7.1 Case and claims management features
Final decision-making
Decision description and scope
Consultation
authority
7.1.1
Development and dissemination of all case and claims TPA Relationship Manager
In consultation with:
management policies that are delegated to agents
Chief Executive
authorised to carry out work on behalf of ACC
In accordance with all policies established by the ACC Board
7.2 Cover for ACC claims
Current
Final decision-making
Decision description and scope
Consultation
Ref
authority
7.2.1
Work effort or strain causing cardio-vascular or
Case Manager
In consultation with:
cerebro-vascular episode (accept or decline cover)
Case Co-ordinator
Medical Advisor
Claims Manager
Technical Specialist
Service Co-ordinator – Sensitive
Claims Unit
7.2.2
Accidental Death
Accept or decline cover for accidental death as a result Claims Manager
In consultation with (if required):
of the following:
Accidental Death Unit
Team Manager
•
Accidental Death Unit
Personal injury as a result of accident
• Work injury
• Injury outside New Zealand
Accept or decline cover for gradual process, disease or Case Co-ordinator
Please note:
infection claims, where claim lodged after accidental
Gradual Process Team
If the claim for gradual process, disease or infection has been
death
accepted and the claimant dies as a consequence of their
Current
Final decision-making
Decision description and scope
Consultation
Ref
authority
personal injury, these do not need a recommendation from the
Lead Occupational Health Advisor
Determine accidental death is consequence of covered Claims Manager
personal injury for:
Accidental Death Unit
• All gradual process, disease or infection claims
Accept or decline cover for accidental death as a result Claims Manager
In consultation with:
of the following:
Accidental Death Unit
Medical Advisor
•
Technical Specialist
Work effort or strain causing cardio-vascular or
cerebro-vascular episode
Accept or decline cover for accidental death as a result Treatment Injury Cover
In consultation with (if required):
of the following:
Specialist
Peer review, Treatment Injury Cover Assessment Centre
•
Treatment Injury Cover
Consequence of treatment for personal injury
Assessment Centre
Team Manager, Treatment Injury Cover Assessment Centre
Medical Advisor, Treatment Injury Cover Assessment Centre
External Clinical Advisor, Treatment Injury Cover Assessment
Centre
7.2.3
Injury outside New Zealand
Accept or decline cover for injury sustained by New
Claims Officer or Case
Zealanders overseas as a result of the following:
Manager Assessment
•
Case Manager
Personal injury as a result of accident
Case Co-ordinator
• Work injury
ISC Customer Service
• Non-occupational gradual process
Representatives - Outward
Bound Team
Service Co-ordinator – Sensitive
Claims Unit
Current
Final decision-making
Decision description and scope
Consultation
Ref
authority
Accept or decline cover for injury as a result of work-
Case Manager
related gradual process, disease, or infection
Case Co-ordinator
Claims Manager
Service Co-ordinator – Sensitive
Claims Unit
Accept or decline cover for injury as a result of the
Case Manager
In consultation with:
following:
Case Co-ordinator
Medical Advisor
• Work effort or strain causing cardio-vascular or
Claims Manager
Technical Specialist
cerebro-vascular episode
Service Co-ordinator – Sensitive
Claims Unit
Accept or decline cover for injury as a result of the
Treatment Injury Cover
In consultation (if required) with:
following:
Specialist
Peer review, Treatment Injury Cover Assessment Centre
• Consequence of treatment for personal injury
Treatment Injury Cover
Team Manager, Treatment Injury Cover Assessment
Assessment Centre
Centre
Medical Advisor, Treatment Injury Cover Assessment Centre
External Clinical Advisor, Treatment Injury Cover Assessment
Centre
Decline claims due to lack of information or withdrawals Case Administrator, Treatment
In consultation with (if required):
Injury Cover Assessment Centre Team Manager, Treatment Injury Cover Assessment
Centre
7.2.4
Personal injury as a result of accident (accept or
Claims Officer
In consultation with (if required):
decline cover)
Lodgement, Assessment,
Medical Advisor
(Refer to sub-clauses below for exceptions not
Entitlements, Treatment or
Technical Specialist
intended to come under 7.2.4)
Registration
Current
Final decision-making
Decision description and scope
Consultation
Ref
authority
Claims Manager
Case Manager
Case Co-ordinator
Claims Administrator Treatment
Injury Cover Assessment Centre
Claims Officer Client Information
Treatment Injury Cover
Assessment Centre
Treatment Injury Cover
Specialist
Service Co-ordinator – Sensitive
Claims Unit
7.2.4a
Approval for the acceptance of renal failure as a result Claims Officer
of a personal injury resulting from an accident (accept
Lodgement, Assessment or
or decline cover)
Registration
Claims Manager
Case Manager
Case Co-ordinator
Treatment Injury Cover
Specialist
Service Co-ordinator – Sensitive
Claims Unit
7.2.4b
Approval for the acceptance of dental claims as a result Claims Officer Entitlement -
In consultation with (if required):
of a personal injury resulting from an accident (accept
Dental
Team Manager
or decline cover)
Claims Manager - Dental
Claims Manager
Current
Final decision-making
Decision description and scope
Consultation
Ref
authority
7.2.4c
Approval for the acceptance or decline of personal
Claims Officer or Claims
injury from allergic reaction or caused by placement of Manager Assessment
a foreign body
Case Manager
Case Co-ordinator
Service Co-ordinator – Sensitive
Claims Unit
7.2.5
Mental injury suffered because of physical injury (in or outside NZ)
Decline cover as evidence shows no clinically
Team Manager
On recommendation of (if required):
significant mental condition
Team Leader
Complex Mental Injury Panel
Accept cover as the mental injury was caused by the
Team Manager
On recommendation of (if required):
ongoing physical effects of the physical injury;
Team Leader
Complex Mental Injury Panel
or
Decline cover, as the mental injury was not caused by
the ongoing physical effects of the physical injury but
was caused by factors clearly unrelated to the injury
and injury circumstances
Accept or Decline cover in circumstances not covered
Team Manager
On recommendation of (if required):
above
Team Leader
Complex Mental Injury Panel
7.2.5a
Decline cover for work related mental injury due to
Team Manager
On recommendation of (if required):
work-place stress (that is not a single event);
Team Leader
Complex Mental Injury Panel
or
Decline cover for work related mental injury as
evidence shows no clinically significant mental
condition
Current
Final decision-making
Decision description and scope
Consultation
Ref
authority
Accept/Decline/Revoke cover for work related mental
Chair, Complex Mental Injury
On the recommendation of:
injury in circumstances not covered above
Panel
Complex Mental Injury Panel
7.2.6
Gradual process, disease or infection (accept or
Case Manager
In consultation with (if required):
decline cover) except for those decisions requiring the Case Co-ordinator
Team Manager
recommendation of Lead Occupational Health Advisor Gradual Process Team
Gradual process work-related hearing loss
Claims Manager
Hearing Loss Team
Accept or decline cover for all claims under AC Act
Case Co-ordinator
On recommendation of:
2001 schedule 2 (external link)
Gradual Process Team
Lead Occupational Health Advisor
Accept or decline cover for:
1. Chemical poisoning/toxicity of gradual or delayed
onset (e.g. Dioxin exposures, polychlorophenol
(PCP) exposures)
2. Respiratory Diseases
3. Environmental illness (e.g. sick Building
syndrome, multiple chemical sensitivity, chronic
fatigue syndrome)
4. Occupational Infections
5. Gradual onset osteoarthritis other than post-
traumatic
6. Occupational Cancer
7.2.7
Treatment injury and transitional Medical misadventure Treatment Injury Cover
In consultation (if required) with:
claims (accept or decline cover)
Specialist
Peer review, Treatment Injury Cover Assessment Centre
Treatment Injury Cover
Team Manager, Treatment Injury Cover Assessment
Assessment Centre
Centre
Medical Advisor, Treatment Injury Cover Assessment Centre
External Clinical Advisor, Treatment Injury Cover Assessment
Centre
Decline claims due to lack of information or withdrawals Case Administrator, Treatment
In consultation (if required) with:
Current
Final decision-making
Decision description and scope
Consultation
Ref
authority
Injury Cover Assessment Centre Team Manager, Treatment Injury Cover Assessment Centre
7.2.7a
Treatment injury claim information request for
Case Administrator, Treatment
In consultation with (if required):
Treatment Injury and Transitional Medical
Injury Cover Assessment Centre Team Manager
Misadventure claims
Treatment Injury Cover
Treatment Injury Cover Assessment Centre
Specialist
7.2.8
Consequence of treatment for personal injury (accept
Treatment Injury Cover
In consultation (if required) with:
or decline cover)
Specialist
Peer review, Treatment Injury Cover Assessment Centre
Treatment Injury Cover
Team Manager, Treatment Injury Cover Assessment Centre
Sections 20(2)(d) and 28(5)
Assessment Centre
Medical Advisor, Treatment Injury Cover Assessment Centre
External Clinical Advisor, Treatment Injury Cover
Assessment Centre
Decline claims due to lack of information or withdrawals Claims Administrator
In consultation (if required) with:
Team Manager, Treatment Injury Cover Assessment Centre
Claims Officer, Treatment Injury
Cover Assessment Centre
7.2.9
Sexual abuse (accept or decline cover)
Service Co-ordinator –
Sensitive Claims Unit
7.2.10
Accept or decline cover (including work injury disputes) Case Co-ordinator
Claims Officer Assessment or
Lodgement
Case Manager
Treatment Injury Cover
Specialist
Service Co-ordinator – Sensitive
Claims Unit
7.2.11
Revoke cover (on medical grounds, excluding all
Case Manager
On recommendation of:
Treatment Injury and Sensitive Claims)
Case Co-ordinator
Claims Officer Assessment
Branch Medical Advisor or Clinical Advisor
Claims Officer - Entitlements
Current
Final decision-making
Decision description and scope
Consultation
Ref
authority
Claims Manager
Treatment Injury Cover
Specialist
Service Co-ordinator – Sensitive
Claims Unit
7.2.12
Revoke cover (all other grounds, excluding all
Case Manager
On recommendation of:
Treatment Injury and Sensitive Claims)
Case Co-ordinator
Technical Specialist
Claims Manager
Claims Officer Assessment
Treatment Injury Cover
Specialist
Service Co-ordinator – Sensitive
Claims Unit
7.2.12a Revoke cover – Treatment Injury
Treatment Injury Cover
In consultation (if required) with:
(includes cover decisions under sections 20(2)(b),
Specialist
Team Manager, Treatment Injury Cover Assessment Centre
20(2)(d) or 28(5))
Treatment Injury Cover
Medical Advisor,Treatment Injury Cover Assessment Centre
Assessment Centre
7.2.12b Revoke cover – Sensitive Claims
Service Co-ordinator
On recommendation of:
Case Administrator
Technical Specialist
Sensitive Claims Unit
7.2.12c Revoke cover – Mental Injuries (excludes Sensitive
Case Manager
On recommendation of:
Claims)
Case Co-ordinator
National Manager, Psychology & Mental Health
Claims Manager
Claims Officer Assessment
7.2.13
Late lodgement of claim
Claims Officer Assessment
Claims Manager
Case Manager
Case Co-ordinator
Current
Final decision-making
Decision description and scope
Consultation
Ref
authority
Service Co-ordinator – Sensitive
Claims Unit
7.2.14
Authorise payment to a non-contracted provider for full Team Manager
cost of assessment to establish cover and/or
Team Leader
entitlements under:
AC Act 2001 Section 55(d) (e)
7.3 Disentitlement
Final decision-making
Decision description and scope
Consultation
authority
7.3.1
Wilfully self-inflicted injury or suicide
Claims Assessor
On recommendation of (If required):
Claims Officer Entitlement
Claims Manager
Case Manager
Complex Mental Injury Panel
Case Co-ordinator
Service Co-ordinator – Sensitive
Claims Unit
7.3.2
Convicted for murder
Principal Advisor, Office of the
On recommendation of:
COO, Operations
Technical Specialist
7.3.3
Claimant in prison
Claims Manager
Claims Officer Entitlement
Specialist Payments Officer
Entitlement Payments Officer
Case Manager
Case Co-ordinator
Service Co-ordinator – Sensitive
Claims Unit
7.3.4
Injured through criminal activity (prior to 1 July 2010)
Authority to make submissions for a District Court
Case Co-ordinator
On recommendation of:
decision
Case Manager
Clinical Advisor
Technical Specialist
or Processing Centre Manager
Service Co-ordinator – Sensitive
Claims Unit
(submissions to) Principal
Advisor, Office of the COO,
Operations
Decision to refer to District Court
Principal Advisor, Office of
the COO, Operations
Authority to disentitle
District Court
7.3.5
Injured through criminal activity (from 1 July 2010 onwards)
Referral to Technical Services
Case Co-ordinator
Case Manager
Clinical Advisor
Service Co-ordinator – Sensitive
Claims Unit
Add Eos repugnant to justice indicator
Technical Specialist
Decision to disentitle
Principal Advisor, Office of the
COO, Operations
7.4 Rehabilitation (for non-serious injury claims)
Final decision-making
Decision description and scope
Consultation
authority
7.4.1
Social Rehabilitation Assessments
Up to 5 hours
Case Co-ordinator
Case Administrator
Case Administrator – Sensitive
Claims Unit
Up to 20 hours
Case Manager
Service Co-ordinator – Sensitive
Claims Unit
Over 20 hours
Team Manager
7.4.1a
Clinical Psychiatric Assessments/Treatments
Up to 16 hours
Case Administrator - Sensitive
Claims Unit
Support Co-ordinator
Claims Officer - Entitlements -
LSIA teams
Service Co-ordinator
Case Administrator
Case Administrator - TIC
Case Co-ordinator
Case Manager
Claims Officer - Assessment
Claims Officer - Entitlements
Claims Officer - Entitlements I/A
unit
Triage Manager
Up to 20 hours
Team Manager
Team Manager Serious Injury
Up to 25 hours
Branch Manager
7.4.1b Neuropsychology Assessments
Approve 1 assessment only
Claims Officer Entitlements –
Independence Allowance Unit
Case Co-ordinator
Case Manager
Claims Manager
Case Administrator - TIC
Case Administrator – Sensitive
Claims Unit
Service Co-ordinator - Sensitive
Claims Unit
Service Co-ordinator
Support Co-ordinator
Triage Manager
7.4.2a
Non Contracted Services - Attendant Care (Non Serious Injury Claims)
Notes:
• Limits apply to combined services, refer 7.4.2g
• Night Rate - these delegations also apply to direct care required at night (over 3
times a night)
Level 1: Up to 14 hours per week
Case Co-ordinator
Case Administrator
Case Administrator – Sensitive
Claims Unit
Level 1: Up to 25 hours per week
Case Manager
Service Co-ordinator – Sensitive
Claims Unit
Level 2: Up to 7 hours per week
Nursing Care: Up to 2 hours per week
Level 1: Over 25 hours per week
Team Manager
Level 2: Over 7 hours per week
Nursing Care: Over 2 hours per week
7.4.2b Attendant Care by Family - Night Rate (less than 3 times a night)
Notes:
• Limits apply to combined services, refer 7.4.2g
• Attendant Care by family up to 3 times per night and less than 2 hours in total
Up to 14 hours per week
Case Administrator
Case Co-ordinator
Case Manager
Case Administrator – Sensitive
Claims Unit
Service Co-ordinator – Sensitive
Claims Unit
7.4.2c
Sleepover Care
• Limits apply to combined services, refer 7.4.2g
• Average of 8 hours Sleepover Care a night, where carer may assist client up to 3
times per night
Up to 7 nights per week (8 hours a night)
Case Manager
Service Co-ordinator – Sensitive
Claims Unit
7.4.2d Oversight Supervision by Family
Note: Limits apply to combined services, refer 7.4.2g
Up to 84 hours per week
Case Manager
Service Co-ordinator – Sensitive
Claims Unit
Over 84 hours per week
Team Manager
7.4.2e
Home Help
Notes:
• The majority of home help needs should be covered under the delegation of 12.5
hours per week. In some cases there may be exceptions such as additional laundry
requirements for incontinence and the majority of these should be covered at Case
Manager level
Up to 12.5 hours per week
Case Co-ordinator
Case Administrator
Case Administrator – Sensitive
Claims Unit
Up to 20 hours per week
Case Manager
Service Co-ordinator – Sensitive
Claims Unit
Over 20 hours per week
Team Manager
7.4.2f
Child Care
For policy, see CHIPS Childcare.
Notes:
• Limits apply to combined services, refer 7.4.2g
• Where possible the child care should be provided at the same time as other home-
based rehabilitation entitlements. Example, the same person could provide home
help by vacuuming the floor while at the same time supervising the children
Up to or over 8 weeks post injury or surgery
Up to 14 hours per week
Case Co-ordinator
Case Administrator
Case Administrator – Sensitive
Claims Unit
Up to 25 hours per week
Case Manager
Service Co-ordinator – Sensitive
Claims Unit
Over 25 hours per week
Team Manager
7.4.2g Total Home Based Rehabilitation (Combined Limits 7.4.2a to 7.4.2f and 7.4.2j
inclusive)
Over total of 84 hours per week
Team Manager
7.4.2h Meals on Wheels
Notes: Limits apply to combined services, refer 7.4.2g
Up to a quantity of 7 units per week
Case Administrator
Case Co-ordinator
Case Administrator – Sensitive
Claims Unit
Up to a quantity of 21 units per week
Service Co-ordinator
Support Co-ordinator
Service Co-ordinator – Sensitive
Claims Unit
Case Manager
7.4.2i
Nursing Services
Up to $7,500
Case Co-ordinator
Case Administrator
Case Manager
Triage Manager
Service Co-ordinator - Sensitive
Claims
Over $7,500
Team Manager
7.4.2j
Home and Community Support Services
Changed to Integrated Home and Community Support
Services 1/3/19
Up to 30 hours per week
Case Co-ordinator
Case Administrator
Case Administrator – Sensitive
Claims Unit
Up to 45 hours per week
Case Manager
Service Co-ordinator - Sensitive
Claims Unit
Over 45 hours per week
Team Manager
7.4.2k
Case Conference Coordinator Fee
Up to $34
Team Manager
7.4.3
Home-based Rehabilitation – where hourly rates for family and private caregivers
exceed base rates as stated in CHIPS. This clause is to be read in conjunction with
7.4.2a - h
• Level 1
National Consistency Panel
• Level 2
• Sleepovers
See CHIPS:
• Attendant Care
Family and private engaged attendant care rates
• Home Help Individual ( family and private) home
help rates
• Child Care Individual (family or private) provider
child care rates
7.4.4
Home-based Rehabilitation – where hourly rates for Non-contracted agency (where there is no suitable contracted agency available) exceed
base rates as stated on CHIPS. This clause is to be read in conjunction with 7.4.2a - h
• Level 1
National Consistency Panel
• Level 2
• Sleepovers
See :
• Attendant Care Non-contracted agency attendant
care rates
• Home Help Non-contracted agency home help
rates
• Child Care Non-contracted agency child care rates
Retrospective Social Rehabilitation Entitlements under the Accident Compensation Acts 1972 and 1982
This section deals with all social rehabilitation entitlements (including backdated attendant) under section 121 of the Accident Compensation Act 1972 and section 80 of
the Accident Compensation Act 1982 for any period prior to 30 June 1992.
If you, receive an application from a claimant to consider social rehabilitation under the Accident Compensation Act 1972 or the Accident Compensation Act 1982 contact
Technical Services.
Current Decision description and scope
Final decision-making
Consultation
Ref
authority
7.4.5
Approve an entitlement up to $500,000
Manager Technical Services
On the recommendation of:
Technical Specialist
Approve an entitlement over $500,000
Deputy Chief Executive
On the recommendation of:
Manager Technical Services
7.4.5a
Appoint external negotiators to form a team with
Chief Executive
senior ACC personnel to negotiate or mediate
contentious backdated entitlement cases
Settle Claims
Chief Executive
On the recommendation of:
Deputy Chief Executive
7.4.5b
Approve or decline the costs associated with the
Team Manager
creation of a:
• Family trust; or
• Personal order; or
Property order prior to payment of retrospective
social rehabilitation
7.4.5c
Approve or decline interest on retrospective social
Manager Technical Services
On the recommendation of:
rehabilitation entitlement when release of the
Technical Specialist
payment is delayed.
7.4.5d
Authorise the release of an interest payment on a
Chief Financial Officer
social rehabilitation entitlement
Retrospective Social Rehabilitation Entitlements under the Accident Rehabilitation and Compensation Insurance Act 1992 and Accident
Insurance Act 1998
This section deals with all social rehabilitation entitlements (including Complex Personal Injuries (CPI)) under the Accident Rehabilitation and Compensation Insurance
Act 1992 and Accident Insurance Act 1998 for periods between 1 July 1992 and 1 April 2002.
If you receive an application from a claimant to consider social rehabilitation entitlement under the Accident Rehabilitation and Compensation Insurance Act 1992 and/or
Accident Insurance Act 1998 please contact Technical Services.
Current Decision description and scope
Final decision-making
Consultation
Ref
authority
7.4.6
Approve an entitlement up to $500,000
Manager Technical Services
On the recommendation of:
Technical Specialist
Approve an entitlement over $500,000
Deputy Chief Executive
On the recommendation of:
Manager Technical Services
7.4.6a
Appoint external negotiators to form a team with
Chief Executive
senior ACC personnel to negotiate or mediate
contentious backdated entitlement cases
Settle Claims
Chief Executive
On the recommendation of:
Deputy Chief Executive
7.4.6b
Approve or decline the costs associated with the
Team Manager
creation of a:
• Family trust; or
• Personal order; or
Property order prior to payment of retrospective
social rehabilitation
7.4.6c
Approve or decline interest on retrospective social
Manager Technical Services
On the recommendation of:
rehabilitation entitlement when release of the
Technical Specialist
payment is delayed.
7.4.6d
Authorise the release of an interest payment on a
Chief Financial Officer
social rehabilitation entitlement
Retrospective Social Rehabilitation Entitlements under the Accident Compensation Act 2001
This set of delegations deals with all social rehabilitation entitlements under the Accident Compensation Act 2001 for social rehabilitation payments before date of
application for periods after 1 April 2002.
Current Decision description and scope
Final decision-making
Consultation
Ref
authority
7.4.6d
Approve or decline an entitlement up to four weeks
Case Coordinator
before date of application
This delegation is subject to all 7.4.2 Assessed
Case Manager
Home based Rehabilitation delegations
Service Co-ordinator -
Sensitive Claims Unit
Approve or decline an entitlement between four to
Team Manager
Eight weeks before the date of application
This delegation is subject to all 7.4.2 assessed home
based rehabilitation delegations
Decline an entitlement greater than eight weeks
Team Manager
In consultation with:
Case Coordinator
before date of application
Case Manager
or
Service Co-ordinator - Sensitive Claims Unit
Approval of an entitlement greater than eight weeks
Manager Technical Services
Technical Specialist
before date of application with the payment up to
$500,000
Approval of an entitlement greater than eight weeks
Deputy Chief Executive
Manager Technical Services
before the date of application with the payment over
$500,000
Current Decision description and scope
Final decision-making
Consultation
Ref
authority
7.4.7
Aids and Appliances (Please note: This includes
needs for Social and Vocational rehabilitation but
does not include Orthoses, refer 7.4.8a or Medical
Consumables, refer 7.4.7a
Other, up to $549 per item
Case Coordinator
Case Administrator
Case Administrator – Sensitive
Claims Unit
Customer Service
Representative (Channel
Operations)
Up to $10,000 per item
Case Manager
Service Co-ordinator -
Sensitive Claims Unit
$10,000 - $20,000 per item
Team Manager
Above $20,000 per item
Branch Manager
Service or Processing Centre
Manager
Power chairs and complex seating systems up to
National Consistency Panel
Manager Home Modifications only if equipment request is part
$40,000
Or
Manager Home Modifications
of a Housing Modification
Power chairs and complex seating systems over
National Consistency Panel
$40,000
Communication and Assistive Technology (IT
National Consistency Panel
Note: If a computer app is requested via a Talklink
communication solutions)
assessment it does not need to come to panel
7.4.7a
Medical Consumables
Up to $549 per item
Case Co-ordinator
Case Administrator
Case Administrator – Sensitive
Claims Unit
Up to $10,000 per item
Case Manager
Claims Manager
Up to $10,00 per item (for surgery)
Claims Officer Treatment
Claims Officer Entitlements
$10,000 to $15,000 per item
Team Manager
Above $15,000 per item
Branch Manager
Service or Processing Centre
Manager
7.4.7b
Contribution to Increased Electricity Costs
Up to $1,000 per month
Team Manager
7.4.8
Artificial Limbs
Primary and Replacement Limb:
Case Manager
Up to - $12,500
Case Co-ordinator
Services Co-ordinator –
Sensitive Claims Unit
Primary and Replacement Limb:
Team Manager
$12,500 - $25,000
Primary and Replacement Limb:
Team Manager
On the recommendation of; National Consistency Panel
Above $25,000
Branch Manager
All requests for Osseointegration Prostheses
Manager Corporate Clinical
Advice
Urgent repairs
Case Manager
Notes:
Case Co-ordinator
Claims Officer Entitlements
No prior approval required from ACC.
Service Co-ordinator –
Limb Centre to fax Case Manager (or Service Centre) within
Sensitive Claims Unit
five working days of completing repair
Non urgent repairs:
Case Manager
Note: No prior approval required from ACC
Up to $1,000
Case Co-ordinator
Claims Officer Entitlements
Non urgent repairs over $1,000
Case Manager
In consultation with: Team Manager
Case Co-ordinator
Claims Officer Entitlement
Service Co-ordinator –
Sensitive Claims Unit
7.4.8a
Orthoses
Non contracted supplier:
Claims Officer Entitlements
Prior approval required
Up to $8,000
Non contracted supplier:
Claims Officer Entitlements
Prior approval required.
In consultation with:
Team Manager
$8,000 to $20,000
Team Leader
Non contracted supplier:
Team Manager
Prior approval required.
In consultation with:
Centre Manager and
Over $20,000
Clinical Advisor
Contracted supplier:
No prior approval required
Primary and replacement orthoses up to $300 per
item
Contracted supplier:
Claims Officer Entitlements
Prior approval required
Primary and replacement orthoses between $300
and $8,000 per item
Contracted supplier:
Claims Officer Entitlements
Prior approval required.
Primary and replacement orthoses between $8,000
In consultation with:
and $20,000 per item
Team Manager
Contracted supplier:
Team Manager
Prior approval required.
In consultation with:
Centre Manager and
Primary and replacement orthoses over $20,000 per
Clinical Advisor
item
7.4.9
Training For Independence Services – Total cost
of Programme (excluding provider travel)
Up to $5,000 per programme
Case Manager
Up to $17,900 per programme
Service Co-ordinator -
Sensitive Claims Unit
Case Co-ordinator
Up to $29,000 per programme
Team Manager
Above $29,000 per programme
Branch Manager
7.4.9a
Living my Life
Up to $40,250 per programme
Case Manager
Up to $90,000 per programme
Team Manager
Branch Manager
7.4.9b
Training for Independence Advisory Service
Up to 14 hours per year
Case Administrators
Case Co-ordinator
Case Manager
Case Administrator – Sensitive
Claims Unit
Service Co-ordinator -
Sensitive Claims Unit
Over 14 hours per year
Team Manager
7.4.10
Housing Modifications (please note this section
also includes Workplace Modifications)
Agreement to subsequent home modifications
Branch Manager
In consultation with (if required): Manager Home Modifications
Up to $1,000
Case Co-ordinator
$1,000 - $10,000
Case Manager
Service Co-ordinator -
Sensitive Claims Unit
$10,000 - $25,000
Team Manager
$25,000 -$50,000
Branch Manager
$50,000 -$200,000
Manager Home Modifications
Above $200,000
Deputy Chief Executive
On recommendation of:
Manager Home Modifications
7.4.10a
Building Advisor
Up to $15,000
Case Manager
Team Manager
Service Co-ordinator -
Sensitive Claims Unit
Above $15,000
Manager Home Modifications
7.4.11
Modifications of motor vehicles (includes freight)
Up to $10,000
Case Manager
Service Co-ordinator -
Sensitive Claims Unit
$10,000 to $15,000
Team Manager
Branch Manager
Above $15,000
Manager Transport for
Independence
7.4.12
Purchase of Motor vehicle
Initial or Subsequent Vehicle Purchase
Team Manager
In consultation with (if required):
Manager Transport for Independence
$15,000
Branch Manager
Initial or Subsequent Vehicle Purchase over $15,000
Manager Transport for
Independence
7.4.12a
Driving Lessons
Up to $2,000
Case Manager
Service Co-ordinator -
Sensitive Claims Unit
7.4.13
Education Support
Up to 20 hours per week
Case Manager
Service Co-ordinator -
Sensitive Claims Unit
Over 20 hours per week
Team Manager
7.4.13a
Education Support Assessments
Up to 5 hours
Case Administrator
Case Administrator – Sensitive
Claims Unit
Up to 10 hours
Case Manager
Case Co-ordinator
Service Co-ordinator -
Sensitive Claims Unit
Over 10 hours
Team Manager
7.4.14
Claimant travel cost to ACC office (when
requested to attend by Case Manager and
subject to payment rates of the Ancillary
Services Regulations)
Note: This applies only in exceptional circumstances
when all other avenues to meet have been
considered and discounted.
All visits to office and Outreach Centre
Case Manager
Service Co-ordinator -
Up to $1,000
Sensitive Claims Unit
Transport and Accommodation for Support People
(related to rehabilitation only)
All applications
Team Manager
7.4.15
Claimant Air Travel
Up to $5,000
Case Manager
Case Co-ordinator
Claims Officer
Manager Home Modifications
Service Co-ordinator
Support Co-ordinator
Triage Manager
Service Co-ordinator -
Sensitive Claims Unit
Over $5,000
Team Manager
7.4.16
Claimant Taxi Travel
Up to $1,000
Case Manager
In consultation with Team Manager if more than $100 per trip
Case Co-ordinator
Service Co-ordinator -
Sensitive Claims Unit
7.4.17
Ancillary Services (please refer to legislation)
Up to $1,000
Customer Service
Representative (Channel
Operations)
Registration and
Compensation Centre
Up to $10,000
Case Manager
Case Administrator
Case Co-ordinator
Claims Officer – Entitlement
Clinical Advisor
Manager Home Modifications
Case Administrator – Sensitive
Claims Unit
Service Co-ordinator -
Sensitive Claims Unit
7.4.17a
Non-Emergency Transport by Ambulance (MFP
Service Items NETBAO & NETBAU)
Up to $500
Case Manager
Case Co-ordinator
Service Co-ordinator -
Sensitive Claims Unit
Up to $2,000
Programme Manager (CMHP)
Team Manager
7.4.17b
Non-Contracted Emergency Transport (MFP
Service Items ETA06 & ETR06)
Up to $1,000
Team Manager
Up to $10,000
Programme Manager (CMHP),
Emergency Transport
7.4.17c
Transport for Independence – Funded transport
Up to $5,200 per year
Team Manager
Up to $15,000 per year
Branch Manager
7.4.18
Concussion Service
Note: Clinical approval is not required for either
stage 1 or stage 2 services
Up to a maximum total for all services of $3,150 per
Case Manager
In consultation with
Case Administrators
(as required):
claim
Case Co-ordinator
Team Manager
Case Administrator – Sensitive
Claims Unit
Service Co-ordinator -
Sensitive Claims Unit
In addition to the total for all services provided.
A maximum of 1 non-attendance per claim
Case Manager
Case Co-ordinator
Service Co-ordinator -
Sensitive Claims Unit
7.4.19
Spinal Cord Injury Reassessment Services
Within contract provisions
Case Manager
Service Co-ordinator -
Sensitive Claims Unit
7.4.20
Elective Surgery for Spinal Cord Claimants
All applications
Elective Surgery Unit
On recommendation of:
Note: pricing is determined by referral to Elective
Medical Advisor
Surgery Unit
7.4.21
Non-acute inpatient rehabilitation
0 – 21 days
Case Co-ordinator
Case Manager
Service Co-ordinator -
Sensitive Claims Unit
Further extensions of Care after 21 days
Team Manager
In consultation with:
Medical Advisor
7.4.22
Spinal Cord Injury Active Rehabilitation Services
Inpatient rehabilitation:
Team Manager
Inpatient rehabilitation where the claimant is
Team Manager
In consultation with:
admitted from the community/post elective surgery
Medical Advisor
7.4.23
Residential Support
All applications
Team Manager
7.4.23a
Palliative Care - Inpatient
Team Manager
7.4.23b
Palliative Care - Community
Team Manager
7.4.24
Active Rehabilitation & Integrated Rehabilitation
Services
All Applications
Designated Area delegation holder
7.4.24
TBI Residential Rehabilitation
(Replacing Active Rehabilitation and Integrated
Rehabilitation)
NB: This service is effective from 1st April 2014
Up to 60 days each admission
Support Coordinator
Case Manager
Service Co-ordinator -
Sensitive Claims Unit
Over 61 days and up to
Team Manager Serious Injury
Team Manager
270 days each admission
Over 271 days and up to
Branch Manager
On recommendation of:
SI Advisor
365 days each admission
7.4.25
Residential Rehabilitation
All applications
Team Manager
7.4.26
Request for Medical Notes (includes requests for
copies)
Up to $350 per request
Administration Officer
Business Support
Case Manager
Case Co-ordinator
Case Administrator
Claims Officer
Claims Manager
Customer Service Officer
Case Administrator – Sensitive
Claims Unit
Service Co-ordinator -
Sensitive Claims Unit
Over $350 per request
Team Manager
Clinical Advisors
Programme Manager (CMHP)
7.4.26a
Request for Medical Reports (includes requests
for copies)
Up to $1,500 per report
Administration Officer
Business Support
Case Manager
Case Co-ordinator
Case Administrator
Claims Officer
Claims Manager
Customer Service Officer
Case Administrator – Sensitive
Claims Unit
Service Co-ordinator -
Sensitive Claims Unit
Over $1,500 per report
Team Manager
Clinical Advisors
Programme Manager (CMHP)
7.4.27
Vocational Rehabilitation Assessments
Up to $1,304 per assessment
Case Manager
Case Co-ordinator
Case Administrator
Case Administrator – Sensitive
Claims Unit
Service Co-ordinator -
Sensitive Claims Unit
Over $1,304 per assessment
Team Manager
7.4.28
Functional Capacity Assessments
Up to $1,000 per assessment
Case Manager
Case Co-ordinator
Case Administrator
Case Administrator – Sensitive
Claims Unit
Service Co-ordinator -
Sensitive Claims Unit
Over $1,000 per assessment
Team Manager
7.4.29
All other assessments (excluding those already
covered in the delegations manual)
Up to $1,500 per assessment
Case Administrator
Claims Manager
Claims Officer Entitlements
Claims Officer Assessments
Case Co-ordinator
Case Co-ordinator - Sensitive
Claims Unit
Case Administrator - Sensitive
Claims Unit
Up to $2,500 per assessment
Case Manager
Service Co-ordinator -
Sensitive Claims Unit
Over $2,500 per assessment
Team Manager
Branch Manager
7.4.30
Pain Management Programme
Up to $7,000 total per client
Case Co-ordinator
Case Manager
Claims Officer Entitlements
Service Co-ordinator -
Sensitive Claims Unit
Up to $10,000 total per client
Team Manager
Up to $30,000 total per client
Centre Manager – Processing
Centre
Branch Manager
7.4.30a
Pain Management Programmes service codes
INEC, IN05, IN50, IN51, IN52, IN53
All applications
Team Manager
On recommendation of: Senior Medical Advisor
7.4.31
Non-subsidised Pharmaceuticals
Schedule line items up to $3,000
Case Manager
Claims Officer Entitlement
Claims Officer Treatment
Service Co-ordinator -
Sensitive Claims Unit
Schedule line items above $3,000
Team Manager
7.4.32
Vocational Rehabilitation Services
For Vocational equipment see 7.4.7.
For Workplace Modifications see 7.4.10
For Self Employed equipment/assistance see 7.4.33
Up to $7,000 total per client
Case Co-ordinator
Case Manager
Service Co-ordinator -
Sensitive Claims Unit
Over $7,000 total per client
Team Manager
7.4.33a
Self employment assistance – developing a self-
employment proposal
Small business training course or preparation of
Team Manager
business plan:
7.4.33b
Self employment assistance – approving a self-
employment proposal
Purchase or modification of equipment for self-
Team Manager
employment venture:
7.4.34
Case management services post capacity for
work decision
Job Search Services:
Case Manager
Service Co-ordinator -
Sensitive Claims Unit
Counselling:
Case Manager
Up to $200 total per claimant
Service Co-ordinator -
Sensitive Claims Unit
Counselling:
Case Manager
In consultation with:
Over $200
Service Co-ordinator -
Team Manager
Sensitive Claims Unit
Budgeting advice:
Case Manager
Up to $200 total per claimant
Service Co-ordinator -
Sensitive Claims Unit
Budgeting advice:
Case Manager
In consultation with:
Over $200
Service Co-ordinator -
Team Manager
Sensitive Claims Unit
7.4.35
Audiology Services and Hearing Aids
Up to $12,000
Claims Manager
Hearing Loss Team
Case Manager
Service Co-ordinator -
Sensitive Claims Unit
Up to $60,000
Team Manager/Leader
Hearing Loss Team
Team Manager - Treatment
Injury Centre
7.4.35a
Audiology Assessments and Reports
Up to $1,000 per assessment or report
Claims Manager
Hearing Loss Team
Case Manager
Service Co-ordinator -
Sensitive Claims Unit
Clinical Advisor - Treatment
Injury Centre
Case Administrator -Treatment
Injury Centre
Over $1,000 per assessment or report
Team Manager/Leader
Hearing Loss Team
Team Manager
Team Manager - Treatment
Injury Centre
7.4.36
Extend Discretionary Entitlement (excluding
elective surgery requests)
Up to $20,000
Technical Specialist
Over 20,000
Manager Technical Services
7.4.36a
Extend Discretionary Entitlement - elective
surgery requests
Up to $50,000
Team Manager, Surgery
Assessments, ESC
Over $50,000
Head of Client Service
With advice, to
Delivery
Deputy Chief Executive
7.4.37
Hepatitis C and Asbestos related claims only
(where centrally managed)
Any rehabilitation expenditure
Case Co-ordinator
Same level of delegation as Case Manager in Branch
Southern Short Term Claims
Centre
Any rehabilitation expenditure
Team Manager
Same level of delegation as Team Manager in Branch
Southern Short Term Claims
Centre
Any rehabilitation expenditure
Centre Manager
Same level of delegation as Branch Manager
Southern Short Term Claims
Centre
7.4.38
Alcohol and Drug Services
Up to $1,000
Case Co-ordinator
Case Manager
Service Co-ordinator -
Sensitive Claims Unit
Over $1,000
Team Manager
7.4.39
Services for the Blind
Up to $2,000
Case Manager
Service Co-ordinator -
Sensitive Claims Unit
Triage Manager
Up to $3,500
Service Co-ordinator
Support Co-ordinator
Up to $10,000
Team Manager
7.4.40
Costs of rental accommodation required post-
discharge
Up to $1000
Case Co-ordinator
Up to $7,500
Case Manager
Service Co-ordinator -
Sensitive Claims Unit
Up to $15,000
Team Manager
Over $15,000
Branch Manager
7.4.41
Non-contracted services, where the service has
contracted providers (MFP service items
ADMIN1, ADMIN2, NCA01, and TSO1)
Please note: These delegation levels apply for the
total cost of the service.
Up to $2,000
Team Manager
In Consultation with: Branch Manager
Up to $20,000
Branch Manager
Centre Manager
7.4.42
External Clinical Advisory Services (MFP service
items ECA01, ECA02, ECA03, ECAN1, ECAN2
and ECAN3)
Up to 20 hours
Case Administrator, Treatment
Injury Cover Assessment
Centre
Clinical Advisors, Treatment
Injury Cover Assessment
Centre
Over 20 hours
Clinical Advisors, Treatment
In consultation with:
Injury Cover Assessment
Treatment Injury Cover Assessment Centre Team Manager
Centre
7.4.43
Supported Living
All programs
Service Co-ordinator –
In consultation with:
Sensitive Claims Unit
Team Manager
7.4.44
Supported Employment
Trial of service for each program
Service Co-ordinator –
In consultation with Team Manager
Sensitive Claims Unit
7.4.45
Case Conference (Social and Vocational
Rehabilitation)
Up to $1,000
Case Manager
Service Co-ordinator –
Sensitive Claims Unit
Up to $2,000
Team Manager
Over $2,000
Branch Manager
7.4.46
Clothing for Social Rehabilitation
Up to $500
Case Manager
Service Co-ordinator –
Sensitive Claims Unit
Up to $1,000
Team Manager
7.4.47
DHB Reimbursement – Specific to Waitemata
DHB
Reimbursement of social rehabilitation costs
(HCSS) provided by DHB prior to the acceptance
of a claim
Up to $2,000
Team Manager
Up to $20,000
Branch Manager
7.5 Rehabilitation - Serious Injury (SI)
Current
Final decision-making
Decision description and scope
Consultation
Ref
authority
7.5.1
Active Rehabilitation (including for spinal cord injuries)
Note: This delegation does not include Integrated Rehabilitation Services. For this refer to 7.5.2.
Up to 80 days each admission
Support Co-ordinator
Case Manager
Service Co-ordinator - Sensitive Claims Unit
Over 80 days and up to 186 days each admission
Team Manager Serious Injury
Team Manager
Team Manager - Sensitive Claims Unit
Over 186 days each admission
Branch Manager
In consultation with SI Advisor
7.5.1a
Active Rehabilitation - Crisis Care
Up to 72 Hours
Service Coordinator
Support Coordinator
Up to 336 hours
Team Manager Serious Injury
Over 336 hours
Branch Manager
In consultation with SI Advisor
7.5.2
TBI Residential Rehabilitation
(Replacing Active Rehabilitation - Integrated Rehabilitation Services)
NB: This Service is effective from 1st April 2014
Up to 60 days each admission
Support
Coordinator
Case Manager
Over 61 days and up to
Team Manager Serious Injury
270 days each admission
Team Manager
Over 271 days and up to 365
Branch Manager
In consultation with SI Advisor
days each admission
7.5.3
Aids and Appliances (social and vocational) Note: The following items are required to be referred to the National Consistency panel for consultation:
Aids or appliances, products or items that are not usually provided by a rehabilitation provider
Vocational equipment over $2000, such as an adjustable/ standing desk
Recreational or hobby-related equipment like hand cycles, sports wheelchairs and all-terrain power chairs (Before an assessment is requested)
Any equipment that is new to the market - Artificial limbs
Up to $15,000
Service Coordinator
Support Coordinator
Over $15,000 and up to $30,000
Team Manager Serious Injury
Manager Home Modifications (only for equipment that is part of a housing modification)
Over $30,000
Team Manager Serious Injury
In consultation with:
Branch Manager
SI Advisor
7.5.3a
Orthoses
Up to $15,000
Service Coordinator
Support Coordinator
Over $15,000
Team Manager Serious Injury
In consultation with:
SI Advisor
7.5.4
Aids and Appliances – related cost of electricity
All services
Team Manager Serious Injury
7.5.5
Alcohol and Other Drug Services
Contracted services up to $600
Service Coordinator
Support Coordinator
Contracted services over $600
Team Manager Serious Injury
7.5.6
Alternative accommodation (rental)
Up to $7,500
Team Manager Serious Injury
Over $7,500 and up to $20,000
Branch Manager
In consultation with Manager Home Modifications
Over $20,000
Manager Home Modifications
7.5.7
Alternative transport (rental)
up to 7 weeks
Service Co-ordinator
Support Co-ordinator
over 7 weeks and up to 24 weeks
Team Manager
Over 24 weeks
Manager, Transport for Independence
7.5.8
Ancillary Regulations – accommodation for clients and support people
Up to $5,000
Service Coordinator
Support Coordinator
Over $5,000 and up to $10,000
Team Manager Serious Injury
Over $10,000 and up to $20,000
Branch Manager
In consultation with SI Advisor
7.5.9
Ancillary Regulations – travel for clients and support people
Up to $1000
Service Coordinator
Support Coordinator
Over $1000 and up to $2000
Team Manager Serious Injury
Over $2000
Branch Manager
In consultation with Team Manager Serious Injury
7.5.10
Artificial Limbs
Up to $25,000, and all repairs
Service Coordinator
Support Coordinator
Over $25,000
Team Manager Serious Injury
On the recommendation of National Consistency Panel
All requests for Osseointegration Prostheses
Manager Corporate Clinical
Advice
7.5.11
Assessments – fee per assessment
All assessments
Service Coordinator
Support Coordinator
7.5.12
Assessments – hourly rate fee
Up to 8 hours
Service Coordinator
Support Coordinator
Over 8 hours
Team Manager Serious Injury
7.5.13
Audiology Services and Hearing Aids
Up to $5,000
Service Coordinator
Support Coordinator
Over $5,000
Team Manager Serious Injury
7.5.14
Blind – Contracted services
Up to $2500
Service Coordinator
Support Coordinator
Over $2500
Team Manager Serious Injury
7.5.15
Case Conference
Up to $1,000
Service Coordinator
Support Coordinator
Over $1,000 and up to $2,000
All Team Managers
Over $2,000
Branch Manager
In consultation with Team Manager Serious Injury
7.5.16
Education Support
Up to 30 hours each week
Service Coordinator
Support Coordinator
Up to 40 hours each week
Team Manager Serious Injury
Over 40 hours each week
Branch Manager
In consultation with SI Advisor
7.5.17
Extended Discretion (s68)
Attendant Care outside NZ (greater than 28 days)
Branch Manager
In consultation with and on the recommendation of Technical
Specialist
All other applications
Branch Manager
In consultation with and on the recommendation of
National Panel
7.5.18
Family Trust, Personal Order or Property Order costs
$5,000
Case Manager
Service Coordinator
Support Coordinator
Over $5,000 up to $20,000
Team Manager Serious Injury
Team Manager
7.5.19
Home Modifications and Workplace Modifications – Building Adviser costs
Up to $15,000
Service Coordinator
Support Coordinator
Over $15,000
Manager Home Modifications
7.5.20
Home Modifications and Workplace Modifications – Building costs – first modification funding
Agreement to subsequent home modifications
Team Manager Serious Injury
In consultation with (if required):
Manager Home Modifications
Up to $25,000
Service Coordinator
Support Coordinator
Over $25,000 and up to $50,000
Team Manager Serious Injury
Over $50,000 and up to $200,000
Manager Home Modifications
Over $200,000
Manager Serious Injury
On the recommendation of Manager Home Modifications
or
Chief Operating Officer
7.5.21
Home Modifications and Workplace Modifications – Building costs – repairs and maintenance
All requests
Manager Home Modifications
7.5.22
Home Support Services (including Integrated Home and Community Support services, Community Nursing and Rural Nursing) covered by
Functional Independence Measure (FIM) Guidelines
Note: The FIM Guidelines relate to clients aged 17 years and over. For decisions relating to clients aged 0-16 years, refer to 7.5.24.
Within the FIM Guidelines or Spinal Cord
Service Coordinator
Support Coordinator
Injury guidelines AND a change of no more than 7
hours/ week
Outside the FIM or Spinal Cord Injury guidelines OR a Team Manager Serious Injury
In consultation with SI Advisor
change of more than 7 hours/week
7.5.23a Meals on wheels
Up to a quantity of 21 units per week
Service Co-ordinator
In consultation with SI Team manager
Support Co-ordinator
7.5.23b Nursing Services
Up to $7,500
Service Co-ordinator
Support Co-ordinator
Between $7,500 - $20,000
Team Manager Serious Injury
Over $20,000
SNA Panel
7.5.23c Case Conference Coordinator
Up to $34
Service Co-ordinator
Support Co-ordinator
7.5.24
Home Support Services (including Integrated Home and Community Support services, Community Nursing and Rural Nursing) – not covered
by FIM Guides
Note: This applies to decisions relating to clients ages 0-16.
All Cares
Team Manager Serious Injury
In consultation with SI Advisor
7.5.25
Home Support Services – higher hourly rates for non-contracted agency and private caregivers
All applications
Branch Manager
On the recommendation of National Consistency Panel
7.5.26
Medical Consumables
Up to $15,000
Service Coordinator
Support Coordinator
Over $15,000
Team Manager Serious Injury
In consultation with SI Advisor
7.5.27
Medical Report and Note Request
All requests
Service Coordinator
Support Coordinator
7.5.29
Non-acute Inpatient Rehabilitation
Up to 3 weeks
Support Coordinator
Over 3 weeks
Team Manager Serious Injury
Branch Manager
7.5.30
Non-contracted services, where the service has contracted providers (MFP service items ADMIN1, ADMIN2, SI100 and TSO1).
Note: This delegation is in addition to the relevant delegation for the service.
Refer to Corporate Delegations Schedule B for information on prices that are outside contract value.
Up to $25,000
Branch Manager
In consultation with SI Advisor
Over $25,000
Manager Serious Injury
On the recommendation of SI Advisor
7.5.30a Non contracted services (NCA01)
Up to $2,000
Team Manager
Up to $20,000
Branch Manager
7.5.31
Pharmaceuticals – Non-subsidised
Up to 30
Service Coordinator
Support Coordinator
Over 30 and up to 60
Team Manager Serious Injury
Over 60
Branch Manager
7.5.32
Pain Management Programmes
Up to $7,000
Service Coordinator
Support Coordinator
Over $7,000
Team Manager Serious Injury
7.5.34
Residential Rehabilitation and Support
Contracted facility
Service Coordinator
Support Coordinator
Non-contracted facility
Team Manager Serious Injury
In consultation with SI Advisor
7.5.34a Palliative Care - Inpatient
Team Manager Serious Injury
All applications up to 42 days
7.5.34b Palliative Care - Community
Team Manager Serious Injury
All applications up to 300 days
7.5.35
Retrospective Social Rehabilitation entitlements (including Home Help, Attendant Care and Child Care) under the Accident Compensation Act
2001
Note: This delegation is in addition to the relevant delegation for the service.
Up to $15,000
Service Coordinator
Support Coordinator
Over $15,000 and up to $30,000
Team Manager Serious Injury
Over $30,000 and up to $100,000
Branch Manager
In consultation with SI Advisor
Over $100,000 and up to $500,000
Manager Technical Services
On the recommendation of SI Advisor & Technical Specialist
Over $500,000
Chief Operating Officer
Important:
This is to be read in conjunction with the above delegation description.
For this delegation to apply the following condition must be met:
7. Only applies in relation to social rehabilitation entitlements; and
8. Only when the claimant is unable to manage their own finances affairs or make personal decision; and
9. Where ACC requires the appointment of a:
7. Family Trust; or
8. Personal order under Protection of Personal and Property Rights Act 1988; or
9. Property order under the Protection of Personal and Property Rights Act 1988
The interest is only payable from the date of acceptance of the decision until the family trust, personal or property order has been executed.
7.5.36
Retrospective Social Rehabilitation entitlements under earlier legislation.
Note: All requests for retrospective funding under earlier Acts must be referred to Technical Services for management.
7.5.38
Spinal Cord Injury – Elective Surgery
Contracted procedures
Service Coordinator
Support Coordinator
Non-contracted procedures
Team Manager Serious Injury
7.5.39
Spinal Re-assessment Services
Up to $5,000
Service Coordinator
Support Coordinator
Over $5,000
Team Manager Serious Injury
7.5.40
Supported Employment – programme
Note: This delegation does not include ongoing support payments or the employer subsidy. For these refer to 7.5.41.
Up to $15,000
Service Coordinator
Support Coordinator
Over $15,000
Team Manager Serious Injury
7.5.41
Supported Employment – ongoing support and/or employer subsidy
All funding
Team Manager Serious Injury
7.5.42
Supported Living – program
Note: this delegation does not include ongoing support or maintenance payments. For ongoing support delegations refer to 7.5.43
Up to $15,000
Service Coordinator
Support Coordinator
Over $15,000
Team Manager Serious Injury
7.5.43
Supported Living – support costs
Note: this delegation does not include ongoing maintenance payments. For this refer to 7.5.44.
Up to 12 hours/week
Service Coordinator
Support Coordinator
Over 12 hours/week
Team Manager Serious Injury
In consultation with SI Advisor
7.5.44
Training for Independence
Up to 26 weeks
Service Coordinator
Support Coordinator
Over 26 weeks
Team Manager Serious Injury
7.5.45
Training for Independence – Supported Activities Program
Up to $35,000
Service Coordinator
Support Coordinator
Over $35,000
Team Manager Serious Injury
7.5.46
Transport for Independence - Driving Lessons
Up to $2000 each year
Service Coordinator
Support Coordinator
Over $2000 and up to $5000 each year
Team Manager Serious Injury
7.5.47
Transport for Independence – Motor Vehicle Modification – standard modification
Up to $10,000
Service Coordinator
Support Coordinator
Over $10,000 and up to $15,000
Team Manager Serious Injury
Over $15,000
Manager Transport for Independence
7.5.47a Transport for Independence – Motor Vehicle Repairs
All repairs
Manager Transport for Independence
7.5.48
Transport for Independence – Motor Vehicle Modification – highly modified vehicle contract
All related costs
Manager Transport for Independence
7.5.49
Transport for Independence – Motor Vehicle Purchase
Initial or Subsequent Vehicle Purchase Up to $30,000 Team Manager Serious Injury
Initial or Subsequent Vehicle Purchase over $30,000
Manager Transport for Independence
7.5.50
Transport for Independence – Funded Transport
Up to $2600 each year
Service Coordinator
Support Coordinator
Over $2600 and up to $10,000 each year
Team Manager Serious Injury
Over $10,000/year
Manager Transport for
In consultation with SI Advisor
Independence
7.5.51
Vocational Rehabilitation Services – Employment (including Spinal Cord Injury Vocational Services)
Notes:
For vocational Aids and Appliances see 7.5.3
For Workplace Modifications see 7.5.20 and 7.5.21
For Supported Employment see 7.5.40 and 7.5.41
Contracted services up to $7,000 in total per client
Service Coordinator
Support Coordinator
Contracted services over $7,000 in total per client
Team Manager Serious Injury
7.5.52
Vocational Rehabilitation Services – Self-employment – pre-approval business plan or small business course
Note:
For vocational Aids and Appliances see 7.5.3
For Workplace Modifications see 7.5.20 and 7.5.21
For Supported Employment see 7.5.40 and 7.5.41
Up to $2000
Team Manager Serious Injury
Over $2000
Branch Manager
7.5.53
Vocational Rehabilitation Services – Self-employment – approval of proposal
Notes:
For vocational Aids and Appliances see 7.5.3
For Workplace Modifications see 7.5.20 and 7.5.21
For Supported Employment see 7.5.40 and 7.5.41
Up to $2000
Team Manager Serious Injury
Over $2000
Branch Manager
7.5.54
Vocational Rehabilitation Services – extension beyond three years
All decisions
Branch Manager
On the recommendation of SI Advisor
7.5.54a Behavioural Support Services
Approve Assessment and Planning (One only)
Service Coordinator
Support Coordinator
Approve Rapid Response Post Exit service (RRPE)
Team Manager Serious Injury
(Up to 12 hours over 3 days)
7.5.54b Behavioural Support Services – Implementation of Support Plan
6 hours per week or 230 hours over a 9 month period Team Manager Serious Injury
7.6 Weekly compensation
Final decision-making
Decision description and scope
Consultation
authority
7.6.1
Calculate weekly compensation (including 3 month
Specialist Payments Officer
Entitlement Payments Officer
interim payments)
7.6.2
Determine eligibility for weekly compensation (based on Case Co-ordinator
Case Manager
incapacity)
Service Co-ordinator - Sensitive
Claims Unit
Determine eligibility for weekly compensation (based on Case Administrator (May
approve a Gap in Certification
incapacity) for Long Term Service Claims –
for this type of claim as per
Maintenance status or Long Term Abatement only
7.6.3a)
claims
Case Administrator – Sensitive
Claims Unit
Determine entitlement for weekly compensation (based Specialist Payments Officer
on incapacity from case manager/co-ordinator/SNA and Entitlement Payments Officer
verification of earner status and earnings)
7.6.3
Pay ongoing weekly compensation (based on incapacity Payments Officer
Entitlement Payments Officer
approved by case manager/coordinator/SNA)
Claims Officer Entitlement -
Specialist Payments Officer
Travel
7.6.3a Pay ongoing weekly compensation for Long Term
Specialist Payments Officer
Payments Officer
Service Claims –Maintenance status or Long Term
Entitlement Payments Officer
Abatement only claims (based on certification of
Claims Officer Entitlement -
incapacity by case administrator)
Travel
7.6.3b Approve gap in certification up to 28 days
Claims Officer Entitlements
Case Manager
Case Coordinator
Service Co-ordinator - Sensitive
Claims Unit
Approve gap in certification up to 90 days for a Serious
Team Manager
Injury profiled claim
7.6.3c Approve the transfer of weekly compensation from one
Team Manager
claim to another for the same client
7.6.4a Determine eligibility for advances of compensation and
Case Manager
Case Co-ordinator
grants
Case Administrator
Claims Manager
Case Administrator – Sensitive
Claims Unit
Service Co-ordinator - Sensitive
Claims Unit
Determine entitlement for advance weekly
Specialist Payments Officer
compensation (based on incapacity from case
Entitlement Payments Officer
manager/coordinator & verification of earner status &
earnings)
7.6.4b Authorise Employer Reimbursement for payment:
Specialist Payments Officer
Entitlement Payments Officer
Up to $20,000
Authorise Employer Reimbursement for payment:
Team Manager
Weekly Compensation Team
Above $20,000
7.6.5
Employer Reimbursement Agreement – signing
Centre Manager
authority
7.6.6
Employer Reimbursement Agreement – payment of
Centre Manager
In consultation with:
interest on late reimbursements
Finance Manager
7.6.7
Reimbursement of overpaid deductions to claimant, also known as ‘Over withheld deductions’ (Child Support, Court Fines, Work and Income and Student
Loan deductions)
Approve reimbursement of overpaid deductions
Team Manager
Client Payments in Eos
7.6.8 Weekly Compensation including Interest, Exception, Override and Top-up payments (release of gross payment)
Up to $100,000
Payment Assessor
Refer
P. in proposed
Up to $250,000
Team Leader
Up to $500,000
Client Service Leader
Over $500,000
Manager, Technical Services
7.7 Treatment
Final decision-making
Decision description and scope
Consultation
authority
7.7.1
High Tech Imaging
Authorise entitlement to High Tech Imaging
Claims Officer -Entitlements
Procedures
Claims Officer – Assessment
(for cover)
Decline all or part of a request for High Tech Imaging Claims Officer –Entitlements
In consultation with:
Procedures
Medical Advisor
Senior Medical Advisor
7.7.2
Elective Surgery
Final decision-making
Decision description and scope
Consultation
authority
Decline elective surgical procedures
Case Administrator Claims In consultation with:
Officer Treatment/ESC
Clinical Advisor
Claims Officer Entitlement/ESC Medical Advisor
Claims Manager ESC/Branch
Approve elective surgical procedures
Case Administrator Claims
In consultation with: Senior Medical Advisor for certain Medical
Officer Treatment/ESC
Procedures.
Claims Officer Entitlement/ESC
Case Co-ordinator
Case Manager
Claims Manager ESC/Branch
7.7.3
[Delegations for Non-core Elective Surgery consolidated into 7.7.2]
7.7.4
Fertility Treatment (including fertility assessments, counselling, diagnostic imaging and drugs)
Up to $30,000
Team Manager
In consultation with:
Manager, Corporate Clinical Advice
7.7.5
Advance or recovery of additional private hospital
Case Manager
In consultation with:
treatment costs
Case Co-ordinator
Team Manager
Claims Officer Entitlements
Technical Specialist
Team Leader
Service or Processing Centre Manager
Debt Management Unit
Debt Account Manager
Service Co-ordinator - Sensitive
Claims Unit
Final decision-making
Decision description and scope
Consultation
authority
7.7.6
Dental Treatment (including retrospective dental surgical procedures) for Covered Dental Injuries
Approve or decline all non-surgical dental treatments Claims Officer Entitlement –
Up to $8,000
Dental
Approve or decline all non-surgical/surgical dental
Claims Manager – Dental
treatment
Up to $15,000
Approve or decline all non-surgical/surgical dental
Team Leader
Claims Manager panel in conjunction with external dental advice
treatments
Team Manager
Between $15,000 and $25,000
if required
Approve or decline all
Team Leader
External dental advice
non-surgical/surgical dental treatments
Team Manager
Between $25,000 and $100,000
Approve or decline all non-surgical/surgical dental
Team Leader
External dental advice
treatments
Team Manager
Exceeding $100,000
Centre Manager
7.7.7
Approve or Decline Payment of Services in MFP
Approve or Decline Purchase of treatment, from treatment or service providers in accordance with:
- Cost of Treatment Regulations, schedule 1 Ancillary Services
- Contracts established by Provider Service Delivery
- ACC policies.
Please Note: This section governs payment for manual and electronic vendor billing only.
For approvals outside of section 7.7.7a see section 7.7.8.
See section 7.7.9 for delegations relating to client reimbursement of treatment costs
Schedule line value up to $20,000
Claims Officer Entitlements
In Consultation with (if required):
Claims Officer Payment
Claims Officer Treatment
Case Co-ordinator
Customer Services
Case Manager
Representative (Contact Centre) Service Co-ordinator Sensitive Claims Unit
Schedule line value above $20,000
Team Manager
Final decision-making
Decision description and scope
Consultation
authority
Team Leader
Schedule line value above $100,000
Centre Manager
Schedule total value up to $200,000
Claims Officer Entitlements
Claims Officer Payment
Customer Services
Representative (Contact Centre)
Schedule total above $200,000
Centre Manager
7.7.7a
Approve or Decline Purchase of Medical services in Eos
Approve or decline payment for:
1) treatment from treatment or service providers in accordance with:
- Cost of Treatment Regulations, schedule 1 Ancillary Services
- Contracts established by Provider Service Delivery
- ACC policies
2) goods and services purchased via Purchase Orders
3) goods and services purchased by a person with the delegations to approve the original purchase or entitlement.
Up to $3,000
Case Co-ordinator
Case Manager
Claims Manager - Accidental
Death Unit
Claims Officer Entitlements
Claims Officer Payment -
ESC/PC
Claims Officer Payments
Claims Officer Treatment
Clinical Advisor
CSR - Provider Help Line
Manager Housing and Vehicles
Final decision-making
Decision description and scope
Consultation
authority
Service Co-ordinator
Support Co-ordinator
Triage Manager
Up to $15,000
Service Co-ordinator - Sensitive In consultation with (if required) :
Claims Unit
Case Co-ordinator
Case Manager
Up to $20,000
Team Manager Serious Injury
In consultation with (if required):
Team Manager
Case Manager
Case Co-ordinator
Service Co-ordinator - Sensitive Claims Unit
7.7.8
To extend treatment beyond treatment profile or
Claims Officer Payments
normal system maxima (generally following receipt of
ACC32 Request for Additional Treatment)
Claims Officer Treatment
Claims Officer Entitlements
Clinical Advisor
Customer Service
Representative, Provider
Helpline
Reimbursement of Full Cover of Treatment over and Claims Officer Payments
above listed in section 7.7.7 in exceptional
circumstances
Claims Officer Treatment
Claims Officer Entitlements
Programme Manager
7.7.9
MFP Client Reimbursements
Approve or Decline reimbursement payment to clients for:
1) treatment by treatment providers in accordance with:
- Cost of Treatment Regulations, schedule 1 Ancillary Services
Final decision-making
Decision description and scope
Consultation
authority
- Contracts established by Provider Service Delivery
- ACC policies.
2) goods and services purchased via Purchase Orders
3) goods and services purchased by a person with the delegations to approve the original purchase or entitlement.
Line value up to $1,000
Claims Officer Entitlements
Claims Officer Payments
Claims Officer Treatment
Line value up to $50,000
Team Leader
Team Manager
Line value above $50,000
Centre Manager
Total value up to $20,000
Claims Officer Entitlements
Claims Officer Payments
Claims Officer Treatment
Total value up to $50,000
Team Leader
Team Manager
Total value above $50,000
Centre Manager
7.7.9a
Eos Client Reimbursements
To approve or decline reimbursements of services to clients for:
1) treatment by treatment providers in accordance with:
- Cost of Treatment Regulations, schedule 1 Ancillary Services
- Contracts established by Provider Service Delivery
- ACC policies.
2) goods and services purchased via Purchase Orders
3) goods and services purchased by a person with the delegations to approve the original purchase or entitlement.
Final decision-making
Decision description and scope
Consultation
authority
Up to $1,000
Case Administrator
Case Administrator - TICAC
Case Co-ordinator
Case Manager
Claims Manager - Accidental
Death Unit
Claims Officer Entitlements
Claims Officer Payment -
ESC/PC
Claims Officer Payments
Claims Officer Treatment
Clinical Advisor
CSR - Provider Help Line
Service Co-ordinator
Support Co-ordinator
Up to $10,000
Team Manager Serious Injury
Team Manager
Up to $20,000
Centre Manager
In consultation with:
Medical Advisor
7.7.10
Spinal Cord Stimulator
Approve Spinal Cord Stimulator Assessment and/or
Branch Manager
In consultation with:
Treatment
Medical Advisor
Senior Medical Advisor
7.8 Accidental death and permanent incapacity
Final decision-making
Decision description and scope
Consultation
authority
7.8.1
Funeral grant (authorise or decline)
Claims Manager
Accidental Death Unit
7.8.2
Survivor's grant (authorise or decline)
Claims Manager
Accidental Death Unit
7.8.3
Child care (authorise or decline)
Claims Manager
Accidental Death Unit
7.8.4
Status of child unborn at death of deceased (establish Team Manager
whether a child born within 12 months of death of
Accidental Death Unit
deceased is deemed to be a dependent)
7.8.5
Weekly compensation (authorise or decline)
Claims Manager
Accidental Death Unit
7.8.6
Calculate/approve continuing weekly compensation for Claims Manager
Accidental Death and Section 60 (permanent
Accidental Death Unit
incapacity) claims including changes to pro rata
Claims Officer
Accidental Death Unit
(HSC)
7.8.7
Commutation of Weekly Compensation Benefits to
Team Manager
Spouses
Accidental Death Unit
7.8.8
Spouse or dependency status arising after date of
Claims Manager
injury of deceased (establish status of surviving
Accidental Death Unit
spouse or other dependent)
7.8.9
Advances of compensation and grants (authorise or
Claims Manager
decline)
Accidental Death Unit
7.8.10
Determine eligibility as a spouse, child
Claims Manager
Accidental Death Unit
7.8.10a Determine eligibility as an other dependent
Claims Manager
Accidental Death Unit
7.8.11
Accidental Death - Approval of payments
• Miscellaneous costs
• Assessments & Reports
Up to $6,000
Claims Officer, Accidental Death
Unit
Claims Manager,
Accidental Death Unit
Up to $10,000
Team Manager,
Accidental Death Unit
7.9 Cessation and suspension
Final decision-making
Decision description and scope
Consultation
authority
7.9.1
Age limits (cease weekly compensation due to National Claims Officer Entitlements
In consultation with:
Case Manager
Superannuation Qualifying Age or elected date)
Case Co-ordinator
Technical Specialist
Case Administrator
Case Administrator – Sensitive
Claims Unit
Service Co-ordinator - Sensitive
Claims Unit
7.9.1b Age limits (cease weekly compensation for children on
Claims Manager
accidental death claims)
7.9.2
Suspend, cancel, or refuse compensation or
Claims Officer Entitlements
Suspension of weekly compensation under s117 requires the
Case Manager
rehabilitation
Case Co-ordinator
approval of a
Clinical Advisor
Technical Specialist
Service Co-ordinator - Sensitive
Claims Unit
7.9.2a Confirm Vocational Independence
Case Manager
In consultation with: Technical Specialist
Support Co-ordinator
Service Co-ordinator - Sensitive
Claims Unit
7.9.3
Entitlement payments, including Interest on Weekly Compensation
Under $10,000
Specialist Payments Officer
On recommendation of:
Entitlement Payment Officer
Claims Officer
Claims Manager
Claims Manager
Case Manager
Service Co-ordinator - Sensitive Claims Unit
Between $10,000 and $100,000
Approved Specialist Payments
Officer
Approved Entitlement Payments
Officer
Between $100,000 and $250,000
Centre Manager
On recommendation of Technical Specialist
Over $250,000
Manager Technical Services
On recommendation of Technical Specialist
7.10 Mediation, review and appeal
Final decision-making
Decision description and scope
Consultation
authority
7.10.1
Review Application – Approve to Hearing
Review Specialist
In partnership with:
Original Delegation Holder
7.10.2
Review Application – Overturn Original Decision
Review Specialist
In partnership with:
Original Delegation Holder
7.10.3(a) Review Application – Settle:
Review Specialist
Less than $2,000
7.10.3(b) Review Application – Settle: Between $2,000 and
Resolution Manager
In consultation with:
$5,000
Original Delegation Holder
7.10.4
Accept or decline extenuating circumstances – Late
Review Specialist
review applications
7.10.4(a) Accept or decline late lodged review application
Senior Review Specialist
relating to 1972 or 1982 Act decision (excluding Lump
Sum decisions)
7.10.4(b) Accept or decline late lodged review application
Senior Review Specialist
relating to 1972 or 1982 Act Lump Sum decision
7.10.5
Award mediation costs (see Mediation, as per review Review Specialist
regulations)
Review Coordinator
7.10.6
Award review costs (as per review regulations)
As a result of a review hearing:
A reviewer allocated under
section 137 of the Accident
Compensation Act 2001
As a result of managing a
Review Application:
Review Specialist
Review Coordinator
7.10.7
Work Injury Reviews (where Claimant is not the Applicant)
Award Claimant expenses as specified or in excess of Review Specialist
those specified in Review Costs Regulations
7.10.8
Appeals
Statutory appeals against ACC - settle at District
Review Monitoring Panel
Court
(chaired by Principal Advisor,
Operations)
Statutory appeals by ACC – at District Court
Review Monitoring Panel
(chaired by Principal Advisor,
Operations)
Statutory appeals against ACC - defend or settle at
Chief Governance Officer
On recommendation of: Review Monitoring Panel and General
High Court
Counsel
Statutory appeals by ACC – at High Court
Chief Governance Officer
On recommendation of: Review Monitoring Panel and General
Counsel
Statutory appeals against ACC – defend or settle at
Chief Governance Officer
On recommendation of: Review Monitoring Panel and General
Court of Appeal
Counsel
Statutory appeals by ACC – at Court of Appeal
Chief Governance Officer
On recommendation of: Review Monitoring Panel and General
Counsel
7.11 Transitional provisions
Final decision-making
Decision description and scope
Consultation
authority
7.11.1
Weekly compensation, continue payments
Authorise, adjust, and cease weekly compensation
Claims Officer Entitlements
Case Manager
Case Co-ordinator
Case Administrator
Case Administrator – Sensitive
Claims Unit
Service Co-ordinator - Sensitive
Claims Unit
Extend, based on certification of incapacity from case
Claims Officer Entitlements
manager/ co-ordinator
Specialist Payments Officer
Entitlement Payments Officer
Authorise, adjust calculations, and cease weekly
Claims Officer –Entitlements
compensation payments
Specialist Payments Officer
Entitlement Payments Officer
7.11.2
Accidental Death
Authorise and cease weekly compensation to surviving Claims Officer Entitlements,
spouse, children, and other dependants
Accidental Death Unit
Revise and cease weekly compensation on account of
a change in financial dependency
7.11.3
Accept or decline late review applications (Lump sums) Senior Review Specialist
Accept or decline late review applications (all other
Senior Review Specialist
reviews)
7.12 Other areas
Final decision-making
Decision description and scope
Consultation
authority
7.12.1
Assess or reassess entitlement to an Independence
Claims Officer Entitlements
allowance
Independence Allowance Unit
7.12.2
Payment of independence allowance – overseas based Centre Manager
claimant
7.12.3
Revision of entitlement decision (within same
Claims Officer Entitlements
In consultation with (if required):
delegation level)
Claims Manager
Team Manager
Case Manager
Team Leader
Manager
Service Co-ordinator - Sensitive Collections & Recoveries
Claims Unit
7.12.4
Payment of interest
7.12.5
Uncollectable debt (decide debt not collectable and write off) where decision revised on medical grounds – section 251(1) (external link)
Up to $ 5,000
Technical Overpayment Analyst
Up to $20,000
Team Manager Technical
Services
Up to $100,000
Manager
Technical Services
Over $100,000
Chief Financial Officer
On recommendation of:
Manager
Technical Services
Final decision-making
Decision description and scope
Consultation
authority
7.12.6
Uncollectable debt (decide debt not collectable and write off) where all criteria are met – section 251(2) (external link)
Up to $ 5,000
Technical Overpayment Analyst
Up to $20,000
Team Manager Technical
Services
Up to $100,000
Manager
Technical Services
Over $100,000
Chief Financial Officer
On recommendation of:
Manager
Technical Services
7.12.7
Uncollectable debt (decide debt not collectable and write off) under ACC policy
Up to $ 5,000
Technical Overpayment Analyst
Up to $20,000
Team Manager Technical
Services
Up to $100,000
Manager
Technical Services
Over $100,000
Chief Financial Officer
On recommendation of:
Manager
Technical Services
7.12.7a Uncollectable vendor and provider debt (decide debt not collectable and write off) under ACC policy where all criteria are met – section 251(2)
(external link)
Up to $500
Team Manager/Leader
In consultation with:
Service or Processing Centre
Claims Officer Payments/Entitlements
Final decision-making
Decision description and scope
Consultation
authority
Up to $1,000
Centre Manager
On recommendation of:
Team Manager/Leader
Service or Processing Centre
Up to $10,000
Manager CACS
On recommendation of:
Centre Manager
Up to $20,000
Chief Operating Officer
On recommendation of:
Manager Service and Processing
Over $20,000
Chief Executive
On recommendation of:
Chief Operating Officer
7.12.8
Refunding over-recovered claimant debt
Up to $500
Team Leader
In consultation with:
Collections and Recoveries
Technical Overpayment Analyst
Up to $1000
Manager
On recommendation of:
Collections and Recoveries
Team Leader
Analysis and Support
Collections and Recoveries
Up to $10,000
Chief Financial Officer
On recommendation of:
Manager
Collections and Recoveries
Over $10,000
Chief Executive
On recommendation of:
Chief Financial Officer
7.12.8a Overpayments in Eos (debt not collectable and write off) where all criteria are met – section 251(2)
Final decision-making
Decision description and scope
Consultation
authority
Up to $400
Payment Assessor
Up to $5,000
Approved Payment Assessor
In consultation with Technical Overpayment Analyst if error
created by Payment Team
Up to $20,000
Technical Overpayment Analyst
Up to $100,000
Manager Technical Services
Over $100,000
Chief Financial Officer
7.12.9
Payment to carer, financially responsible person, or trust
Authorise or decline any entitlement under $5,000
Claims Officer Entitlements
In consultation with:
Case Manager
Technical Specialist
Service Co-ordinator - Sensitive
Claims Unit
Authorise or decline any entitlement over $5,000
Team Manager
In consultation with:
Case Manager
Technical Specialist
Service Co-ordinator - Sensitive
Claims Unit
7.12.10 Compensation, grant, or allowance inalienable
Authorise compensation, grant or allowance (except
Claims Officer Entitlements
Case Manager
Independence Allowance to an insurance company)
Case Co-ordinator
Service Co-ordinator - Sensitive
Claims Unit
Authorise Independence Allowance to insurance
Centre Manager
Final decision-making
Decision description and scope
Consultation
authority
company
7.12.11 Payment by ACC outside the scope of statutory entitlements. (Previously wrongful action)
Up to $2,000
Operational Unit Manager
$2,000 to $20,000
Principal Advisor, Office of the
On the recommendation of: Technical Specialist
COO
In consultation with:
Legal Services
$20,000 to $50,000
Chief Operating Officer
In consultation with:
Principal Advisor, Office of the COO
Legal Services
Over $50,000
Chief Executive
On the recommendation of: Chief Operating Officer
In consultation with;
Legal Services
Principal Advisor, Office of the COO
Decline a request for a Payment outside the scope of
Principal Advisor, Office of the
On the recommendation of: Technical Specialist
statutory entitlements
COO
7.12.12 Offences
Recommend prosecution if a claimant has committed
Claimant Fraud Investigations
In consultation with:
an offence against ACC
Manager
Senior Examining Officer – Claimants
Claims Officer
Final decision-making
Decision description and scope
Consultation
authority
Service or Processing Centre Manager
Team Manager
7.12.13 Lump sum compensation
10% to 100% Whole Person Impairment
Team Leader / Team Manager – In consultation with:
Independence Allowance/Lump Corporate Medical Advisor when necessary*
Sum Unit
7.12.14 Approval of Delegations for Pilot Programmes up to six months duration
Up to six months duration
Head of Provider Service
In consultation with:
Delivery
Programme Manager
7.12.15 Security guards for a provider’s location
Up to 20 hours per week
Case Administrator
Case Administrator – Sensitive
Claims Unit
Up to 40 hours per week
Case Coordinator
Case Manager
Service Co-ordinator - Sensitive
Claims Unit
Up to 50 hours per week
Team Manager
7.14 Approval for payment of claims-related invoices and
reimbursements
Final decision-making
Decision description and scope
Consultation
authority
7.14.1
Medical fee transactions handled via MFP
For Vendor payment or Client reimbursement
Note: Initial control is around purchase order approval, as per the delegation to purchase goods and services for claimants listed above.
Note that invoices not covered by a purchase approval or under regulation must be approved by a person who has the delegation to approve the original
purchase or entitlement.
Manual Invoice Line
Role Name
MFP Security Group
Line value of manual invoice up to $20,000
Claims Officer Entitlements
177 - MFSP Payment Processing
Claims Officer Payments
217 - MFSP Elective Surgery Payments
Claims Officer Treatment
Customer Service
Representative (Provider
Contact Centre)
Line value of manual invoice $20,000 - $100,000
Team Manager
178 - MFSP Team Manager
Team Leader
Line value of manual invoice above $100,000
Centre Manager
432 - MFS Manager Payments Processing
Manual Invoice Total
Total value of manual invoice up to $20,000
Claims Officer Entitlements
177 - MFSP Payment Processing
Claims Officer Payments
217 - MFSP Elective Surgery Payments
Claims Officer Treatment
Final decision-making
Decision description and scope
Consultation
authority
Customer Service
Representative (Provider
Contact Centre)
Total value of manual invoice $20,000 - $100,000
Team Manager
178 - MFSP Team Manager
Team Leader
Manual schedule line above $100,000
Centre Manager
432 - MFS Manager Payments Processing
Manual Schedule Line
Manual schedule line up to $20,000
Claims Officer Entitlements
177 - MFSP Payment Processing
Claims Officer Payments
217 - MFSP Elective Surgery Payments
Claims Officer Treatment
Customer Service
Representative (Provider
Contact Centre)
Manual schedule line $20,000 - $100,000
Team Manager
178 - MFSP Team Manager
Team Leader
Manual schedule line above $100,000
Centre Manager
432 - MFS Manager Payments Processing
Manual Schedule Total
Manual schedule up to $200,000 in total
Claims Officer Entitlements
177 - MFSP Payment Processing
Claims Officer Payments
217 - MFSP Elective Surgery Payments
Claims Officer Treatment
178 - MFSP Team Manager
Customer Service
Representative (Provider
Contact Centre)
Final decision-making
Decision description and scope
Consultation
authority
Manual schedule above $200,000 in total
Centre Manager
432 - MFS Manager Payments Processing
Electronic Schedule Line
Electronic schedule line up to $20,000
Claims Officer Entitlements
177 - MFSP Payment Processing
Claims Officer Payments
217 - MFSP Elective Surgery Payments
Claims Officer Treatment
Customer Service
Representative (Provider
Contact Centre)
Electronic schedule line $20,000 - $100,000
Team Manager
178 - MFSP Team Manager
Team Leader
Electronic schedule line above $100,000
Centre Manager
432 - MFS Manager Payments Processing
Electronic Schedule Total
Electronic schedule up to $200,000 in total
Claims Officer Entitlements
177 - MFSP Payment Processing
Claims Officer Payments
217 - MFSP Elective Surgery Payments
Claims Officer Treatment
178 - MFSP Team Manager
Customer Service
Representative (Provider
Contact Centre)
Electronic schedule above $200,000 in total
Centre Manager
432 - MFS Manager Payments Processing
Client Reimbursement Line
Total line value of Client Reimbursement up to $1,000 Claims Officer Entitlements
177 - MFSP Payment Processing
Claims Officer Treatment
217 - MFSP Elective Surgery Payments
Claims Officer Payments
Final decision-making
Decision description and scope
Consultation
authority
Total line value of Client Reimbursement up to $50,000 Team Manager
178 - MFSP Team Manager
Team Leader
Total line value of Client Reimbursement above
Centre Manager
432 - MFS Manager Payments Processing
$50,000
Client Reimbursement Total value
Client Reimbursement total value up to $20,000
Claims Officer Entitlements
177 - MFSP Payment Processing
Claims Officer Payments
217 - MFSP Elective Surgery Payments
Claims Officer Treatment
Client Reimbursements total value up to 50,000
Team Manager
178 - MFSP Team Manager
Team Leader
Client Reimbursements total value above $50,000
Centre Manager
432 - MFS Manager Payments Processing
GST and Invoice Errors
Correction of GST errors & obvious errors in invoice
Claims Officer-Payments
177 - MFSP Payment Processing
calculation
217 - MFSP Elective Surgery Payments
7.14.2
Accredited Employer Reimbursements and Employer Reimbursement Agreements
$0 - $20,000
Specialist Payments Officer
Entitlement Payments Officer
Claims Officer Entitlements
Accidental Death Unit
$20,000 - $50,000
Branch Manager
Team Manager Service or
Processing Centre
Final decision-making
Decision description and scope
Consultation
authority
$50,000 - $500,000
Head of Client Service Delivery
$500,000 - $1 million
Chief Operating Officer
$1 million+
Chief Executive
7.14.2a Department of Work and Income Reimbursement Agreements
$0 - $20,000
Specialist Payments Officer
Entitlement Payments Officer
Claims Officer Entitlements
Accidental Death Unit
$20,000 - $500,000
Unit Manager
Team Manager Service or
Processing Centre
$500,000 - $1 million
Chief Operating Officer
$1 million+
Chief Executive
7.14.3
Credit note approval: Delegations as per invoices (see above)
7.14.4
Accredited Employer Insurer Reimbursements for Gradual Process Claims, Cost on Returned Claims, and Shared Responsibility (MFP service
items INRE1, INRE2 and INRE3)
Up to $500,000
Insurer Liaison Manager
Over $500,000
Chief Executive
In consultation with:
Insurer Liaison Manager