GOV 030178 Inbound and Outbound Document Checks.pdf

Roles and Responsibilites
The overarching principle for any document checks is that it is everyone’s responsibility to ensure the correct and
relevant information is attached to a claim, and/or released from ACC.
The table below provides further guidance on the role of each position in document checks:

Check Type
Recovery Teams
Recovery Administration
3-point check
N/A
Responsible (Inbound Document

Management) for ensuring
incoming documents are
uploaded to the correct client’s
record
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  Third-Party
Responsible for the third-party and
Responsible for redacting based on
und
relevance checks
instruction of the Recovery Team
Act

members
Inbo
Email Recovery Administration to

undertake any redactions
Should seek clarification from the
Relevance

Recovery Team if insufficient instructions
When emailing Recovery
received
Administration, they should provide
clear instruction on the information that
needs to be redacted
Third Party
Responsible for the third-party and
Responsible for redacting based on
Information
relevance checks
instruction of the Recovery Team

members
Relevance
Email Recovery Administration to

undertake any redactions
Should seek clarification from the
nd

Recovery Team if insufficient instructions
received
bou
When emailing Recovery
Other Party
Official
ut
Administration, they should provide
O
clear instruction on the information that
needs to be redacted
the
Dispatch/House It is the responsibility of all team members to ensure outbound documentation is sent
keeping
to the correct recipient and meets quality standards

under
Example One – Sending an Initial Medical Assessment referral
Who
Action
Recovery Team member
Compiles document group
Completes third-party and relevance checks - identifies third-party information
in a Stay at Work report
Sends a redaction email to Recovery Administration and provides instructions,
Released  e.g.
“Document group – Medical Documents; Document type – ACC7430 Stay at
Work – plan progress and completion; please remove third party information on
page xx”
Recovery Administration
Uses Adobe Pro to redact third party name from al  pages and re-uploads
document
Completes housekeeping and dispatch check
2

Sends referral
A Recovery Team or Recovery Administration TL wil need to remove the original document

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Act
Information
Official
the
under
Released
3

Example Two – Sending an Orthopaedic Medical Case Review
Who
Action
Recovery Team member
Compiles document group for referral
Completes third-party and relevance checks – notes that GP notes contain
references to historical sexual abuse
Sends a redaction email to Administration and provides instructions, e.g.
“Document group – Medical Documents; Document type – Medical
Reports/Notes; please remove non-claim related information on page xx”
Recovery Administration
Uses Adobe Pro to redact references to sexual abuse and re-uploads
document
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Completes housekeeping and dispatch check
Sends referral
Act
A Recovery Team or Recovery Administration TL wil  need to remove the original document

Example Three – Processing inbound GP notes
Who
Action
Recovery Administration
Completes 3-point check and uploads documents
Sends You have new mail task to Recovery Team
Recovery Team member   Completes third-party and relevance checks – identifies that GP notes contain
Information
references to the client’s husband who is having treatment for testicular cancer
Sends redaction email to Administration and provides instructions, e.g.
“Medical Reports/Notes uploaded on 18 February 2020 @ 9.28; please remove
third party information on page xx”
Recovery Administration
Uses Adobe Pro to redact information about client’s husband and reuploads
Official

document
A Recovery Team or Recovery Administration TL wil  need to remove the original document
the

under
Released
4

Inbound Checks
Types of inbound check
Inbound Document Management are often the first point in the inbound checking process and are responsible for
an initial 3-point check. This ensures that information is uploaded to the correct file. Due to the superficial nature of
the 3-point check, it remains the responsibility of the Recovery Team members to check any uploaded
documentation for third-party or irrelevant information and ensure it is redacted.
Recovery Teams should task redaction to Administration.
3-point
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Purpose
Accountable roles
Ensure incoming documents are uploaded to
Inbound Document Management Team
Act
the correct client’s record

Examples of 3-point check
Information
Action
Medical notes from provider contain 3 data points –
Upload the documents
client name/address, date of birth and claim number -
that match with the client’s Eos record
Information
Unable to match 3-data points in medical notes from
Investigate further. Look for other data points that might
provider
match, e.g. the provider involved, the injury type, a
signature. Call the provider. If stil  unable to match,
discuss with TL
Official
Third-party
Purpose
Accountable roles
the
To ensure that no personally identifiable
Recovery Teams
third-party information is on the document

that has been uploaded to the claim
This would normally be the person who receives the
You have new mail task from the Inbound Document
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Management Team
Examples of third-party check
Information
Action
GP notes contain another patient’s medical certificate
Email Recovery Administration to remove, redact and
re-upload (put in document description that unrelated
information was removed on receipt). A Recovery or
Released
Administration TL wil  need to remove original
document
GP notes contain other individuals’ random claim
Email Recovery Administration to remove, redact and
numbers or ACCID numbers
re-upload (put in document description that unrelated
information was removed on receipt). A Recovery or
Administration TL wil  need to remove original
document
5

ACC requests an Independence Al owance assessment Send the report back to author and ask them to submit
report – there is a section that relates to another client
an amended report
1982
Act
Information
Official
the
under
Released
6

Relevance Check
Purpose
Accountable roles
To ensure that only information relevant is
Recovery Teams
uploaded to the claim
Examples of relevancy check
Information
Action
Client has an Anterior Cruciate Ligament
Where it is clearly irrelevant, email Recovery
(knee) injury – a DHB assessment outlines
Administration to remove, redact and re-upload (put in
the details of a historic sensitive claims event
document description that unrelated information was
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removed on receipt). TL wil  need to remove original
document
Act
Client has a claim for a broken leg – medical notes
Where it is clearly irrelevant, email Recovery
contain cervical smear test results
Administration to remove, redact and re-upload (put in
document description that unrelated information was
removed on receipt). TL wil  need to remove original
document
Client has a thoracic injury and ACC requests an
Refer the report back to author to determine relevance
orthopaedic assessment – the report contains
references to bi-lateral knee replacement

Information

Official

the

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Released
7

Outbound Checks
Whilst many of these checks are administrative in nature, they can only be executed when clear and thorough
instruction has been provided by the Recovery Team member. Both Recovery Administration and the Recovery
Teams play an important role in ensuring outbound checks do not result in privacy breaches.
It is always important to consider the recipient of the information when undertaking an outbound check and as this
has a bearing on the type of action taken.
Information that is not relevant for a provider (e.g. for an assessment referral pack) is not ‘withheld’, it is simply not
provided. In these cases there is no need to use withholding grounds from the Privacy Act to justify why we have
redacted something. However, when a client requests their own information, we need to tel  them why we have
withheld any information.
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Third-Party
Act
Purpose
Accountable roles
To ensure that no personally identifiable third-party
Recovery Teams and Recovery Administration
information is included in the document being sent
Examples of relevance check
Information
Sending to provider
Sending to client
Provider home addresses
Redact – no need to provide a
Withhold under s29(1)(a) of Privacy
withholding reason
Act 1993 and redact
Information
Identifiable information about other  Redact – no need to provide a
Withhold under s29(1)(a) and
individuals, e.g. a report contains
withholding reason
redact. Please note: This will also
another client’s name and claim

need to be removed permanently
number in the footer
from the claim. Recovery or

Official

Administration TL removes
NB. Where the information is on a
original document - the redacted

single page just remove
version must re-uploaded
the
NB. Where the information is on a
single page just remove
Other individuals’ random claim
Redact – no need to provide a
Withhold under s29(1)(a) and
numbers or ACCID numbers
withholding reason
redact. This wil  also need to be
under
removed permanently from the
claim as above
Other individuals’ identifiers, e.g.
Redact – no need to provide a
Withhold under s29(1)(a) and
Drivers’ Licence numbers, IRD
withholding reason
redact. This wil  also need to be
numbers

removed permanently from the
claim as above

Released
Information about client’s family
Consider if it’s applicable to release  Consider whether it is applicable to
members, e.g. Oranga Tamariki
in context, otherwise redact – no
release in context, otherwise
notes about a family conference
need to provide withholding reason  withhold under s29(1)(a) and redact
Next of kin information
Redact – no need to provide a
Leave in
withholding reason
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Relevance check
Purpose
Accountable roles
To ensure that only information relevant to the claim is  Recovery Teams and Recovery Administration
sent
Determining relevance can be difficult to do, however, if
it feels wrong, it probably is
Examples of relevance check
Information
Sending to provider
Sending to client
1982
Client has a rotator cuff (shoulder)
If clearly not relevant, redact – no
Leave in
injury - clinical notes mention PTSD  need to provide a withholding
Good practice would be to
reason
permanently remove this from the
Act
file
Client has a Treatment Injury for a
If clearly not relevant, redact – no
Leave in
hernia - GP notes contain
need to provide a withholding
Good practice would be to
references to asthma, eczema and  reason
permanently remove this from the
diabetes
file
Client has an Anterior Cruciate
If clearly not relevant, redact – no
Leave in
Ligament (knee) injury – a DHB
need to provide a withholding Information
Good practice would be to
assessment outlines the details of a  reason
permanently remove this from the
historic sensitive claims event
file
Client has a concussion injury –
If clearly not relevant, redact – no
Leave in
clinical notes refer to a torn ankle
need to provide a withholding
Good practice would be to
Official
ligament injury
reason
permanently remove this from the
file

the

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Released
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Other Party Check
Purpose
Accountable roles
To check for any other relevant withholding reasons
Recovery Teams and Recovery Administration
(Sections 27-30 of the Privacy Act). Ensure that
information being released does not breach legal
privilege, is not likely to prejudice the maintenance of
the law, is not likely to endanger the safety of an
individual, etc
Examples of other party check
1982
Information
Sending to provider
Sending to client
Legal y Privileged, e.g. emails
Redact – no need to provide a
Withhold under s29(1)(f) and redact;
Act
between a case owner and ACC’s
withholding reason
leave in EOS file
Legal Services about whether to do
a s103 assessment (may be able to
return to pre-injury role)
Non-core pricing, e.g. hospital notes  Redact – no need to provide a
Withhold under s28(1)(b) and
contain a breakdown of elective
withholding reason
redact; leave in EOS file
surgery costs
Fraud informant information, e.g. file  Redact – no need to provide a
Withhold under s27(1)(d) and
Information
note indicating that client’s
withholding reason
redact; leave in EOS file
neighbour called the Fraud Line to
allege client has been driving a
delivery van
Fraud investigation techniques, e.g.  Redact – no need to provide a
Withhold under s27(1)(d) and
Official
a memorandum explains how a
withholding reason
redact; leave in EOS file
surveil ance activity was carried out
the
Delicate health information which
Leave in if relevant
Withhold under 29(1)(c) - after
could emotional y disturb client, e.g.
consultation with individual’s
client has a history of suicidal
medical practitioner - and redact;
ideation and a psychiatric report
leave in Eos file
indicates that the client is
malingering
under

Released
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Dispatch Check
Purpose
Accountable roles
To ensure that documents are being sent for one client Recovery Teams and Recovery Administration
only and sent to the correct recipient

Examples of dispatch check
Information
Action
Purchase order extension letter being emailed to a
Remove incorrect document. Establish how error
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provider. A second document for another party is
occurred. Advise TL if recurring multiple times from
identified during the Smart Gate check
same person (for learning opportunities)
Act
Vocational Independence letter being posted to client.
Remove incorrect document. Establish how error
During a buddy check, a second letter located in
occurred. Advise TL if recurring multiple times from
envelope
same person (for learning opportunities)
Request for medical notes being requested from
Change email address. Establish how error occurred.
Auckland DHB. During Smart Gate check, it is found
Advise TL if recurring multiple times from same person
that the email address is for Capital and Coast
(for learning opportunities)

Information
Housekeeping Check
Purpose
Accountable roles
To ensure outbound documentation meets quality
Recovery Teams and Recovery Administration
standards
Official
Examples of housekeeping check
the
Information
Action
Letter is not signed
Fix and sign letter (to prevent delays in information
getting sent)
Letter is not on letterhead
Fix letter (to prevent delays in information getting sent)
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Fields in form not populated
Fix or return to tasker – advise TL if recurring multiple
times from same person (for learning opportunities)
Email contains misspel ings or poor grammar
Fix or return to tasker – advise TL if recurring multiple
times from same person (for learning opportunities)
Released

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Act
Information
Official
the
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Released
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