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Appendix 1
Payments Outside Scope of Statutory Entitlements 
Policy v11.0

Payments outside the scope of statutory entitlements are payments made by ACC to manage potential liabilities under Crown Entities 
Act 2004, Section 17. These payments were previously referred to as ‘wrongful action’ or ‘ex-gratia’ payments.
This page provides information on:
• criteria required for a client to be paid outside ‘the scope of statutory entitlement’
• what defines a serious service failure
• what defines a financial loss
• what defines a non financial loss
• how we compensate the client
Please note that privacy breaches are not addressed through this process. All enquiries around privacy breaches and potential 
compensation must be addressed through the Privacy Team.
For information on payments for backdated weekly compensation, go to 'Backdated Weekly Compensation' process group folder 
under: Claims Management> Manage Client Payments > Operational Policies > Weekly Compensation > in Promapp.
If we consider issuing a decision to decline weekly compensation after a review/appeal or a settlement has indicated that weekly 
compensation should be paid, then this case must be referred to the Weekly Compensation Panel to:
• check that the decision made to decline was robust
• recommend whether a payment outside the scope of statutory entitlement should be considered (if appropriate).
1.0 Criteria for payments outside the scope of statutory entitlements
For a payment to be made outside the scope of statutory entitlements, the following criteria must be met:
• ACC committed a serious service failure, and
• the client experienced a measurable financial loss because of ACC’s actions, or
• the client experienced a non-financial loss because of ACC's actions.
If you receive a payment request that can’t be resolved through statutory entitlement, and ACC runs the risk of court action due
to the service failure, you should prepare a submission.
2.0 Serious service failure
Service failures can occur when:
• a client’s entitled to a payment, but for some reason this wasn’t identified early enough
• the client isn’t entitled to a payment but we’ve incorrectly advised them they are.
Both of these scenarios could result in a loss for the client. If they request payment from what they see as a service failure, we 
first need to see if this can be resolved through statutory entitlements.
See AC Act 2001, Section 69
A serious service failure requires more than a simple omission or delay. It requires ACC to have fallen well below reasonable 
service standards. The following criteria normally should be met when considering if a serious service failure has occurred:
• there’s serious failure by ACC to do so something that was a legislative requirement or an error in the way something was
• the failure falls outside the scope of a normal rectifiable human error (serious error is negligent and risks putting ACC under
threat of law liability).
3.0 Measurable financial loss
If a serious service failure occurs a client may be eligible for a payment outside the scope of statutory entitlement if they either 
experienced a measurable financial loss and they can demonstrate the loss that was caused by the serious service failure.
ACC > Claims Management > Manage Claims > Operational Policies > Managing Claims at ACC > Claim management  > Payments Outside Scope of Statutory Entitlements
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Appendix 1
A financial loss could include:
• income that could have been earned from a rightful entitlement that’s been delayed due to ACC’s inaction, payment of inter-
est on late payment of weekly compensation does not apply
• additional costs incurred by the client whilst trying to get their entitlement
• incorrect advice provided by ACC that resulted in a financial commitment for the client
• ACC committing to pay for something with no entitlement.
4.0 Non-financial loss
A client may also be eligible for a payment outside the scope of statutory entitlements if they experience a non-financial loss 
and they can demonstrate the loss was caused by the serious service failure.
A non-financial loss could include:
a. stress, distress, anxiety experienced by the client due to the serious service failure
b. significant inconvenience to the client
c. damage to the client's reputation
d. other effects
5.0 Specific claim examples
NOTE Example: Unlawful suspension of independence allowance
In Stewart (337/2004), the District Court found that ACC couldn’t suspend entitlement to the independence allowance 
on medical grounds without going through the statutory independence allowance reassessment process.
QBE stopped paying the client’s independence allowance entitlement in 2005 without going through the proper 
process. This alone constituted a serious error. However, there was also the issue about whether or not this decision 
should have been made in the first place. There was a wealth of medical information supporting the client’s on-going 
incapacity being related to the original covered injury. However, his entitlements were suspended on the basis of a file 
The case met the criteria in relation to serious error despite the decision having originally been made by a private in-
surer. Once QBE files were handed back to ACC, the Corporation was obliged to notify the insurer of any liabilities 
within 20 days of becoming aware of them. As that timeframe had passed ACC was now liable for any payment out-
side the scope of statutory entitlements due.
In regards to the quantifiable loss this was calculated on the basis of the interest from the date of suspension of the 
independence allowance to the date it was reinstated.
NOTE Example: Rest home costs incurred
The client fractured her hip 2004. This year she returned to hospital for removal of rods. Prior to her discharge a 
needs assessment was completed. The assessor recommended 7 hours home help and 10 hours attendant care 
assistance per week.
Instead of returning home, the client was discharged to a rest home. A short time later, ACC was advised that the 
client had died. ACC advised the client’s daughter, that ACC would pay the rest home costs.
It had since been determined that there was no injury-related need for rest home care. However, ACC had given a 
clear undertaking to the family that ACC would meet this cost.
NOTE Example: Reimbursement for duplicate prescription receipt if ACC loses original
A client has sent their application for reimbursement of prescription fees to their case manager. In turn, the case man-
ager has sent the application to the processing centre.
However, after three weeks of not hearing back from ACC the client contacts the case manager, who discovers the 
application cannot be found.
The client now has to submit a new application. When they go to the pharmacy to get a duplicate of their original re-
ceipt the pharmacy charges them a fee for the duplicate.
This fee is not a prescription cost, but a cost incurred by the client due to ACC having lost the original application. ACC 
will then reimburse for the prescription fee as well as the costs of obtaining the duplicated receipt.
ACC > Claims Management > Manage Claims > Operational Policies > Managing Claims at ACC > Claim management  > Payments Outside Scope of Statutory Entitlements
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Appendix 1
NOTE Example: Non-economic loss experienced due t incorrect suspension of weekly compensation a significant 
period of time
A client had an accident in March 1999, ACC provided entitlements up until 2002 when no further medical certificates 
were received.
The client contacted ACC in 2004 advising they had been unable to work since 2002 and ACC investigated whether 
they were incapacitated. As a result, ACC confirmed weekly compensation should be reinstated from 2002, advising 
the client’s advocate they would need to provide medical certificates to cover that period. The claim was subsequently 
closed due to no medical certificates being produced.
The client contacted ACC in 2017 asking for weekly compensation from the date of the accident. ACC’s Technical 
Specialist noted that despite incapacity being established in 2004, the focus was on obtaining backdated medical 
certificates rather than obtaining earnings details and paying the arrears the client was entitled to. This constituted a 
serious service failure, and a back payment of weekly compensation and interest was made.
Further quantifiable losses due to the serious service failure were not able to be provided, but the client’s mother pro-
vided a letter stating it, “was beyond her ability to estimate the financial loss” and “The failure deprived him of his 
lawful entitlements for thirteen years, causing significant and complex economic and non-economic harm to him and 
his family”.
6.0 The submission
If you identify a case where it appears there has been a serious service failure resulting in a loss to the client, a submission for 
‘payment outside the scope of statutory entitlements’ should be prepared.
The submission needs to include:
• amount the client is seeking
• details surrounding the claim
• alleged errors ACC made
• quantified losses incurred by the client if the loss is financial, and/or
• details of the non-financial impact on the client
Once the submission is prepared, and the amount sought is over $2,000, the submission is referred onto a Resolution Spe-
cialist for their consideration. Email the submission to [email address]. Resolution Services will assess the the 
payment outside the scope of statutory entitlements criteria have been met and decide on the appropriate compensation for 
the serious service failure.
For amounts under $2,000 the submission is referred to the Client Service Leader for approval.
The Resolution Specialist will make a recommendation for amounts over $2,000, then work with senior staff and Legal Ser-
vices to gain approval for the request. If the request is not approved they will let you know and work with you to draft a letter to 
the client.
Framework for determining POSSE compensation for non-financial loss
Delegations framework - sharepoint
7.0 Making the payment
Once written approval has been given, you need to:
1) Create a letter to the client advising them of the decision, noting that as it is a decision outside the scope of statutory entitle-
ments, review rights do not apply (seek guidance from Resolution Services if required). Email the letter to the client if that is 
the preferred contact method. If posting create a NGCM Send letter task for admin.
2) Create a Purchase Order using the following details:
• Client or representative
• Entitlement code WA02
• Amount to be entered as directed by Client Service Leader/Resolution Specialist (In Unit Price field). See (b) and (c) for who 
can authorise the purchase order and send them an approval task.
3) Generate a Make MFP Payment task using the same details above and transfer the task to the Hamilton SC- Claimant 
Reimbursement queue
4) Check a week later to make sure the payment has been received by the client and if not, follow up
If the amount payable is less than $2,000 the Client Service Leader can authorise the purchase order
If the amount payable is between &2,000 and $5,000 the Senior Resolution Specialist or Senior Review Specialist can autho-
rise the purchase order
If the amount payable is over $5,000 the Principal Advisor, DCE Office Service Delivery can authorise the purchase order
ACC > Claims Management > Manage Claims > Operational Policies > Managing Claims at ACC > Claim management  > Payments Outside Scope of Statutory Entitlements
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Appendix 1
Framework for determining POSSE compensation for non-financial loss 
Determine if a serious 
Collect all relevant information to the complaint: 
Assess the information. Advise the Principal 
Has there 
service failure has 
If the referral lacks information/detail go back to the person/team that referred the request and ask for 
Advisor, DCE Office, Service Delivery if it is 
Proceed – if a serious 
Stop – if a serious 
been a 
suspected no serious service failure has occurred. 
service failure has 
service failure has not 
If unsure around some of ACC’s policies or processes and how these are applicable to the client’s situation seek 
They will make decision.  
advice from a subject matter expert, e.g. a Technical Specialist.  
In what way has the client 
What are the characteristics of the non-financial harm experienced? 
Collate the information the client has provided on 
Stop – if: 
been impacted (stress, 
Has the failure damaged the client’s relationships? 
the impact/harm experienced due to the serious 
Proceed – if: 
the client does 
distress, inconvenience, 
Has the failure impacted on the client’s mental health? 
service failure.  
there is a 
anxiety, damage to 
How much effort has the client exerted in attempting to rectify the failure?  
detailed account 
reputation, or other 
Has the client had to seek help through other means when ACC should have been providing support? 
of the nature of 
the non-
Has the failure exacerbated the effects of the client’s injury? 
the non-financial 
How many aspects of the client’s life have been impacted by the failure? 
Consider the circumstances unique to the client and whether the effects of the failure are more significant to 
there is a 
other factors 
them than people in a different situation? 
detailed account 
seem most 
of the affect this 
likely to have 
Was the serious service 
The POSSE payment is to compensate for the impact caused by serious service failure when statutory entitlements cannot 
Disentangle the impacts caused by the serious 
has had on the 
caused the 
failure a material cause of 
rectify the situation, other factors are outside the scope of POSSE. 
service failure and other sources impacting on the 
Impact of 
the non-financial loss, or is 
failure on the 
it is reasonable 
it is not 
it reasonable to think 
Consider the holistic factors at play that could reasonably lead to the client’s feeling of harm. Then attempt to isolate the 
to consider the 
other factors were the 
impact the serious service failure could have reasonably had. 
serious service 
to think the 
predominant cause? 
failure caused 
In some situations, the underlying cause of the non-financial impact may not be the serious service failure, but the failure 
the harm 
impact could 
exacerbates the harm. In this situation compensation must only be to the exacerbation of the effect. 
people in 
have been 
Would most people be 
Consider all the characteristics of the non-financial harm experienced, the longevity of the impact, and the specific context 
Assess whether the non-financial harm is 
caused by the 
impacted in a similar way 
unique to the client. 
proportionate to the serious service failure.  
situations would 
by the serious service 
likely be affected 
Would the disclosed non-financial impact affect most people, in a comparable situation to the client, in a similar way? 
Advise the Principal Advisor, DCE Office, Service 
in a similar way. 
Apologise for the serious 
Delivery if compensation is not deemed necessary, 
service failure, but no 
the Principal Advisor will make decision. 
compensation required. 
The longevity of the 
The information initially collected when assessing the request for a POSSE will contain information on the longevity of the 
The length of the impact should be fairly easy to 
impact – how long has 
find out by examining the information the client 
passed since the failure? 
has provided. 
The scale of the impact – 
Examine the characteristics of the non-financial harm and consider the scale of the harm the client has experienced.  
Assess the severity of the impact on the client. 
how severe has the impact 
of the failure been? 
Will the failure have a 
Consider the impacts to date, but also whether the failure has caused harm that will continue into the future, and whether 
Assess whether the harm caused by the failure will 
Consider – these factors 
lasting impact on the 
the POSSE payment is going to rectify the impact on the client completely. If the payment (regardless of how much) will 
still impact on the client, even post compensation 
contribute to the 
not resolve the issue it indicates the severity of the impact is very high. 
compensation amount. 
n amount 
Is the nature of the failure 
Consider the nature of the failure: 
Assess the nature of the failure and whether this 
particularly egregious in its 
Was it a systemic failure of ACC’s processes? 
should have an impact on the amount of 
Was it human error, and if so, how many times was the error done? 
Was there malintent from ACC staff? 
Was there a breach of legislation? 
How much compensation 
Consider previous POSSE settlements for non-financial loss: 
Refer to previous POSSE compensation payments 
was awarded in similar 
Examine how much compensation has been given for other cases to provide context. 
for non-financial loss. 
If there are similar characteristics between cases use this to inform the amount of compensation for the client. 
Decision – decide on 
Decision on 
amount of compensation, 
How should the client be 
The following should be considered as a general guide for compensating a client: 
Determine how the client should be compensated. 
get this approved by 
Small sum of compensation (up to $500) – minor distress/inconvenience. 
delegation holder, inform 
Medium sum of compensation ($500 to $2000) – considerable distress/inconvenience. 
Large sum of compensation (over $2000) – substantial distress/inconvenience. 

Appendix 1
Framework for determining POSSE compensation for non-financial loss 
Do others share a similar 
Consider other perspectives of what a reasonable amount of compensation is: 
Consult with a senior colleague on the proposed 
view on the amount of 
Speak with senior colleagues on the amount of compensation they think appropriate. 
amount of compensation, gain approval from 
Gain approval from delegation holder on the amount determined. 
delegation holder, consult with the client if 
If possible, the client should be consulted on the amount of compensation proposed. If the client is not happy 
with the initial offer the amount can be negotiated if appropriate. 

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