held that the legal approach to causation is different from the medical or scientific approach. Where medical evidence may only acknowledge a “possible connection” between an event and an injury, the legal method allows courts to draw “robust inferences” based on the sequence of events. The standard of proof is the balance of probabilities — not beyond reasonable doubt.
“The legal approach to causation is different from the medical or scientific approach… the legal method looks to the presumptive inference which a sequence of events inspires in a person with common sense.”
Accident Compensation Corporation v Ambros [2007] NZCA 304, [2008] 1 NZLR 340
The Court of Appeal also noted that proximity alone may be sufficient to prove causation in some circumstances — for example, where a person develops an allergic reaction shortly after receiving a penicillin injection. The Court cautioned against placing excessive weight on statistical evidence, observing that statistics can create an “illusion of precision.”
The standard of proof for Accident Compensation Corporation (ACC) claims is the civil standard: the balance of probabilities. This means you must show that it is more likely than not that your injury was caused by the accident or event. This is a significantly lower threshold than the criminal standard of beyond reasonable doubt.
In practice, however, the Accident Compensation Corporation (ACC) often requires claimants to provide medical evidence that meets a higher standard than the law requires. The Forster, Barraclough, and Mijatov report found that the Accident Compensation Corporation (ACC) selectively deploys higher evidential burdens for claims it considers “high risk” or expensive, while accepting lower-risk claims on the basis of a general practitioner’s agreement alone.
A Performance Improvement Framework (PIF) review of the Accident Compensation Corporation (ACC) in December 2014 identified a pattern where the Accident Compensation Corporation (ACC) swings between a focus on claimant satisfaction and a focus on financial performance. Because the standard of causation is inherently flexible, the way the Accident Compensation Corporation (ACC) applies it can effectively tighten or loosen without any change to the law — and without public consultation or parliamentary scrutiny.
One of the most common reasons the Accident Compensation Corporation (ACC) declines or limits claims is the presence of a pre-existing condition or degenerative change. If the Accident Compensation Corporation (ACC) determines that your symptoms are attributable to a pre-existing condition rather than the accident, it may decline cover entirely or accept cover for the initial injury but refuse to fund ongoing treatment.
The High Court addressed this issue in Johnston v Accident Compensation Corporation [2010] NZHC 1726, where the Court acknowledged the link between the accident and the claimant’s current condition, but held that more is needed than the triggering of an existing injury.
“Obviously there is a link between the accident and Mr Johnston’s current situation. But a settled line of authority has said that is not enough. More is needed than the triggering of an existing injury. The accident must cause its own injury which continues to contribute to the incapacity.”
Johnston v Accident Compensation Corporation [2010] NZHC 1726
This means that if you have a pre-existing back condition and an accident aggravates it, the Accident Compensation Corporation (ACC) must cover the injury caused by the accident — but only so long as the accident-related injury continues to materially contribute to your incapacity. If the Accident Compensation Corporation (ACC) determines that your symptoms are now attributable solely to the underlying condition, it may revoke cover.
Where a person suffers multiple injuries that contribute to incapacity, section 295 of the Accident Compensation Act 2001 addresses how the Accident Compensation Corporation (ACC) is to manage the interaction between those injuries. This provision is relevant where, for example, a person has an existing covered injury and then suffers a subsequent injury that compounds the incapacity.
The accident must cause its own independent injury that continues to contribute to the incapacity. Merely triggering symptoms of a pre-existing condition is not sufficient for ongoing cover. But an accident that genuinely worsens or adds a new dimension to a pre-existing condition can attract cover for the component attributable to the accident.
There are significant gaps in the Accident Compensation Corporation (ACC) scheme. The following are not covered:
If you have cover, Part 4 of the Accident Compensation Act 2001 sets out the entitlements available to you, which may include:
The details of these entitlements, including calculation methods and eligibility criteria, are set out in Schedule 1 of the Accident Compensation Act 2001.
The Accident Compensation Corporation (ACC) processes approximately one point nine (1.9) million claims per year. The number of claims that are declined or have entitlements refused is substantially higher than many people realise.
The Forster, Barraclough, and Mijatov report “Solving the Problem” (2017), published by the University of Otago Faculty of Law Legal Issues Centre and funded by the New Zealand Law Foundation, estimated that the Accident Compensation Corporation (ACC) makes between two hundred thousand (200,000) and three hundred thousand (300,000) formal adverse decisions per year. This includes:
The report found that the Accident Compensation Corporation (ACC) itself cannot reliably quantify the number of adverse decisions it makes. This failure has been documented repeatedly over fifty (50) years — from the Woodhouse Report in 1967, through Ian Campbell’s observation in 1996, the Honourable Ruth Dyson’s statement in 2004, the Right Honourable Sir Geoffrey Palmer’s criticism in 2008, and Miriam Dean Queen’s Counsel (QC)’s finding in 2016 that she was “surprised ACC could not readily provide comprehensive and reliable data on its cover and entitlements decisions.”
Even where the Accident Compensation Corporation (ACC) accepts your initial claim for cover, this does not guarantee ongoing entitlements. The Accident Compensation Corporation (ACC) can — and frequently does — narrow the scope of what is covered through subsequent causation assessments. For example, the Accident Compensation Corporation (ACC) may accept cover for an initial back injury but later decline to fund surgery on the basis that the need for surgery is attributable to pre-existing degeneration rather than the accident.
The Forster, Barraclough, and Mijatov report identified this as a significant access to justice barrier. The Accident Compensation Corporation (ACC) holds an inherent advantage in causation disputes: it has access to medical advisors, clinical records, and institutional resources that individual claimants do not.
If the Accident Compensation Corporation (ACC) has declined your claim, limited your entitlements, or revoked cover, do not accept the decision without seeking advice. The standard of proof is the balance of probabilities — not the standard the Accident Compensation Corporation (ACC) may have applied. Courts have held that “robust inferences” of causation can be drawn where there is no evidence to the contrary.
The following Parts of the Accident Compensation Act 2001 are particularly relevant to understanding cover and entitlements:
The Forster, Barraclough, and Mijatov report is available in full at the New Zealand Legal Information Institute (NZLII).
The Accident Compensation Corporation (ACC) scheme was designed to protect all New Zealanders from the consequences of personal injury. But the gap between the promise and the reality is wide — and it falls on injured workers to bridge it.
Working for Workers provides advocacy and support for workers navigating the Accident Compensation Corporation (ACC) system. If your claim has been declined, your entitlements restricted, or your cover revoked, we can help you understand your rights and challenge the decision.
Please contact us today to discuss your situation.
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