GOV-032953
BUSINESS RULE
Enterprise Business Rules Portal
Rule Deactivated: 06/05/2023
This rule is no longer applicable and is only available for historical purposes.
Rule Replaced
This rule has been replaced by: Identifying the maximum cover decision
timeframe allowed
Advising client of four month maximum Business
Rule
cover decision timeframe (NOT ACTIVE -
REPLACED)
Rule Purpose
This rule ensures the client is told when ACC cannot make a
cover decision within the legislative timeframe for a non-
complicated or complicated claim.
A
client must be informed that a
cover decision on their
claim will be made
within four months from the
date of lodgement if ACC is not able to make
the cover decision on the claim within the applicable of the following
maximum cover decision timeframes:
the 21 day maximum cover decision timeframe for
non-complicated
claims.
the two month maximum cover decision timeframe for
complicated
claims.
GOV-032953
Business Terms
Maximum cover decision timeframe
Tags
Timeframes Cover Deactivated Replaced
Related Policy
Other Data
Owner
Approvers
[Out of Scope]
[Out of Scope]
Feedback
Approval Date: 24/12/2018
GOV-032953
BUSINESS RULE
Enterprise Business Rules Portal
Identifying the maximum cover decision timeframe allowed
Business Rule
Rule Purpose
To determine what the maximum cover decision timeframe allowed is
The maximum cover decision timeframe must be determined by using the Maximum cover decision timeframe from date of lodgement column of the
Identifying and extending the cover decision timeframe decision table
Do I have all
How many
Can I extend the cover decision timeframe?
the
cover decision
Maximum cover
What is the
information
timeframe
Can I extend the decision timeframe
claim type?
required to
extensions have cover decision
from date of
Subject to
Reason
make a cover already been
timeframe?
lodgement/start
decision?
made?
date (day 0)
If all required information has been received a cover decision on a
none
no
within 21 days
-
non-complicated claim must be made within 21 days from date of
lodgement
Non-
complicated
yes
Only one timeframe extension is allowed on a non-complicated
one
no
within 4
claim This extension can be no longer than 4 months from the date
months
-
ACC received the request After this extension the cover decision
must be made within the date advised to the client
The client must be told about If you do not have all the information required to make a cover
none
yes
within 4
months
the extension within 21 days
decision on a non-complicated claim you can extend the cover
of lodging their claim
decision timeframe once, up to 4 months from date of lodgement
Non-
complicated
no
Only one timeframe extension is allowed on a non-complicated
one
no
within 4
claim This extension can be no longer than 4 months from the date
months
-
ACC received the request After this extension the cover decision
must be made within the date advised to the client
none
no
within 2
months
-
If all required information has been received a cover decision on a
complicated claim must be made within 2 months
If all required information has been received after one timeframe
Complicated
yes
one
no
within 4
months
-
extension, a cover decision on a complicated claim must be made
within 4 months of date of lodgement
Two or
If all required information has been received after two or more
more
no
within 9
months
-
timeframe extensions, a cover decision on a complicated claim must
be made within 9 months of date of lodgement
The client must be told about If you do not have all the information required to make a cover
none
yes
within 4
months
the extension within 2 months decision on a complicated claim you can make an initial timeframe
of lodging their claim
extension of up to 4 months from date of lodgement
The client must agree to the
If you do not have the required information to make a cover decision
on a complicated claim after one extension you may make a further
Complicated
no
one
yes
within 9
months
extension within 4 months of
lodging their claim
timeframe extension, with the client's agreement A cover decision on
a complicated claim must be made within 9 months of lodgement
The client must agree to any
Further timeframe extensions are allowed, with the client’s
Two or
further extensions within the
agreement, if further information is required to make a cover
more
yes
within 9
months
extended timeframe agreed
decision A cover decision on a complicated claim must be made
to in the previous letter
within 9 months of lodgement
Business Terms
Complicated claim Non-complicated claim Maximum cover decision timeframe Date of lodgement
Tags
CovDec Claim: Cover Decision
GOV-032953
Related Policy
Timeframes to determine cover
Other Data
Owner
Approvers
[Out of Scope]
[Out of Scope]
Feedback
Approval Date: 7/05/2023
GOV-032953
BUSINESS RULE
Enterprise Business Rules Portal
Cover decision time limit
Business Rule
Rule Purpose
This ensures ACC makes a cover decision within the legislative
timeframes for non-complicated and complicated claims.
A cover decision for a claim must be made within the maximum cover decision
timeframe of that claim.
Business Terms
Claim Cover decision
Maximum cover decision timeframe
Tags
Claim: Cover Decision CovDec Claim Type Timeframes
Related Policy
Other Data
GOV-032953
Owner
Approvers
[Out of Scope]
[Out of Scope]
Feedback
Approval Date: 24/12/2018
Document Outline
