22 August 2023
Monica
[FYI request #23716 email]
Kia ora
Your Official Information Act request, reference: GOV-026905
Thank you for your request of 6 August 2023, asking for information about cover decisions under the
Official Information Act 1982 (the Act). Our answers are provided in turn below:
1) How ACC determines cover decisions when we receive conflicting views from treating providers
When information received gives differing views or diagnoses, the cover assessor requests specialist clinical
guidance, and for more complex claims, a report from an independent third-party provider.
2) Who reviews and comments on scans provided by client
Where high-tech imaging, such as CT scans, are provided by clients and it was not commissioned by ACC,
cover assessors request specialist clinical review.
3) Do cover assessors have a medical background? Cover assessors are not required to have a medical qualification. Specialist cover assessors are required to
have a qualification and annual practicing certificate.
4) What medical information does ACC collect from treating providers/GPs?
When we request medical records, we only request information relating to the claim. Refer to section 3.0
and 7.0 of the ‘Request medical or clinical records Policy’ (attached) for more details.
The following policies related to the above answers are included in the appendix:
• Seek External Clinical Advice
• Seek Internal Guidance
• Assess Cover for an Additional Injury or Change in Diagnosis
• Cover criteria for pre-existing conditions Policy
• Request medical or clinical records Policy
As staff names were not requested, they have been deemed out of the scope of the request and removed.
As this information may be of interest to other members of the public
ACC may decide to publish a copy of this response on ACC’s website. All requester data, including your
name and contact details, will be removed prior to release. The released response will be made available
www.acc.co.nz/resources/#/category/12. If you have any questions about this response, please get in touch
You can email me at
[email address]. Ngā mihi
Sara Freitag
Acting Manager Official Information Act Services
Government Engagement
GOV-026905 Page 1 of 1
Document Outline
