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Review codes
CATERGORY CODE DESCRIPTION
1982 ACT REVIEWS
W3
Accident Compensation Act 1982 Matters
W5
Backdated Attendant Care Compensation Reviews - Accident Compensation Act 1982
LEVY REVIEWS
W6
First and Later Premium Reviews
CODE OF ACC CLAIMANTS RIGHTS (this is used for complaint reviews for OCI)
W8
Code of ACC claimant's rights
COVER (used for al cover review applications)
Y1
Cover - accident
X5
Cover - criminal injury
X3
Cover - gradual process
Cover - is there a personal injury (eg hernia, dental cover, revoked cover, decline additional
X2
injury)
X4
Cover - medical misadventure (Pre 2005)
X26
Cover - mental injury (this is only used for mental injury covers)
X29
Cover - treatment ijury (only used for treatment injury cover made by TIC)
Y2
Overseas injuries (ord resident etc.)
FATAL ENTITLEMENTS
Y5
Death benefits compensation
Y10
Death benefits - child care
Y7
Death benefits - funeral grant
Y8
Death benefits - survivors grant
SUSPENSION/DISENTITLEMENT
Y4
Disentitlement (criminal activities / WISI)
X8
Suspension/cessation of entitltments
X9
Suspension/non-compliance
IA/LS (independence al owance and lump sum payment)
Y25
Independence al owance
Y26
Lump sum (2001 Act)
JURISDICITON (only used when there is no decision made by ACC)
Z5
No jurisdiciton - other (code we use)
Z6
No jurisdiciton - code
LATE ISSUES
Y12
Out of time - failure to issue decision
Z2
Out of time - late lodgement of application for review
DEBT
Y13
Overpayments
TREATMENT - Accepted Cover
Physical treatment regulations (eg: additional treatment and any other treatment / Dental /
Z1
treatment declined e.g. physio, along with medications)
ELECTIVE SURGERY
X28
Decline funding for surgery costs
REHAB
X10
Individual Rehabilitation Plan (IRP) (Victoria Mil s)
Y16
Rehabilitation - aids and appliances (eg: hearing aids, orthopaedic appliances etc)
ts160957
1 November 2018
Review codes
Y17
Rehabilitation - attendant care, home help, child care etc
Rehabilitation - education support (usual y from a serious injury including birth and having to
X12
re-learn)
X13
Rehabilitation - housing support (modifications)
X14
Rehabilitation - motor vehicles (purchase and modifications)
X15
Rehabilitation - training for indpendent living (social rehab, dressing, everyday living)
ANCILLARY SERVICES
Z3
Transport to tratment, accommodation, escort etc
WEEKLY COMPENSATION
X6
Entitlement to weekly compensation
Y23
Upper age limits (NZSQA 65+ weekly comp for 12mths+)
X17
Weekly abatement of compensation (calculation) (returning to work part time)
X18
Weekly compensation (calculation)
Y20
Weekly compensation - interest for late payment
Weekly compensation - loss of potential earnings (LOPE where they were a potential earner)
Y19
VI ISSUES
X16
Vocational rehabilitation (re-training/education/teritary study)
Work capacity assessment (VI decision) (where the client doesn’t agree that they can work
X7
(they have 2x assessments occupational and medical)
WORK INJURY
X23
Work injury dispute
ts160957
1 November 2018
ŽĐƵŵĞŶƚ ϰ
Relevant Document Checklists:
Cover:
1. ACC45/ACC18 (document used to lodge claim with ACC)
2. Cover Extension letters
3. Med notes for cover investigation
4. Radiology or other diagnostic information (if any)
5. Specialist referrals (if any)
6. Specialist reports (if any)
7. Clinical and/or Tech comment for cover investigation (if any)
8. Relevant contacts (if any)1
9. Cover Letter
10. Print Claim file
Surgery:
1. ACC45
2. Injury history for same body site (tbd)
3. Cover Decision
4. Radiology or other diagnostic information
5. All medical notes – especial y those from the treating surgeon.
6. ARTP.
7. CAP or clinical advisor comment
8. Surgery decision.
Lump sum/Independence Al owance:
1. ACC45 of each claim for cover included in the assessment (?)
2. Schedule of client injuries (to be discussed further)
3. ACC54 (Application form)
4. ACC554 (LSIA Medical Certificate) for each injury assessed
5. IA/LS payment report.
6. Medical notes used for the assessment (usual y uploaded as a document group)
7. AMA Report
8. Previous AMA reports (for decisions on reassessments)
9. AMA Peer Review Report
10. IA/LS decision letter
Vocational Independence:
1. ACC45 for each claim with incapacity or the schedule of client injuries2
2. Pre-Injury Job description.
3. Relevant contacts (if any)
4. Individual Rehabilitation Plan/s
5. Voc Rehab/pain program completion reports/s
6. All medical reports that are relevant to the covered physical injuries
7. Initial Medical Assessment
8. Initial Occupational Assessment
1 If the review specialist wishes to specifically refer to contacts recorded in the print claim file, its recommended to copy and paste the full
contact or email into a word document and store it as a document in Eos.
2 Please ensure that if the SCI is used, that it is checked for declined injuries within covered claims
9. VI02 letter (entry to VI)
10. ACC193: Vocational Independence Claimant questionnaire
11. ACC194: Vocational Independence GP questionnaire
12. ACC691: Vocational Independence Assessment readiness check
13. ACC191: Vocational Independence quality check form
14. Vocational Initial Medical Assessment
15. Vocational Initial Occupational Assessment
16. ACC850: Decision rational
17. Vocational Independence Decision letter
Hearing Loss:
•
ONIHL Cover:
1. ACC45
2. Cover extension letters
3. ACC725 Hearing Loss Employer questionnaire (if applicable)
4. ACC724 Hearing loss questionnaire
5. ACC612 Audiology report
6. ACC723 Otolaryngologist report
7. Decision Letter
•
TI Cover
1. ACC45
2. TI stuff
•
Trauma Cover
1. Same as Cover with the addition of the ONIHL forms.
•
Entitlements – First Assessment
1. Cover decision
2.
•
Entitlements – Reassessment
1. ACC612 Audiometric report
2. ACC613 Hearing Loss Questionnaire
3. HLS76 Re-aiding entitlement approval decision
Dental:
1. ACC42 or ACC45
2. Dental Records
3. Dental Advice
4. Cover decision
Work Injury Dispute:
1. ACC45
2. Liable employer notification
3. Cover Decision letter
4. Relevant contacts
5. See Cover above – all information used to make cover decision including med notes, reports
etc.
WRMI:
1. ACC45
2. Liable employer notification
3. Cover Decision letter
4. Relevant contacts
5. See Cover above – all information used to make cover decision including med notes, reports
etc.
ADU:
Weekly Comp:
Suspension:
