GOV-029412
Your claim number is [Claim number auto]
Date auto
Client Title Auto Client Full Name Auto
Additional Recipient Reference Auto
Address Line 1 Auto
Address Line 2 Auto
Suburb Auto
Town Or City Auto Post Code Auto
Dear Client Title Auto Client Surname Auto
We’ve received your claim and we need more time
We’ve been told you were injured while being treated by a registered health professional. This
means we will consider your claim as a treatment injury claim.
What happens now
These types of claims can be complex, and we need to ask the people involved in your treatment
for more information.
We need your authority for us to col ect medical and other records relevant to your claim. I’ve
included an ACC6300 Authority to collect medical and other records form that you can use to
authorise ACC to collect relevant medical and other records to help make decisions about your
claim. You can either sign this form or contact us if you’d like to discuss other ways to provide your
authority.
[Optional] We’ve asked [DHB/Practice] to forward us a Treatment Injury Claim form which provides
more detailed information about your injury. If you believe [DHB/Practice] is not the most
appropriate provider to complete this form, please let us know as soon as possible. We expect to
receive the claim form by [date] and will remind them if necessary.
We’re required to make a decision within four months of receiving your claim, but sometimes it can
take longer to get the information we need. If this happens, we’ll get in touch to ask you for more
time.
We’l be in touch with you as soon as possible and certainly by [date - 4 months from lodgement]
In the meantime, please keep any receipts and medical certificates, as we may be able to help with
treatment costs and other support for your injury if we approve your claim. Work & Income may be
able to provide some financial help while we consider your claim.
Sharing your information
If we believe an event that led to your injury raises a risk of further harm to the public, by law we’re
required to share information about your claim with the appropriate regulatory authorities (eg
Director General of Health).
TI01

GOV-029412

Concerns about the care you received
If you’re concerned about the care you’ve received during treatment, most health providers, such
as hospitals, have a Customer/Patient Service department which should be able to help.
Alternatively, you can contact the Health and Disability Commissioner, who is responsible for
dealing with complaints about health and disability providers.

Enclosed information
We’ve enclosed the fol owing information for you:
• Assessing cover for your treatment injury claim
• Health and Disability Commissioner Learning from Complaints
We’re happy to answer your questions
Please call me on [Contact Details auto] if you would like to talk about this letter. I’ll be able to help
you faster if you have your claim number ([Claim Number Auto]) ready.
Yours sincerely

[Staff_Name auto]
[Job Title auto]
Telephone: [Telephone]
Encl. Authority to collect medical and other records (ACC6300), Assessing cover for your treatment
injury claim, Health and Disability Commissioner Learning from Complaints
TI01

GOV-029412

Assessing cover for your
treatment injury claim
The information below tells you more about how we determine cover for your treatment injury
claim.
What do we mean by treatment injury?

A treatment injury is an injury you get while seeking or
Keep your receipts and medical certificates.
receiving treatment from a registered health
While we assess your claim, please keep any related
professional.
medical certificates and receipts for your costs. We may
be able to help with treatment costs and other support for
Treatment can also include diagnosis, monitoring,
your injury if we approve your claim.
investigation or advice.
How wil  we assess your claim?
How will I know if ACC has approved my claim?
We’ll write to you. We’ll also let you know the help
First, we need the following forms:
ACC has to offer and how to go about getting it.
ACC2152 – treatment
The person who treated
injury claim form
you completes this form
What happens if my claim isn’t approved?
to provide details about
We’ll call you and write to you to explain our decision.
the treatment you
If you disagree with it, we’ll work with you to sort out
received
your concerns. You also have the right for the decision
to be reviewed by an independent reviewer.
ACC6300 – Authority to
You complete this form
collect medical and other
to authorise ACC to
What may not be covered?
records
collect relevant medical
and other records to help
ACC may not be able to cover all treatment that doesn’t
make decisions about
go well. We can’t approve your claim if your injury is:
your claim
•  the result of a health condition you had before you
received treatment
In some cases we may need more information about
•  a necessary part, or an ordinary result, of your
your injury and the events that led to it. We may ask for
particular treatment
medical advice from other health professionals,
including those involved in your treatment.
•  caused by a decision an organisation made when
allocating health resources
How long will the process take?
•  caused because you unreasonably delayed or
Because a treatment injury claim may require us to
refused to give consent for your treatment
collect information from a number of sources, it can take
•  treated, but the treatment didn’t achieve the desired
anything from a few weeks to several months to assess
result
your claim.

We’re happy to answer your questions.
If you’d like to know more, please call your Client Service staff member or 0800 101 996.  In addition, you may be
interested in the following information:
For information on…
See the guide …
help we can provide
Getting help after an injury (ACC2399 – booklet)
how we collect and use your information
Collection and disclosure of information (INPIS01 –
information sheet)
your rights to receive a high standard of service, and how
Working together to resolve issues (ACC2393 – booklet)
we resolve any concerns you may have
Copies are available at any ACC Branch, on our website www.acc.co.nz or by calling 0800 101 996.

GOV-029412

ACC6300
Authority to collect medical and other
records
Please complete this form to authorise ACC to collect relevant medical and other records about your claim.

When you’ve finished, please return this form to [email address] or your closest Mail Centre:

If you live in Northland, Auckland, Waikato or Bay of Plenty:
•
PO Box 952, ACC Hamilton Hub, Hamilton 3240

If you live in Taranaki, Manawatu-Whanganui, Hawke's Bay, Wellington or the South Island:
•
PO Box 408, ACC Dunedin Hub, Dunedin 9054

1. Client details
Client name: [Client full name auto]
Claim number: [Claim number auto]
Date of birth: [Date of birth auto]
Date of injury/event: [Date of injury auto]
Address:
[Address Line 1 Auto]
[Address Line 2 Auto]
[Address Line 3 Auto]
[Post Code Auto]
2. Collecting your medical and other records
Why we ask for your authority to collect your medical and other records
To establish your entitlement to compensation, rehabilitation and treatment we may need to collect medical
and other records about you from a third party, such as your General Practitioner (GP), other medical
professional or employer. We need your authority to collect them.
These records could include:
•  medical reports
•  details of your accident
•  medical history relevant to your claim
•  specialist reports and assessments
•  your employment details and history
•  tax records.
In each case, we’d only seek records that are or may be relevant to your claim during the life of your claim.
We’ll let you know about the types of records we need to collect, and why we need to collect them to make
these decisions about your claim. Please contact us if you’d like to discuss this further.
How you can provide your authority
You can either sign this form or contact us if you’d like to discuss other ways to provide your authority. These
may include for example, setting the duration of your authority or asking us to contact you for authority on a
case by case basis.
Collecting and using your personal information
ACC collects your personal and health information to assess whether your claim is covered under the ACC
scheme, to manage your claim, and to assess and provide appropriate rehabilitation, treatment, and
compensation to you. We also use personal information for other lawful purposes connected with our
functions and activities under the Accident Compensation Act 2001 (including research, policy development,
maintaining a claims database, systems testing, levy setting, internal processes including investigations,
training and processing information requests).
ACC6300
June 2023
Page 1 of 3

GOV-029412

ACC6300 Authority to collect medical and other records
ACC may need to obtain medical and other records about you from third parties such as your General
Practitioner (GP), specialists, other medical professionals or treatment providers, or your employer.
Providing information to ACC is voluntary. However, if relevant information is not provided, ACC may not be
able to determine whether you are eligible for cover or for particular entitlements. Under the Accident
Compensation Act 2001, you must provide information that is relevant to your claim when ACC reasonably
requires you to provide it. ACC may decline to provide any entitlement if you unreasonably refuse to give
ACC any relevant information or to authorise ACC to obtain records that may be relevant to your claim.
ACC shares personal and health information with other agencies for the purposes of managing claims and
entitlements, to fulfil our other statutory functions, and in other situations where permitted or required by law.
These agencies include government agencies, external providers (eg treatment providers) and your employer
(including for non-work related injuries).
You have the right to access and request correction of personal and health information that ACC holds about
you.
The Privacy Act 2020 and the Health Information Privacy Code 2020 apply to your personal and health
information. Further details of how and why we collect, use, store and disclose information are set out in our
Personal Information and Privacy Policy, which may be viewed on our website acc.co.nz/privacydisclaimer.
For more information about privacy, to request access or correction of your personal and health information,
or if you have a question or concern, contact us:
[email address]
The Privacy Officer
Accident Compensation Corporation
PO Box 242
Wellington 6011
3. Declaration
Please read and sign the following declaration:
I declare:
•  that the information given in this form is true and correct and that I have not withheld any information
likely to affect my application. I will inform ACC of any change in circumstances which may affect my
entitlements.
I authorise:
•  ACC to collect the following information and to use and disclose it in an accordance with the
purposes set out above and in ACC’s Privacy Policy:
•  medical and other records which are or may be relevant to my claim
•  details of my accident
•  tax records, employment details and history which are or may be relevant to my claim
•  the holders of such information to provide it to ACC
•  the treatment provider to lodge this claim for me
Client name: [Client full name auto]
Claim number: [Claim number auto]
Signature:
Date:
4. Client representative’s declaration
If applicable, please read and sign the following declaration:
I declare that I have authority to consent on behalf of the client to the collection of medical and other records
that are or may be relevant to the client’s claim. I authorise ACC to collect medical and other records which
are or may be relevant to the client's claim.
Signature:
Date:
Representative’s name:
Phone number:
What is your relationship to the client?
ACC6300
June 2023
Page 2 of 3

GOV-029412
ACC6300 Authority to collect medical and other records
Why is the client unable to sign this form?
ACC6300
June 2023
Page 3 of 3

GOV-029412
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GOV-029412

GOV-029412
Make cover or funding decision :: Make Treatment Injury
cover decision

v182.0
Outputs
6.0
Issue decision
5.0
Arrange External Assessment
4.0
Assess additional information
Admin)
Linked Process
Request Clinical Records or Information (without Recovery
Linked Process
Request Clinical Records (Cover)
3.0
Assess claim
2.0
Contact Client
riggers & Inputs
T
1.0
Complete pre-assessment checks
Assessor
Assessor
Assessor
reatment and Support
Cover
Specialist Cover
T
ACC > Claims Management > Manage Claims > Claims Assessment Pilot > Make cover or funding decision :: Make Treatment Injury cover decision
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Page 1 of 7

GOV-029412
Make cover or funding decision :: Make Treatment Injury
cover decision v182.0
Summary
Objective
Standardised procedure template for cover assessment
Background
General cover
Global
[Out of Scope]
Process
Owner
Global
Process
Expert
Variation
Expert
Procedure
1.0 Complete pre-assessment checks
Cover Assessor, Specialist Cover Assessor, Treatment and Support Assessor
a Complete pre-assessment checks.
Pre-assessment checklist
NOTE What if the claim is for Treatment Injury, Treatment Injury Mental Injury or FACS?
Send acknowledgement letter to the client. Refer to letter and form guidance.
Treatment Injury | Letters and forms guidance
b Check how you use Recovery Admin before proceeding.
Claims Assessment - How do I use Recovery Admin
c Familiarise yourself with the client and claim. Refer to the Familiarise yourself with client and claim guidance.
Treatment Injury |Familiarise yourself with the client and claim
d Determine eligibility for cover or funding. Refer to the linked information for guidance.
Accident Compensation Act 2001, Section 38, Date on which person is to be regarded as suffering treatment injury
Treatment Injury Exclusions from Cover Policy
Necessary Part or Ordinary Consequence of Treatment Policy
Causal Link Policy
Context of Treatment Policy
Cover Criteria for Treatment Injury Policy
NOTE What if you determine the claim or request doesn't meet the eligibility criteria?
Go to Activity 6.0 Issue Decision.
e Refer to the Claims Assessment Traffic Light for consideration, if applicable.
Claims Assessment Traffic Light
f Check you have the delegation to make a decision without seeking internal guidance. (Go to the 'Explanations' tab, second tab
from the left) and refer to the guidance on the landing page for this claim or request type.
Delegations Framework
NOTE What if the claim for cover is for MICPI/WRMI or TIMI?
Even though the Delegations Framework states 'must seek guidance' this is referring to the Psychiatric Assessment
report only. Guidance is not required at this point in the process. Continue this process.
NOTE What if you need to seek internal guidance ?
Review the 'Standards for Seeking Guidance' and make sure they are met before proceeding to 'Seek Internal Guid-
ance (Claims Assessment)'. If you request guidance, once received return to this process.
PROCESS Seek Internal Guidance (Claims Assessment)
Standards for Seeking Guidance
NOTE What if the request is for surgery?
Refer to the 'Principal Clinical Advisors considerations list' to determine if you must seek guidance.
ACC > Claims Management > Manage Claims > Claims Assessment Pilot > Make cover or funding decision :: Make Treatment Injury cover decision
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GOV-029412
Principal Clinical Advisor consideration list
g Record assessment information and update Eos, if applicable.
TI | TIMI | FACS | Confirm cover decision task template
h Determine if you can make a decision.
NOTE What if it is a request for surgery and you are unable to make a decision?
Send the ELE01 letter to the client and Lead Provider.
NOTE What if you are able to make a decision?
Go to '6.0 Issue decision'.
2.0 Contact Client
Cover Assessor, Specialist Cover Assessor, Treatment and Support Assessor
a Determine if you need to contact the client. Refer to client conversation guidance.
Treatment Injury | Initial client conversation guidance
NOTE What if you don't need to contact the client at this point?
Go to '3.0 Assess Claim'. Return to '2.0 Contact Client' if required.
b Review the client conversation guidance.
c Contact the client or ATA by phone.
NOTE What if you are unable to contact the client?
1) Leave a voice message, if possible
2) Send text: "Kia Ora, ACC attempted to call you to discuss your claim. Please call us on 0800 101 996 [insert ext if
applicable] so we can gather some information from you. Ngā mihi [insert Name]"
3) Add 'Followed up Claimant' to the master task and update the target date to 2 working days from today's date
4) Attempt to contact the client a second time. Then refer to the Client Call Attempts instructions if you are unable to
make contact.
What to say in a voicemail message
Create and send text
Claims Assessment - Client Call Attempts
d Confirm you are speaking with the right person by asking ACC's identity check questions.
Identity Check Policy
NOTE What if the client is presenting a threat of self harm?
For guidance refer to the NG Guidelines Managing Threat of Self-harm Calls.
NG GUIDELINES Managing Threat of Self-harm Calls
e Check the client's details match the Eos Party record.
NOTE What if you need to verify the client's email address?
In Eos, in the Client's Party record, select Email tab, select Email from Template, select Verify Client Email Address. In
the body of the email bold the bullet points. Delete the client's name from the subject line.
NOTE What if client details are incorrect on their Eos party record?
Update client details.
NOTE What if the client's name has changed?
Refer to the Change client's legal name Policy.
Change clients legal name Policy
f In Eos, record the conversation as a contact on the claim.
NOTE What if the client wishes to withdraw the claim?
Go to 6.0 Issue Decision task (f).
NOTE What if you determine a decision can made following the conversation with the client?
Go to '6.0 Issue Decision', unless you are waiting for guidance.
g In Eos, generate and send letters and documents, if applicable.
NOTE What if the claims is for Mental Injury caused by Physical Injury, Work Related Mental Injury or Treatment
Injury Mental Injury claim?
Send CVR13 / ACC4244 / PSYIS02 / ACC6300 to the client and CVR14 / ACC4245 to the Provider. In addition to this
for WRMI claims send CVR15 to Employer.
ACC > Claims Management > Manage Claims > Claims Assessment Pilot > Make cover or funding decision :: Make Treatment Injury cover decision
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GOV-029412
3.0 Assess claim
Cover Assessor, Specialist Cover Assessor, Treatment and Support Assessor
a Check if there are open tasks on the claim that you can action and complete.
b Check consideration factors for this claim or request type. Refer to the linked consideration factors for guidance.
Treatment Injury - Traffic Light (Consideration factors)
c Check if you need to request clinical records. Refer to the linked guidance for when to request clinical records.
TI | TIMI | FACS | Guidance for requesting clinical records (SCA)
Treatment Injury | Guidance on requesting clinical records (CA)
NOTE What if you determine you need clinical records?
If you are making a decision on a Treatment Injury (including FACS & TIMI), WRGP or General Cover (including MI)
claim, go to 'Request Clinical Records (Cover)' process, otherwise go to 'Request Clinical Records (without RA)'
process. Once received continue this process.
d Consider if you need internal guidance.
NOTE What if you determine you need internal guidance?
Review the 'Standards for Seeking Guidance' and make sure they are met before proceeding to 'Seek Internal Guid-
ance (Claims Assessment)'. If you request guidance, once received return to this process.
PROCESS Seek Internal Guidance (Claims Assessment)
Standards for Seeking Guidance
e Consider if you need External Clinical Advice.
NOTE What if you determine you need External Clinical Advice?
Go to 'Seek External Clinical Advice'. Once received, return to this process.
PROCESS Seek External Clinical Advice
NOTE What if you are an SCA and require internal or external advice?
In Eos, generate the ACC2184 Cover decision tool to guide your analysis when requesting advice.
ACC2184 Treatment injury cover decision tool
f Update assessment information.
TI | TIMI | FACS | Confirm cover decision task template
g Determine if you can make a decision.
NOTE What if you have determined a client is eligible for a Whole Person Impairment Assessment?
Contact client to advise decision. Record this as a contact on the claim.
NOTE: If the client is in prison, consider the practicalities of arranging an assessment prior to issue a decision. For
guidance refer to 'Clients in Prison Policy.
Go to 6.0 Issue decision task (f).
Clients in Prison Policy
NOTE What if you are unable to make a decision at this point on a Hearing loss claim?
Check if the timeframe to make a decision needs to be extended. Go to 'Extend Cover Decision Timeframe' process.
Then go to '5.0 Arrange External Assessment' to refer the client to an ENT specialist.
PROCESS Extend Cover Decision Timeframe
NOTE What if you are able to make a decision?
Go to '6.0 Issue Decision'
NOTE What if you are unable to make a decision?
Check if the timeframe to make a decision needs to be extended. Go to 'Extend Cover Decision Timeframe', then con-
tinue this process.
NOTE: This excludes Permanent Injury Compensation requests as there are no legislative timeframes to make a deci-
sion, send PIC03.
PROCESS Extend Cover Decision Timeframe
PROCESS
Request Clinical Records (Cover)
Cover Assessor, Specialist Cover Assessor, Treatment and Support Assessor
PROCESS
Request Clinical Records or Information (without Recovery Admin)
Cover Assessor, Specialist Cover Assessor, Treatment and Support Assessor
ACC > Claims Management > Manage Claims > Claims Assessment Pilot > Make cover or funding decision :: Make Treatment Injury cover decision
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GOV-029412
4.0 Assess additional information
Cover Assessor, Specialist Cover Assessor, Treatment and Support Assessor
a Review additional information received.
b Determine whether you are able to make a decision and that the client meets the eligibility criteria. Refer to the linked infor-
mation for guidance.
Causal Link Policy
Cover Criteria for Treatment Injury Policy
Context of Treatment Policy
Treatment Injury Exclusions from Cover Policy
Necessary Part or Ordinary Consequence of Treatment Policy
Accident Compensation Act 2001, Section 38, Date on which person is to be regarded as suffering treatment injury
NOTE What if you have determined a client is eligible for a Whole Person Impairment Assessment?
Contact client to advise decision. Record this as a contact on the claim.
NOTE: If the client is in prison, consider the practicalities of arranging an assessment prior to issue a decision. For
guidance refer to 'Clients in Prison Policy.
Go to 6.0 Issue decision task (f).
Clients in Prison Policy
NOTE What if you need to request additional clinical records and/or reports?
If you are making a decision on a Treatment Injury (including FACS & TIMI), WRGP or General Cover (including MI)
claim, go to 'Request Clinical Records (Cover)' process, otherwise go to 'Request Clinical Records (without RA)'
process. Once received continue this process.
PROCESS Request Clinical Records (Cover)
NOTE What if you are able to make a decision?
Go to '6.0 Issue Decision'.
NOTE What if you are unable to make a decision at this point?
Review the 'Standards for Seeking Guidance' and make sure they are met before proceeding to 'Seek Internal Guid-
ance (Claims Assessment)'. If you request guidance, once received return to this process.
PROCESS Seek Internal Guidance (Claims Assessment)
Standards for Seeking Guidance
NOTE What if you believe based on guidance and/or new information for a TI claim it needs to be upstreamed to a
Specialist Cover Assessor?
Go to 'Treatment Injury and Additional Treatment capability matrix'.
Treatment Injury capability matrix
c Update assessment information.
TI | TIMI | FACS | Confirm cover decision task template
ACC2184 Treatment injury cover decision tool
d Check if an external assessment is required.
NOTE What if the claim is Treatment Injury Mental Injury?
You must send the client for a Mental Injury Assessment. Go to 5.0 Arrange External Assessment.
NOTE What if an external assessment is not required?
Go to '6.0 Issue Decision'.
5.0 Arrange External Assessment
Cover Assessor, Specialist Cover Assessor, Treatment and Support Assessor
a Determine assessment type.
NOTE What if you determine a ENT Specialist assessment is required?
Go to Arrange Ear Nose & Throat (ENT) Assessment. Once this process has been completed return to this process.
PROCESS Arrange Ear Nose & Throat (ENT) Assessment
NOTE What if you determine a Standalone Workplace Assessment maybe required?
Go to Set up Standalone Workplace Assessment. Once this process has been completed return to this process.
PROCESS Set Up Standalone Workplace Assessment
NOTE What if you determine a Comprehensive nursing assessment maybe required?
Go to Arrange Comprehensive Nursing Assessment (CNA). Once this process has been completed return to this
process.
PROCESS Arrange Comprehensive Nursing Assessment (CNA)
ACC > Claims Management > Manage Claims > Claims Assessment Pilot > Make cover or funding decision :: Make Treatment Injury cover decision
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NOTE What if you determine a Whole Person Impairment Assessment maybe required?

Go to Arrange Whole Person Impairment Assessment. Once this process has been completed return to this process.
PROCESS Arrange Whole Person Impairment Assessment
NOTE What if you determine a Mental Injury Assessment maybe required?
Go to Arrange Mental Injury Assessment for Cover. Once this process has been completed return to this process.
PROCESS Arrange Mental Injury Assessment for Cover
NOTE What if you determine a Medical Case Review Assessment maybe required?
Go to Arrange Medical Case Review (MCR) Assessment. Once this process has been completed return to this
process.
PROCESS Arrange Medical Case Review (MCR) Assessment
NOTE What if you determine a Neuropsychological Assessment maybe required?
Go to Assess and Arrange Neuropsychological Assessment. Once this process has been completed return to this
process.
PROCESS Assess and Arrange Neuropsychological Assessment
b Determine if you can make a cover decision.
NOTE What if you are unable to make a decision at this point?
Review the 'Standards for Seeking Guidance' and make sure they are met before proceeding to 'Seek Internal Guid-
ance (Claims Assessment)'. If you request guidance, once received return to this process.
PROCESS Seek Internal Guidance (Claims Assessment)
Standards for Seeking Guidance
6.0 Issue decision
Cover Assessor, Specialist Cover Assessor, Treatment and Support Assessor
a Check if the client is being managed in a Recovery Team or by a Third Party Administrator.
NOTE What if the client is being managed?
Consider client impact when you are issuing a decline decision.
b Review decline decision client conversation guidance.
TI | TIMI| Decline decision client conversation guidance
NOTE What if you are approving or declining an Additional Treatment funding request?
Don't contact the client unless the client has requested contact. Go to task (f).
NOTE What if cover has been accepted?
Contact the client if there are entitlements pending or client has requested contact. If not go to task (f).
c Contact the client or ATA by phone to discuss decision.
NOTE What if you are unable to contact the client?
1) Leave a voice message, if possible
2) Send a text requesting they call us on [Insert phone number]
3) Create a contact to record attempted client contact. Go to task (f).
What to say in a voicemail message
NOTE What if you are issuing a decline cover decision and are unable to contact the client.
Record the attempt as a contact on the claim. Go to task (f).
d Confirm you are speaking with the right person by asking ACC's identity check questions.
Identity Check Policy
e In Eos, record the details of the conversation as a contact on the claim.
f Create a contact to capture decision rationale with Reason as 'Contact with Internal Party', select 'Internal' as Direction and
select 'Other' as Method of Contact. Refer to linked Decision Rationale templates for content to use in the description.
TI | TIMI | FACS | Decision rationale templates
g Update Eos, including cover status.
Update Medical tab
Create Hearing loss indicator
Cover decision updates
Edit Treatment Injury tabs
h Create or update Purchase Order, if applicable.
Create Purchase Order | Claims Assessment
ACC > Claims Management > Manage Claims > Claims Assessment Pilot > Make cover or funding decision :: Make Treatment Injury cover decision
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i In Eos, generate and send decision letter / email. Refer to linked Communication guidance and templates.
Treatment Injury | Letters and forms guidance
TI | TIMI | FACS | Communication guidance and templates
NOTE What if you have determined a client is eligible for a Whole Person Impairment Assessment?
Go to Arrange Whole Person Impairment Assessment.
PROCESS Arrange Whole Person Impairment Assessment
j Check if there is written guidance on the claim if you are issuing a decline decision.
NOTE What if clinical advice was obtained for a decline decision?
Send the written guidance transcript located in the documents tab in Eos with the decline letter.
k Check you have a valid email address or valid physical address for the client.
NOTE What if you don't have either of these?
Save the decision letter on the claim.
l Check if there are open tasks for support and/or entitlements.
NOTE What if there are open tasks for treatment and/or support?
Refer to the queue matrix to determine where to send the task.
Work type queue matrix
m Run the EMD, if applicable.
NOTE What if you are accepting a Fatal claim?
Don't run the EMD. In Eos, create a 'Follow up Fatal' task. Add 'handshake' details to the task. Transfer to Accidental
Death Claims department queue as HIGH priority.
NOTE What if you are accepting or declining a hearing loss claim?
Don't run the EMD. Transfer the claim to Dunedin SC Actioned Cases department queue.
NOTE: If you are accepting a Treatment Injury Hearing Loss claim, transfer the claim to the Hearing Loss - Assess-
ment queue with the master task as HIGH priority requesting HL indicator is updated and send decision letter to client.
Identify engagement model and transfer claim
NOTE What if you are declining cover?
Transfer the claim to the actioned cases queue for this claim type or to Actioned Cases - Registration.
n Check the EMD has streamed the claim correctly.
NOTE What if it hasn't been streamed correctly?
Manually stream the claim to actioned cases queue or Recovery Team identified by the EMD.
o Check if hard materials were needed to inform your decision.
NOTE What if you received hard materials and want to have them destroyed?
Go to 'Authorise Destruction of Physical Claim Documents that are Digitised' process
PROCESS Authorise Destruction of Physical Claim Documents that are Digitised
NOTE What if you received hard materials and want to return them to the Provider?
Go to 'Prepare and send client information by courier' process.
PROCESS Prepare and Send Client Information by Courier
ACC > Claims Management > Manage Claims > Claims Assessment Pilot > Make cover or funding decision :: Make Treatment Injury cover decision
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Document Outline