Personal Information and
Privacy Policy
POLICY
5.3.0
NUMBER
TOPIC
Care and protection of personal information; privacy
OWNER
Head of Privacy
DATE
8 September 2022
APPROVED
APPROVER
Board
DATE OF
25 February 2023
NEXT
REVIEW
1 Objective
This Personal Information and Privacy Policy (policy) sets out how ACC collects, stores, uses,
discloses, retains, and protects personal information.
Personal information is taonga (treasured), and we consider ourselves to be kaitiaki (guardians) of
any personal information we receive. For the purposes of this policy, personal information includes
health information. We are committed to managing personal information in line with the Privacy Act
2020, the Health Information Privacy Code 2020, any related legislation and recognised best
practice.
We have a wide range of statutory functions and duties under the Accident Compensation Act 2001.
We collect, use, store and share personal information to fulfil those functions and duties, as well as
for related lawful activities. We are entrusted with personal information. It is fundamental that we
protect this information and use it only for permitted purposes and in appropriate ways.
Key to our goal of Stewardship/Kaitiakitanga is the value we create for our public and for our partners,
including our Māori Treaty partners. Maintenance of public trust and support for the scheme and how
we deliver it is critical to the sustainability of the scheme. In order to achieve this everyone at ACC
must be well-equipped to protect the personal information entrusted to us by our clients, our people,
our providers, and our businesses.
2 Scope
This policy applies to all ACC people, including employees, secondees, and independent contractors.
This policy applies to all personal information we collect and have access to. This includes all
information held on claim files about our clients and our people (ACC staff claims), together with all
information about our people, providers, and businesses.
This policy is supplemented by the Personal Information and Privacy Guidelines, which further detail
how we collect, store, use, disclose, retain and protect personal information.
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Personal Information and Privacy Policy
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3 Policy statements
The policy is underpinned by the principles and rules of the Privacy Act 2020 and Health Information
Privacy Code 2020. These govern how agencies manage personal and health information throughout
the information lifecycle: collection, storage, access, correction, use and disclosure.
3.1 We collect, use and store personal information to carry out our functions and
responsibilities under the Accident Compensation Act 2001, as well as for related lawful
activities.
We collect, use, and store personal information to perform our functions and responsibilities including
as set out in section 3.4 below. Personal information may be obtained from clients, health providers,
employers, and other agencies. We also collect personal information about other individuals
including our people, providers, and businesses. ACC people who receive or gather information for
us are directed by internal guidelines, procedures and training that specify the boundaries of
collection and its use.
3.2 We commit to making people aware of the collection of personal information
When collecting personal information from our people, businesses, clients, health providers,
employers and other agencies, we must inform them of:
• the purposes for collection
• who will receive their personal information
• any laws under which we are authorised to collect their personal information (such as the
Accident Compensation Act 2001)
• what could happen if the client does not provide the personal information we need, and
• their rights to access and request correction of that personal information
We will only collect personal information by means that are lawful, fair and do not intrude
unreasonably on an individual’s personal affairs. “Fair and reasonable” in this context means we will
aim to collect personal information from individual clients rather than third parties unless there is a
lawful reason for doing otherwise. When collecting information from third parties we obtain consent
from the individual concerned, unless there is a good reason why consent is not required.
We will inform our customers and our people of our purpose for collection and their rights to access
and correct that information. Irrelevant and unnecessary personal information will be returned to the
supplier or destroyed where practicable.
3.3 We facilitate access to and respect an individual’s right to seek amendment of factually
incorrect personal information as a key priority
We commit to providing individuals with access to their personal information unless an exception
under the legislation applies. Requesters are verified and the information is provided to them within
legislative timeframes and boundaries.
We commit to keeping personal information accurate and up to date. We have a clear process for
handling amendment requests which our people follow. If there is good reason for not amending the
information, we will invite the individual to submit a statement of correction and we will ensure that it
is read together with the original document in future.
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Personal Information and Privacy Policy
8 September 2022
3.4 We commit to using personal information only for the purpose for which it was obtained
and other lawful purposes.
We only use personal information for the purposes for which it was collected, for directly related
purposes, and for the purposes of carrying out the Scheme and lawful functions related to ACC,
except where limited statutory exceptions apply.
We primarily use information to:
• assess and provide entitlements to compensation, rehabilitation and medical treatment
• assist the evaluation of our services and performance
• contribute to research into injury prevention and effective rehabilitation
• develop policy
• ascertain levy payments and maintain the scheme (including a claims database)
• facilitate training, quality monitoring, system testing and continuous improvement purposes
• enable effective rehabilitation outcomes by sharing relevant information with our partners
(employers and providers) to allow them to play an active role in supporting injured people
• act as an employer, which requires us to collect and use personal information about our
employees for work purposes
• conduct investigations (including for integrity issues)
• respond to information requests
In line with ACC policies and guidelines, only relevant information is used for any given purpose,
including where use involves disclosure.
Where personal information is not relevant or necessary for an activity, all reasonable efforts will be
taken to anonymise, cleanse, or otherwise remove personal information.
3.5 Personal information is disclosed to other parties only where there is authority to do so
We may use and disclose personal information to fulfil our legislative obligations and protect the
health and safety of our clients, staff and third parties.
We will primarily disclose personal information with the informed authority of the individual
concerned. We may also disclose information where authority has not been granted by the individual
concerned. In all instances, any disclosure will be with authority either granted by the individual
concerned or granted by law.
We will take reasonable steps to ensure third parties protect the personal information we share with
them in line with legislation and with the same care we give to it ourselves.
Where personal information may be disclosed outside of New Zealand, we will ensure it is afforded
similar, reasonable care as is granted in New Zealand, in line with our legal requirements.
We commit to appropriately using unique identifiers when handling personal information.
3.6 We commit to storing personal information with reasonable safeguards against loss and
disclosure and retaining it in line with legislative requirements
The personal information we hold is taonga and must be protected from loss, unauthorised access,
use, modification or disclosure. This applies to our electronic systems and all personal information
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Personal Information and Privacy Policy
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stored in hard copy. Information regarding how ACC secures personal information is set out in the
Information Security Policy.
We will store personal information in accordance with the Accident Compensation Act 2001 and
Public Records Act 2005 (including disposal authorities as issued by the Chief Archivist). We commit
to only holding information for as long as we have a legal reason to hold it.
If we identify we have received personal information that is not relevant to our functions and duties,
where reasonably practicable, it will be returned or destroyed securely.
3.7 We have clear, consistent processes for reporting, managing and escalating privacy
incidents
ACC people or contractors should report a potential or perceived incident, either that they have
observed or have contributed to, within 24 hours of becoming aware of the incident or as soon as
practicable.
Privacy incidents are breaches or near misses of any of the privacy rules or principles, including this
policy, by ACC people or parties contracted to us. Every incident needs to be reported to the Privacy
Team and prompt steps will be taken to prevent or mitigate harm resulting from the incident and
prevent its recurrence.
We will notify the Office of the Privacy Commissioner and the affected individual or individuals as
soon as practicable (and typically within 72 hours) of becoming aware of a breach that we reasonably
believe has caused or is likely to cause serious harm, or where we think it is otherwise appropriate
to do so, aligned with best practice guidance and our legislative obligations.
We will use the data collected from privacy incident reports to gather insights and lessons learned
for reporting purposes in order to better prevent future privacy incidents ensuring a continuous
improvement approach to enhancing privacy practices.
3.8 Care of personal information is embedded in everything we do
We provide regular training to ensure both new and existing staff understand the relevant privacy
principles for their role, what good privacy practice looks like, and how to appropriately report privacy
incidents or raise concerns about privacy and inappropriate behaviour. We will apply a continuous
improvement approach to our privacy practices; we will learn from mistakes and frequently review
our processes and training to ensure it is fit for purpose.
3.9 We commit to ensuring we have effective policies and processes which reflect current
best practice standards
We are committed to ensuring we have effective policies and processes which reflect the most up-
to-date best practice standards.
How we handle the personal information in our care is governed by this policy, and our people are
guided on best practice by our guidelines and documented processes. We are committed to
maintaining and updating these policies, guidelines and processes, with an approach to both
continuous improvement and fixed review schedules.
Our business practices and processes, related IT systems and networked infrastructure, have
privacy proactively embedded into their design by the completion of privacy risk assessments,
anytime they may affect the way we handle personal information.
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• ensures policy content is accurate, relevant, complete and aligned with other
related policies and the Corporate Policy Governance Framework
• liaises with subject matter experts and relevant groups and committees,
including the Enterprise Risk Team and external shareholders (for example: NZ
Public Service Association)
• ensures policies are communicated, and training activities and guidance
documents are in place to support implementation of the policy
• ensures mechanisms are in place to monitor compliance with privacy policies
• considers and, if appropriate, approves policy exceptions
• responds to and addresses any non-compliance issues and ensures processes
are in place to identify, manage, record and report policy breaches and
exceptions as appropriate
• ensures policies are reviewed within a three-yearly cycle or as otherwise
required
• responsible for the management of the privacy function including:
o breach and complaint management
o measuring and reporting on our privacy performance
o setting our privacy strategy
o implementing our privacy maturity plan - privacy risk identification and
mitigation
o privacy stakeholder engagement
Privacy Officer
• support compliance with this policy and the relevant legislation
and Privacy
• oversee investigations into privacy-related complaints lodged with the Privacy
Team
Commissioner and ACC
• ensure there is a process in place for responding to requests for access to, or
correction of, personal information
• participate, as required, in the development and review of this policy’s
standards and procedures to ensure they meet requirements
• ensure the policy owner and leads are informed of any potential future changes
that may affect a policy
• identify privacy risks and mitigations
1st Line of
• Managers, People Leaders, and all ACC people should ensure appropriate
Assurance
processes and activities are in place to track compliance
• each policy should include monitoring and oversight mechanisms that follow the
principles of the 5 Lines of Assurance
People Managers have specific responsibilities for:
• notifying privacy incidents to their manager
• proactively assessing and managing privacy risk
• managing all privacy reporting requirements through the Privacy Reporting Tool
• liaising with the People and Culture Group where necessary following privacy
incidents to ensure consistent follow up with staff
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• supports employees and Leaders to determine actions that are
required as a result of the breach
• completes root cause analysis of breaches
• monthly reporting on our privacy breaches and Enterprise Risk
Reporting to the Executive and Board
• attestation compliance
• delivery of the privacy programme
• privacy assurance reviews
• ownership of privacy policies and guidelines
• specialist advice and support, including privacy-by-design
• escalates breaches to the Group’s Leadership Team and Deputy
Chief Executive – Corporate and Finance when appropriate
• notification of serious breaches to Office of the Privacy
Commissioner
• updates risk registers as required
3rd Line
Internal Audit
• perform periodic audit activities intended to assess and/or provide
(and external
insights into (among other things) compliance with the Policy and
providers)
the adequacy and effectiveness of the Group’s practices to
monitor compliance and deal with breaches
• report to the Executive, Risk Assurance and Audit Committee and
Board on the outcomes of such activities
Office of the
• provides external monitoring and oversight of our compliance with
Privacy
the Privacy Act through its advice and complaints functions, and
Commissioner
public reporting on these. The Commissioner can issue a
compliance notice if we are not meeting our obligations under the
Privacy Act.
4th Line
Executive
• ensures each Group has sufficient emphasis on building and
maintaining privacy risk management and meeting compliance
obligations
• ensures effective processes and monitoring are in place to meet
compliance obligations for the Personal Information and Privacy
Policy
• acts in an appropriate and timely manner in response to reports
received that alert the Executive to opportunities to improve
Personal Information and Privacy Policy compliance activities.
• receives regular reporting on:
o privacy as an Enterprise Risk
o privacy compliance
o progress against the Privacy Maturity Assessment
Framework (PMAF)
5th Line
Risk
• recommend any material changes to this policy
Assurance
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and Audit
Committee
Board
• responsible for approving any material changes to the Level 1
Policies, including text related to monitoring and oversight of
compliance with the Personal Information and Privacy Policy
• acts in an appropriate and timely manner in response to reports
received that alert the Board to opportunities to improve Personal
Information and Privacy Policy compliance activities
• responsible for ensuring privacy risk management is in place and
also responsible for setting the Privacy Risk Appetite Statement
• receives regular reporting on:
o privacy as an Enterprise Risk
o privacy compliance
o progress against the Privacy Maturity Assessment
Framework
7 Breaches of Policy
We require any potential or perceived privacy incidents to be reported within 24 hours of becoming
aware of the incident or as soon as practicable. This includes incidents that have been observed or
directly contributed to.
Our Code of Conduct requires our people to comply with all our policies.
Breaches of this policy can result in a range of consequences for us and our clients.
While we strive to be good guardians of personal information, incidents will happen. When they do,
our priority is to make things right. Accidental failures to achieve the standards in this policy will not
normally be grounds for disciplinary action. Repeated or deliberate failures (including by failing to
report a privacy incident) may result in disciplinary action.
8 Contacts
Questions regarding the interpretation or management of the policy can be directed to the Privacy
Team.
9 Definitions
Health Information
Governed by the Health Information Privacy Code, ‘health information’ is the following classes of
information about an identifiable individual:
a) information about the health of that individual, including their medical history;
b) information about any disabilities that individual has, or has had;
c) information about any health services or disability services that are being provided, or have
been provided, to that individual;
d) information provided by that individual in connection with the donation, by that individual, of
any body part or any bodily substance of that individual or derived from the testing or
examination of any body part, or any bodily substance of that individual; and
e) information about that individual, which is collected before or in the course of, and incidental
to, the provision of any health service or disability service to that individual.
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Perso
nal Information
The Privacy Act 2020 governs 'personal information', that is:
a) information about a living, identifiable individual; and
b) including information relating to a death that is maintained by the Registrar-General under
the Births, Deaths, Marriages, and Relationships Registration Act 1995 or any former Act (as
defined in section 2 of the Births, Deaths, Marriages, and Relationships Registration Act
1995).
Information may be personal information even if the individual concerned cannot be identified from
the information itself, provided there is some other 'link' in information held by the agency which
means the individual is identifiable.
That being the case, personal information may include information that does not actually identify the
individual concerned, including information that is only about an 'identifiable' individual by reason of
extrinsic knowledge or information, or information that can be linked to an identifiable individual
through the use of other information.
For the purposes of this policy, ‘health information’ is included in the definition of ‘personal
information’.
Privacy Maturity Plan
Formalises our approach to improving privacy maturity at ACC. It embeds a culture of information
stewardship that aligns with the other being made to improve our customers' experiences.
Privacy Maturity Assessment Framework
A self-assessment developed by the Government Chief Privacy Officer to help agencies assess their
privacy capability and maturity.
Serious Harm
Serious harm is not defined in the Privacy Act. Examples of serious harm include physical harm or
intimidation, financial fraud including unauthorised credit card transactions or credit fraud, family
violence, and psychological or emotional harm.
10 References
This policy should be read in conjunction with the Personal Information and Privacy Guidelines, the
Privacy Maturity Plan, and the Information Management Policy.
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11 Version Control
Version
Date
Change reason
Who
1.1
14/06/2018
Updated old version to new draft
Out of scope
1.2
10/07/2018
Reflecting comments from Head of Privacy Out of scope
1.3
20/07/2018
Reflecting comments of Corporate Policy Out of scope
Review Working Group
1.4
30/07/2018
Formatting and minor edits
Out of scope
1.5
11/06/2021
Moved to new template and updated for Out of scope
Privacy Act 2020
2.0
29/07/2022
Updated to new version to reflect Out of scope
recommendations
from
the
Clark
Independent Review
Accident Compensation Corporation
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Obtain Client Authority to Collect Information v42.0
Summary
NOTE What if your client is under 16 years of age?
Your client's parent, guardian or nominated
person will provide the authority to collect infor-
Objective
mation. When your client turns 16 they can give
To obtain verbal or written authority from the client so that we
the authority themselves therefore you need to
can collect relevant medical or other records.
request authority from the client directly as per
Background
steps in this process.
Obtaining client authority to collect information is required when
ACC needs to gather client medical or other records, and en-
Clients under 16 with complex mental injuries,
sures our clients understand the type of information we might
require that you identify a Safe Contact. Your
request and why.
clients' Safe Contact or guardian can provide au-
thority to collect information on your clients
Use this process to either obtain:
behalf. Depending on who your clients' Safe
• informed verbal authority during client onboarding to ensure
Contact is you will need to Obtain Authority to
the client is aware of what they've consented to when the
Collect Information and/or Authority to Act .
ACC45 claim form has been lodged, or
• written authority via MyACC or an ACC6300 form when verbal
For more details refer to the information and
authority is not appropriate.
process below.
PROCESS Identify Safe Contact for Child
Each time we request information about a client, we should
Clients
first explain why we are collecting the information, and how we
Children and Adolescents Consent
intend to use it.
NOTE What are the different authority types?
ACC6300 Expire – As long as the ACC6300 is on the claim and
There are five different authority types and a
the claim is actively managed there is no need to redo it. If the
Conditions section on the Consent tab:
claim hasn’t been active for more than a year and then needs to
be managed again, redo an ACC6300 even if one was already
• ACC45: The ACC45 claim form that provides
on the claim. While waiting for a renewed 6300 to be completed,
ACC with initial authority to collect information
a verbal confirmation with the client that they are still happy
• Verbal: A pre-recorded message played to the
to give consent and a contact made in the claim is enough to
client during onboarding, to ensure they are in-
demonstrate that the client has provided interim authorisation. -
formed of the authority they have previously pro-
Privacy Team
vided on the ACC45 claim form and reaffirm this
• MyACC: The client has reviewed the authority
Owner
Out of scope
terms and conditions and provided authority to
collect information via MyACC. Eos creates the
Expert
Out of
ACC6300D form as a record of the client's
agreement.
Procedure
• ACC6300: The client has reviewed the authority
terms and conditions and signed their authority
1.0 Determine appropriate type of authority
on the ACC6300 Authority to collect medical and
Cover Assessor, Recovery Assistant, Recovery Coor-
other records form. Eos holds a record of this
dinator, Recovery Partner, Specialist Cover Assessor,
when it has been signed and returned
Treatment and Support Assessor
• Withdrawn: The client has advised they no
a In Eos, check what existing authority there is on the
longer give authority for any of the above au-
claim.
thority types and we have 'Withdrawn' their au-
thority. No records can be requested if the type is
NOTE What if you view Client Authority through
Withdrawn
Claim on a Page (COAP)?
Claim on a Page will show if there is consent on
Conditions: The client has provided authority to
the client's claim, but to view more details or
collect information in one of the ways above but
make changes you will need to open the claim in
they have also provided certain conditions to
Eos.
their authority. The conditions are recorded as
View Client Consent
comments in the Conditions text box.
NOTE What needs to be on the claim for the
ACC6300 information to show in MyACC?
The Recovery Plan must be created, verbal Au-
thority loaded on the RP before the ACC6300 will
show in MyACC.
MyACC: The client has reviewed the authority
terms and conditions and provided authority to
collect information via MyACC. Eos creates the
ACC6300D form as a record of the client's
agreement.
b Determine if it's appropriate to request informed verbal
authority or written authority using the Obtain Verbal or
Written Authority Guidelines below or click on the Share-
point link.
ACC Guidelines to obtain verbal or written authority
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NOTE What if you need to obtain informed verbal
Disclosure Statement - Consent Recording
authority during the Welcome Conversation?
NOTE What if the client doesn't agree to the pre-
Go to Activity 2.0 Obtain informed verbal au-
recorded verbal authority?
thority.
If they want to:
NOTE What if the client's claim is active and has
• provide authority in writing, fully or with condi-
been open for 12 months?
tions, go to Activity 2.1 Obtain written authority
Progress to an ACC6300 via form or MyACC as
• decline all authority options, go to the Decline
noted in the 'NG GUIDLINES Obtain Verbal or
or Withdraw Client Authority to Collect Infor-
Written Authority' above.
mation process.
PROCESS Decline or Withdraw Client Au-
NOTE What if you need to obtain written authority
thority to Collect Information
from the client?
Go to Activity 2.1 Obtain written authority.
NOTE How often do you need to update the au-
thority to collect information when given ver-
Personal and Property Orders for Clients Policy
bally?
NOTE What if the information is needed for the birth
Consider updating the consent indicator at 6 and
mother of an injured baby is required?
12 months post welcome conversation if the con-
Send the ACC6301 – Authority to collect medical
sent is verbal.
& other records – Birth Mother.
d Go to Activity 4.0 Update claim.
Refer to Promapp page "Triage and Allocate
Claim (Treatment Injury)" for more information.
PROCESS Triage and Allocate Claim
2.1 Obtain written authority
(Treatment Injury)
Cover Assessor, Recovery Assistant, Recovery Coor-
NOTE Do we accept Electronic Signatures?
dinator, Recovery Partner, Specialist Cover Assessor,
Information from the Privacy Team - Since Lock-
Treatment and Support Assessor
down we have been more lenient in accepting
a Discuss and confirm if the client would like to provide
electronic signatures. However, a client's name
written authority via:
typed on a form isn't enough to accept the
• MyACC
ACC6300, unless we have spoken with that
• an emailed ACC6300 Authority to collect medical and
client about typing their name and have captured
other records form
this in a detailed 'contact' on EOS.
• a posted ACC6300 Authority to collect medical and
other records form.
2.0 Obtain informed verbal authority
ACC6300 Authority to collect medical and other
records
Recovery Assistant, Recovery Coordinator, Recovery
Partner, Specialist Cover Assessor, Treatment and Sup-
NOTE What if the client wants to use MyACC?
port Assessor
Advise them to log in to MyACC and complete
a Advise the client that we want to explain how we gather
the authority on the Injury Details section.
and use their information by playing a pre-recorded mes-
The ACC6300D will be uploaded to Eos
sage. Confirm they are ready to listen to this.
automatically if provided via MyACC.
b Play the pre-recorded consent message
NOTE What if the client wants it to be emailed?
• Advise that they'll need to print, sign and scan
NOTE How do you play the pre-recorded consent
the form back to ACC
message?
• Check if the client's email address is verified. If
1.Select "Invite More People" in the top right
not, got to Update Client's Party Record to verify
hand corner of the active call window
the email address
2. Enter the extension for the Verbal Consent
• Email it to the client.
Recording: 50013 and press OK
PROCESS Update Client Party Records
3. You will appear in a Conference with the
Verbal Consent Recording and the Client
NOTE What if the client wants it to be posted?
4. Once the consent recording has finished play-
• Ensure they have a valid postal address
ing, it will automatically leave the phone confe-
• Send a Send Letter task to the Recovery
rence
Administration department queue to request it to
NOTE How do you play the pre-recorded message
be posted.
using Genesys Cloud?
NOTE What if the client wants to provide their own
1. Select the 'Transfer' arrow icon
conditions?
2. In 'Name or Number' bar, type 'Consent' and
• Discuss obtaining alternative conditions, using
select 'Consent IVR' when it pops up
the Privacy - Authority Principles as a guide
3. Select 'Consult'. This places the customer on
• Request them to send their conditions in writ-
hold and dials the IVR. While IVR is connecting,
ing.
click on ALL to bring the customer into the call.
4. The IVR message plays, then disconnects
automatically, leaving the Staff Member and cus-
tomer on the phone together.
c Verbally confirm that the client agrees.
NOTE What if the client requests a copy of what
they have consented to?
The consent is a pre-recorded message and can
be emailed to the client if requested. Attach the
Disclosure Statement - Consent Recording.
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NOTE What is the CLI01 letter and when should you
use it?
If you require the ACC6300 and the ACC165 to
be completed by the client, you can use the
CLI01Branch ACC6300 ACC165 Letter With
Task - Client, which has the cover letter and the
two forms attached.
You can also use this if you only require the
ACC6300, just remember to remove the infor-
mation about the ACC165.
As this letter has the cover letter already done it
is a good way to send the form to the client.
Privacy - Authority Principles
NOTE What if the client doesn't agree to provide
any authority?
Go to the Decline or Withdraw Client Authority to
Collect Information process. This process ends.
PROCESS Decline or Withdraw Client Au-
thority to Collect Information
b In the appropriate system Eos or Salesforce, create a
Follow Up task for 10 working days from today to confirm
the client has completed and provided their authority.
NOTE What if the client needs to use an electronic
signature on the form
Information from the Privacy Team - Since Lock-
down we have been more lenient in accepting
electronic signatures. However, a client's name
typed on a form isn't enough to accept the
ACC6300, unless we have spoken with that
client about typing their name and have captured
this in a detailed 'contact' on EOS.
3.0 Review returned authority document
Cover Assessor, Recovery Assistant, Recovery Coor-
dinator, Recovery Partner, Specialist Cover Assessor,
Treatment and Support Assessor
a Receive the 'NGCM - Action Attached Documentation'
task.
NOTE What if you've received an NGCM - Action At-
tached Documentation task?
Close the task as it's to inform you that the
ACC6300 form has been uploaded to the claim.
b Review the written authority to confirm you understand
and accept any conditions provided.
NOTE What if the conditions need to be further cla-
rified with the client?
Contact the client to confirm the conditions and
clarify any uncertainties.
4.0 Update claim
Cover Assessor, Recovery Assistant, Recovery Coor-
dinator, Recovery Partner, Specialist Cover Assessor,
Treatment and Support Assessor
a In Eos, add the applicable consent record type and any
conditions on the Consent tab.
Add Client Consent
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Request medical or clinical records Policy v20.0
Summary
Policy
1.0 Rules
Objective
Client medical or clinical records help in a range of situations.
a When dealing with a client’s medical or clinical records,
They:
we must take care to observe the requirements of the Pri-
vacy Act 2020 and the Health Information Privacy Code
• help inform cover and support decisions
2020. For more information, and the difference between
personal and health information see ACC's privacy page.
• provide further information about the injury, client and diag-
nosis
A client must supply us with the information we need to
make a decision about a claim unless they have a
• help develop the rehabilitation plan
reasonable reason not to. See the Accident Compen-
sation (AC) Act 2001, Section 72. Section 55 of the Act
• help identify and manage any risks.
refers to the ‘Responsibilities of the claimant to assist in
establishment of cover and entitlements’ and generally
We can ask providers, including general practitioners (GPs) and
extends to responsibilities at the request of the Corpo-
District Health Boards (DHBs) to provide us with these medical
ration. This means that ACC will, as part of its inves-
or clinical records. See Requesting clinical records from DHBs.
tigative role, request the relevant supporting information
Providers who spend time preparing medical or clinical records
from the client, and their treating providers. Once investi-
(including completing an ACC554 LSIA medical certificate), can
gations are complete, a decision can be made on the
invoice ACC for that time.
claim.
1. Rules
All medical or clinical records provided to ACC must be
2. When to request medical or clinical records
kept on the client’s file.
3. Limits on what we can request
Accident Compensation Act 2001, section 72 -
4. Medical or clinical record request forms and letters
Responsibilites of claimant who receives entitlement
5. Non-DHB provider medical or clinical records - Prior approval
6. Service codes and prices
http://www.legislation.govt.nz/act/public/2001/0049/lat
7. Types of medical or clinical records
8. Quality
9. District Health Board (DHB) medical or clinical records -
2.0 When to request medical or clinical records
Knowing your DHB
a When the client requests cover, additional diagnosis,
10. Level of urgency
support, or treatment from ACC, the onus/responsibility
11. Prior approval
rests with the client and/or their provider to supply sup-
12. Service codes and prices
porting clinical or medical information to help us to make
13. What we don't pay for
the decision. If the client and/ or their provider has not
14. Types of medical or clinical records
supplied the supporting information, ACC will, as part of
15. Exceptions
its investigative role, request the relevant supporting
16. Quality
information from the client, and their treating providers.
17. Completing the ACC2386 Clinical Records Request - DHB
Once investigations are complete, a decision can be
made on the claim.
On the other hand, if ACC is considering withdrawing
Owner
support or treatment, revoking cover, or ceasing entitle-
Out of scope
ments such as weekly compensation, then the onus/
Expert
Out of
responsibility sits with ACC to request the supporting
medical or clinical records
Before making a request, you must ensure that the infor-
mation has not already been requested. You must also
check that clients are registered patients at the medical
practices where notes need to be requested from.
When a provider requests additional treatment or other
support on behalf of their client they should include all
medical or clinical records with their request, at no addi-
tional charge to ACC or the client.
b Overseas medical records may be required in ordered to
determine cover on a claim.
In these cases, it is ACC’s position that ACC is respon-
sible for the sourcing of the medical records from the
overseas provider as well as paying the provider directly
for those records.
This responsibility doesn’t extend to ACC sourcing and
purchasing overseas medical records for the purpose of
investigating entitlement and/or treatment.
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c Sections 56 and 57 Accident Compensation Act 2001
6.0 Service codes and prices
(the act) state that ACC must investigate cover on a claim
a
at its own expense. There is nothing in the act barring
See Codes and prices for non-DHB medical or clinical
ACC from gathering medical records from overseas when
records.
the records are required to determine cover.
Codes and prices for non-DHB clinical records
d Examples of when overseas medical records may be re-
quired to determine cover:
• A client who meets the definition of being ordinarily resi-
7.0 Types of medical or clinical records
dent in New Zealand who suffers a personal injury whilst
a The type of medical or clinical record(s) required will
overseas and seeks cover for that injury when they return
depend on the reason for the request. Records can in-
to New Zealand.
clude:
• A medical specialist comment is required from an over-
seas-based specialist due to the level of expertise re-
• copies of specialist reports, directed from one medical
quired (e.g. complex treatment injury claims where an
practitioner to another
opinion is sought from an overseas based medical spe-
• investigation results
cialist who is an expert in the relevant field).
• clinical notes
• A client has immigrated to New Zealand and it needs to
• reports by medical consultants
be determined whether their personal injury sustained in
• hospital records, including admission and discharge
New Zealand is a new injury or a reaggravation of an
summaries
injury that occurred overseas before the client emigrated.
• counselling notes for sensitive claims
• notes on surgical operations
• pathology and laboratory tests
PROCESS
Request Clinical Records
• reports on special tests and diagnostic procedures in-
cluding x-ray and scan results
• physiotherapy notes.
PROCESS
Request Clinical Records for Treat-
ment Injury
3.0 Limits on what we can request
8.0 Quality
a
a
You must have a reason for requesting medical or clinical
The number of medical or clinical record pages received
records.
from a provider may not reflect the time spent reviewing
and editing. If you have concerns about the quality or
We're only allowed to request information relating to the
quantity of provider medical or clinical records or their in-
claim, so the provider must review the record and edit out
voices, discuss this with:
any unrelated information. You must therefore use the
correct service code to allow them to do this if necessary
• a medical advisor
and invoice us correctly.
• your supplier manager
• the provider.
4.0 Medical or clinical record request forms and let-
9.0 District Health Board (DHB) medical or clinical
ters
records - Knowing your DHB
a
a
You must use the correct form or letter to request medical
Knowing how the DHB you work with stores and
or clinical records.
processes their client medical or clinical records will help
you with your requests. For example if a client is still in
b To request clinical notes and medical reports from pro-
hospital, their medical record will be on their hospital
viders use the relevant form or letter:
ward, rather than with the hospital medical records
MD09a Further info – consultation notes – vendor
department.
MD09b Allied - Further info - Consultation Notes -
Avoid making duplicate requests. You must make sure
Vendor
the request is necessary and complete the forms tho-
roughly.
NOTE Please make sure you have specified where
the provider/vendor should send the re-
Request the medical or clinical records from the correct
quested notes to (the correct return email or
contact.
postal address).
c Work Injury Inquiry Team
10.0 Level of urgency
MD10b Allied - Further info - Medical Questionnaire -
Timeframes for Clinical notes..PNG
Vendor
5.0 Non-DHB provider medical or clinical records -
Prior approval
a If medical or clinical records are likely to take more than
an hour to prepare, the provider must get prior approval
from the case manager who raised the initial request.
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11.0 Prior approval
b When requiring mental health records, there are specific
a
timeframes and requirements:
If you’re requesting more than 340 pages from the DHB,
they will seek prior approval from the case owner. The
To ensure ACC only collects information relevant and
case owner must then consider whether the volume of
necessary for decision making, we need to communicate
information is actually needed. If it is needed, either:
with our clients to determine a timeline for which to col-
lect mental health records.
• amend the request to be more specific, ie request a
date range or a particular treatment event, or
This aids in establishing a timeline with the client of their
engagement with mental health services, organizations
• give approval to proceed as originally requested, and
and Primary Health Care services.
adjust the purchase approval increasing the price accor-
dingly.
16.0 Quality
a The number of pages received from a DHB may not re-
flect the time spent reviewing and editing. If you have
12.0 Service codes and prices
concerns about the quality or quantity of medical or clin-
a
ical records or their invoices, discuss this with your team
• the payment rates that DHBs charge ACC for copies of
manager.
medical or clinical records are standardised across the
country
• the DHBs know to claim payment for a range rather
than a number of pages, eg 1-20 pages etc.
17.0 Completing the ACC2386 Clinical Records Re-
quest – DHB
a All components for Section 1 (vendor details), Section 2
13.0 What we don’t pay for
and 4 (patient details) and Section 6 (ACC staff member
a Missing mandatory information including:
details) must be completed.
• documentation required as part of the Non Acute
Section 3 (request details) is the most important section
Rehabilitation Services Schedule (ACC74, ACC739,
to complete accurately and may take the longest.
ACC9 and ACC740)
• Injury – review the claim Injury and Medical tab in Eos
• documentation that may be attached to support the
to assist you in identifying or confirming the injury
ACC705 which could include Emergency Department/
• Dates you require the records – you may have many
Discharge report, ACC45, Allied Health Needs Assess-
options for confirming the dates the client was in hospital
ment
for example, ACC74, ACC9, ACC705 or check with the
client directly.
• services provided in a fracture clinic under the Clinical
Services contract.
ACC2386 DHB request for copy of notes - Vendor
A purchase order should not be loaded for a payment for
these requests.
NOTE Please make sure you have specified where
the provider/vendor should send the re-
quested notes to (the correct return email or
postal address).
14.0 Types of medical or clinical records
a The type of medical or clinical record requested will differ
depending on the reason for the request. Also see Sce-
narios for requesting DHB clinical records.
Scenarios for requesting District Health Board clin-
ical records - Reference
Types of medical records.PNG
15.0 Exceptions
a • The Elective Surgery, Treatment Injury and National Se-
rious Injury Service units may have specific requirements
when:
— making a request for a medical or clinical record
— determining cover or support
— managing the rehabilitation or risks
• What is requested is generally directed and reviewed by
a Clinical Panel
• Treatment injury or elective surgery may request the
client’s full DHB record including nursing notes.
ACC > Claims Management > Manage Claims > Operational Policies > Treatment and Rehabilitation > Vocational rehabilitation > Request medical or clinical records Policy
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Request Clinical Records v99.0
Summary
NOTE What if you require notes from Oranga Tama-
riki?
Use the below link.
Objective
PROCESS Request and Obtain External
To request medical or clinical records from a client's vendor, so
Agency Records
that we have enough information to make a cover, support or
treatment decision.
NOTE What if you need to request records from
New Zealand Police?
Background
Use the below link.
ACC must request medical or clinical records from a client’s
PROCESS Request and Obtain External
vendor if we don’t already have enough information to make
Agency Records
a cover, support or treatment decision. ACC can ask exter-
nal vendors, including General Practitioners (GPs), District
NOTE What if you need clinical or medical records
Health Boards (DHBs) and specific treatment vendors (such as
from a DHB?
physiotherapists or chiropractors) to provide ACC with medical
Check if the reason for requesting the records
or clinical records related to the case.
aligns with one or more of the scenarios for
requesting District Health Board (DHB) clinical
Client medical or clinical records help in a range of situations.
records
They:
• help inform cover, support or treatment decisions
Scenarios for requesting District Health Board clin-
• provide further information about the injury, client and diag-
ical records - Reference
nosis
NOTE What if the information request is for a prison
• help develop the rehabilitation plan
facility?
• help identify and manage any risks.
you will need to know the current/last facility the
client was held.
Each time we request information about a client or a claim, the
you must contact them first to confirm they hold
client should be aware of the request and why we need the
the records and confirm the vendor number and
information.
email address to send the information request
Owner
then follow the GP request
Out of scope
NOTE What if you need to obtain Specialist records
Expert
Out of scope
or High Tech imaging?
Specialist notes or High Tech Imaging contracts
Procedure
require them to send through their reports within
5 working days of the patient consultation. Only
PROCESS
Create or Update Recovery Plan
submit a request for these records if it has been
Recovery Assistant, Recovery Coor-
more than 5 working days and they have not
dinator, Recovery Partner
been received. A Purchase Order is not required
for these requests.
NOTE What are the timeframes for receiving infor-
PROCESS
Arrange Medical Case Review
mation?
(MCR) Assessment
If you are requesting information from a DHB,
Recovery Assistant, Recovery Coor-
the timeframe is:
dinator, Recovery Partner
• non-urgent request – 21 working days
• urgent request – 6 working days
PROCESS
Seek Internal Guidance
If you are requesting information from a non-
Clinical Advisor, Practice Mentor, Tech-
DHB (GP, Medical Centre), the timeframe is:
nical Specialist
• non-urgent request – 11 working days
• urgent request – 6 working days
c In Eos, in the Consent tab of the Recovery Plan, check if
1.0 Determine requirement for clinical records
the client has provided authority to collect medical and
Recovery Assistant, Recovery Coordinator, Recovery
other records from third parties or has an ATA in place.
Partner
NOTE What if there is no authority on the client's
a Check the claim for information already on the claim,
claim, or the authority has expired?
before proceeding.
Refer to the NG GUIDELINES Obtain Verbal or
b Determine what type of medical or clinical records you
Written Authority for guidance.
need to obtain by referring to the links below.
If an ACC6300 is needed, Go to the Obtain
Client Authority to Collect Information process.
Best Practice Guidelines for requesting medical
PROCESS Obtain Client Authority to Col-
notes
lect Information
Request medical or clinical records Policy
ACC Guidelines to obtain verbal or written authority
Summary of the Health Information Privacy Code
Policy
Personal Information Requests Policy
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NOTE What if you need notes older than 2 years or
d Check that the client has been seen by the Vendor you
more? or if there are multiple claims for the
are requesting records from for this injury/claim.
client?
NOTE What if the Provider is under contract?
To ensure ACC only collects information relevant
To check to see if a Provider is under contract,
and necessary for decision making, we need to
search via MFP, if under contract a purchase
communicate with our clients to determine a
order is not required. When completing the e-
timeline for which to collect medical records.
form, in the 'Purchase Order Number required'
To help guide your conversation with the client to
drop down box, select 'No'.
establish a timeline of their engagement with
mental health services, organisations and Pri-
NOTE What if the client has been seen by (including
mary Health Care services, please consider
but not limited to) a Specialist or Surgeon at
asking the client the following questions:
a Private Hospital?
• Have you spoken to your Doctor about any
Contact the Specialists rooms to confirm where
concerns with being unable to sleep, stress or
this request should be sent. Eg. Private Hospital
anxiety?
or Specialists rooms. Add the specialist name to
• Have you spoken with any health care profes-
the request for information.
sionals such as Doctors or organisations about
the
NOTE What if the claim is for a client with a Mental
assault and support?
Injury?
• When did you first engage with these health
If you are requesting mental health records from
care professionals or organisations? DD/MM/
any of the following providers, you must contact
YYYY or a rough estimate eg June 2018 is suffi-
them first to confirm they hold the records and
cient
confirm the email address to send the infor-
• Confirm the client is happy for ACC to collect
mation request:
these clinical records from the date of DD/MM/
• GP records - Please confirm the name of the
YYYY to assist in ACC making a cover decision
Doctor they saw. If there are multiple names,
and support decisions on ongoing entitlements
preferably
and support?
list the most recent one. If the Doctor is a locum
of the Practice, please provide a name of some-
If, following your conversation with the client,
one
you’re unable to determine a specific period to
who is registered at the practice. The request will
request clinical records, then up to 2 years of
be made under their name instead.
Clinical Records can be requested as a reason-
• Physiotherapist or Allied Health providers
able timeframe.
Specialist or other records
• Mental Health Services or programmes which
If there is a clear reason that 2 years is likely to
could be funded through Primary Health Organi-
be insufficient, we can collect up to 5 years if
sations or Non-Governmental Organisations
rationale exists that we are reasonably likely to
Ensure a contact action is used to record this
need this. ACC will then be able to determine,
conversation.
once the information is received, whether we
have sufficient information for the purpose we re-
If the email address provided has not been veri-
quested it. In all instances, it is essential to con-
fied, go to Verify Provider and Vendor email ad-
sult and confirm what information ACC intends to
dresses then return to this process.
collect, with the client.
DHB's and Oranga Tamariki are the exception to
At least one claim must have a signed Authority
this as we are not able to verbally confirm that
to Collect information (ACC6300) within the cur-
they hold information. If requesting from a DHB,
rent year. Discuss with the client if you need to
follow the usual process. If requesting from
request information not already on file. Docu-
Oranga Tamariki, use below link.
ment their verbal authority.
PROCESS Request and Obtain External
Agency Records
NOTE What if you are requesting Mental Health
e In Eos, check the correct Vendor is entered as a partic-
notes?
ipant on the claim.
Before requesting Mental Health notes a signed
NOTE What if the Vendor hasn't been added as a
ACC6300 Authority to collect information must
participant?
be on the file. (Received within the last 12
Add the Vendor as a participant to the claim
months)
NOTE What if the provider has not been set up as a
NOTE What if you need notes where a client has an
Vendor?
active claim, but you require notes for other
claims for the same client that are inactive?
In MFP, confirm the provider is not a Vendor.
Contact the Vendor to confirm they hold the
Check the other claims for information before
records and confirm the email address, physical
proceeding to request information.
address and contact phone number for follow-up.
In the task to Recovery Administration - note the
Request for notes on Multiple claims, but to one
use of Vendor ACC Default J99966 & above
provider, Task on active claim noting all claim
information
numbers
Manage Participants
Request for notes on previous claims:
f In Eos, add a NGCM - Information Requests activity and
The task should be created on the active claim (if
complete as per the Requesting Clinical Records system
no active claim, task on the claim you need) in
steps.
the task, note which claim number you need clin-
ical notes for and add the vendor as a participant
Requesting Clinical Records
on claim
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NOTE What if the information request is no longer
NOTE What if you are requesting medical notes for
required?
multiple claims from the same vendor?
Cancel the following tasks:
Note the following in the task:
• NGCM - Information Request
• Specific "from" and "to" dates.
• NGCM - Follow up Requested Information
• NGCM - Continue to Follow up Requested
• If you are requesting additional notes for a
Information
claim from the same vendor, to avoid duplication
• NGCM - Incomplete Information Request task
check the from and to dates on the previous re-
• NGCM - Follow up Request for Clinical
quest.
Records
For example: 1st request for medical information
This will remove the tasks from the Recovery
"from" date is 21/06/2019 to 21/08/2019 (Present
Admin Queue (do not close the task or place a
date in which the purchase order was created).
comment on the task asking for the task to be
Next request will go "from" 21/08/2019 "to"
closed).
21/10/2019.
Cancel a task
NOTE What if you are requesting information prior
g
to seeking internal guidance or information
Complete the eform with all the relevant information and
has been requested by an advisor?
instructions for Recovery Admin to action.
Request the additional information using the Re-
NOTE What if the information request is for a GP
quest Clinical Records process above. Then
Practice, 24-hour surgery or 24-Hour Medical
extend the target date of the clarification task to
Centre?
later than the due date of the medical notes task.
Please indicate the name of the Doctor they saw.
Ensure you update the clarification task descrip-
If there are multiple names, preferably list the
tion to reflect you have requested additional
most recent one.
information.
If the Doctor is a locum of the Practice, please
h Add a note in the Recovery Plan, under the appropriate
provide a name of someone who is registered at
Life Area recording the reason for the information re-
the practice. The request will be made under
quest.
their name instead.
NOTE What if you're a Cover Assessor?
NOTE What if the information request relates to
notes needed to make a cover decision?
Edit the 'Confirm Cover Decision' task and add
the details to record the request for information.
Edit the task and change the priority to 'High'.
NOTE What if the claim is for Mental Injury but
requesting notes for physical injuries only
2.0 Review request for clinical records
When creating your task, add title in task
Recovery Administrator
description PHYSICAL INJURY NOTES ONLY,
a
not in the request Eform - then complete the
Upon allocation of the 'NGCM - Requested Information'
eform with all the relevant information and
task in Salesforce, open the associated task in Eos and
instructions for Recovery Admin to action.
select [Do Task] from your task queue.
Include: List the diagnoses that you would like
b Review the task to check Recovery Team member has
notes on and the name of the most recent Doctor
provided the name of the Vendor.
who treated them at the facility. If the ACC45 has
sensitive material, we will need to have a current
NOTE What if the information needed is from over-
ACC6300 to proceed.
seas?
Refer to the Making an overseas payment link
NOTE What information do you need to include in
below for more information.
the information request task?
Refer to the 'Referring Tasks to Recovery
Making an overseas payment
Administration - Principles'. Ensure you record
http://thesauce/team-spaces/chips/compensation/wee
all claims numbers you are requesting notes on if
NOTE What if the name of the Vendor hasn't been
requesting notes on more than one claim.
provided in the task?
Referring Tasks to Recovery Administration - Prin-
The Vendor details should be included in the
ciples
task. If the details are missing, contact the re-
questor for the information and ask them to add
NOTE What if the request for clinical notes is from a
as a Participant on the claim.
DHB?
Refer to 'Contacts for requesting District Health
NOTE What if the vendor has not been added as a
Board clinical records' to locate who to request
Participant on the claim?
the information from and add the DHB as a
The Recovery Team member should be adding
participant using the correct vendor code.
the vendor as the Participant on the claim. but if
this has not been completed, contact the Recov-
Contacts for requesting District Health Board clinical
ery Team Member asking them to add the
records
Vendor as a participant before creating the pur-
NOTE What if the Vendor is a DHB?
chase order
In the NGCM - Information Request, note that
the client's ACC6300 needs to be sent with the
request. (Received within the last 12 months)
NOTE What if the request is for hard materials?
Clearly state in the task description "Hard mate-
rials [type of material] required from [provider] to
be sent to [your address]".
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NOTE What if the vendor is noted as Vendor ACC
NOTE What if the information request is for Treat-
Default J99966?
ment Injury claim?
Some records may be requested from Vendors
Check the cover status on the General tab and
who are not set up as an ACC Provider. In this
Claim Type, eg Cover Status - Accept, Claim
case, the Vendor Default of J99966 is used.
Type Treatment Injury - ticked
edit the letter: remove the ACC address and add
vendor name and address copy and paste from
If Treatment Injury ticked and Held Claim, follow
the task
Request Clinical Records for Treatment Injury -
linked below
NOTE What if the request is for medical notes for
multiple claims?
If Treatment Injury ticked and accept follow 2.0 d
When requesting notes on Multiple claims, but to
one provider, the Purchase Order is created on
NOTE What if the information request is for a Mater-
the active claim; all claims numbers should be
nal Birth Injury (MBI) claim?
listed in the letter.
Check the cover status on the General tab and
Claim Type, eg Cover Status - Accept, Claim
Request for notes on previous claims:
Type
When requesting notes on a previous claim, the
Maternal Birth Injury – ticked Follow 2.0d.
task should be received on an active claim which
notes the claim number the notes are needed
If Treatment is also ticked and claim is accepted,
for. Purchase Order and request letter should be
also follow 2.0d.
completed on the previous claim number. Close
the request task- this will create a follow up task,
If Maternal Birth Injury – ticked & Treatment
edit this follow up task with the previous claim
Injury is also ticked and Held Claim, follow Re-
number the Purchase Order was created on.
quest Clinical Records for Treatment Injury -
c
linked below
Check the task to determine if you need to generate a
Purchase Order.
Request Clinical Records for Treatment Injury
NOTE What if you don't need to create a Purchase
Order?
Go to Activity 4.0 (d) Create and send request.
3.0 Request GP records
d Identify the vendor type for the information request.
Recovery Administrator
NOTE What if the information request is for GP
NOTE Can you request Clinical Records electron-
records?
ically via SureMed?
Go to Activity 3.0.
ACC's preferred method for requesting Clinical
NOTE What if the information request is for DHB
Records from GP's is electronically through the
records?
SureMed portal. If needed you can still request
Clinical Records manually by continuing with this
Go to Activity 3.1.
process.
NOTE What if the information request is for private
PROCESS Request GP Clinical Records -
hospital records?
SureMed
If PO needed Go to Activity 3.0. if no PO is
a View the [Add Info] tab in the task.
needed Go to Activity 3.3.
b Create the Purchase Order.
NOTE What if the information request is for Physio-
therapy records?
Creating purchase orders using general + QE
Go to Activity 3.2.
NOTE What if the information request is for Spe-
cialist records?
Go to Activity 3.3.
NOTE What if the request is for Oranga Tamariki?
Use the below link.
PROCESS Request and Obtain External
Agency Records
NOTE What if the request is for hard materials?
If the request is for hard materials (ie tooth
sample), include the address of the staff member
requesting it in the "How to send the requested
information" section of the letter.
NOTE What if the request is for New Zealand Police
Use the below link.
PROCESS Request and Obtain External
Agency Records
ACC > Claims Management > Manage Claims > Gather Additional Information or Advice > Request Clinical Records
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NOTE What information do you need to create the
NOTE What if there are questions to be included in
Purchase Order?
the information request?
Choose the appropriate Entitlement Code or a
Generate the 'MD02a GP - Further info - Medical
combination of codes:
Notes - Vendor' letter.
MEDR – (is an hourly rate for the time taken by
Admin Template - MD02a GP Further info - Medical
the Medical Practitioner to prepare and review
Reports – Vendor
the medical notes).
COPY – (is the cost for practice admin staff to
NOTE What if the claim is for Mental Injury but
photocopy and prepare existing medical notes
requesting notes for physical injuries only
that may be paper based).
Follow the task template for physical injury
records request, use NGCM Email template.
*If you mark the request as 'Urgent', provide the
Make no mention of any mental injuries.
reason.
We are not requiring mental health notes, do not
add this.
After selecting the Entitlement code(s), proceed
as follows:
f Text to include in letters, that haven't been updated in
1) Rehab Action / Claim: Treatment (Search)
Eos:
2) Tick the 'Medical Notes/Reports – Tmt (Quick
add)
Privacy
3) Quantity Approved: MEDR - 1, COPY - up to
As we are dealing with a client’s medical or clinical
max of 30
records, it is important that both you and ACC comply
4) Frequency: Quarter
with the requirements of the Privacy Act 2020 and the
5) Create PO
Health Information Privacy Code 2020. ACC asks that
6) Purchase Method: Non-Contracted.
you supply only the information we need to make a cover,
support or treatment decision about this claim, and do not
If there are questions for the GP vendor, select
give us any client information that we do not need for that
the 'MD02a GP - Further info - Medical Notes -
purpose. Please review any records and remove any
Vendor' letter. In this case, select 'In total' as the
unrelated information before you send files to us.
[Frequency] when raising the PO, this will ensure
the document template populates the right quan-
tity. Alternatively, manually amend the template
3.1 Request DHB records
to change quantity from 0 to 1.
Recovery Administrator
c Approve the Purchase Order.
a View the [Add Info] tab in the task.
NOTE What if you get a Limited Payment error mes-
b Create the Purchase Order.
sage when authorising the Purchase Order?
Creating purchase orders using general + QE
If you have received a request to amend a Pur-
chase Order or create a Purchase Order for
Contacts for requesting District Health Board clinical
client reimbursements, change the limited pay-
records
ment indicator.
NOTE What information do you need to create the
Purchase Order?
1) In Eos, go to the 'Validations' tab, select 'Edit'
Use Entitlement Code DHBC.
and update the Limited Payment List Indicator to
If questions need to answered by a DHB Spe-
'No'.
cialist, use Entitlement Code: DHBR1.
2) Select 'OK'.
3) Go back to the Purchase Order to authorise.
After selecting the DHBC Entitlement code, pro-
ceed as follows with steps 1 – 6 as below. If you
Once you have authorised the Purchase Order
require further information, refer to the 'Creating
and notified the vendor remember to change the
purchase orders using general + QE System
Limited Payment List Indicator to 'Yes'.
Steps' document below.
d Any mention of sexual abuse or sensitive claims needs to
be changed to “Mental Injury”.
1) Rehab Action / Claim: Treatment (Search)
e
2) Tick the 'Medical Notes/Reports – Tmt (Quick
Generate the MD01a GP - Further Info - Medical Notes -
add)
Vendor letter by selecting 'add documents'.
3) Quantity Approved: 1
NOTE What if the request relates to a Mental Injury
4) Frequency: Quarter
claim?
5) Create PO
Refer to the admin template for what needs to be
6) Purchase method: non contracted
updated in the MD01a letter.
7) Choose the correct vendor. (Use the link
above for contacts for requesting DHB Clinical
Admin Template - MD01a GP Further Info - Medical
Records).
Notes - Vendor
c Approve the Purchase Order.
NOTE What if the request is urgent?
Update the sentence under the 'How to invoice
ACC' with the following:
'Please forward the requested reporting within 5
days'.
When emailing add URGENT to the email sub-
ject line.
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NOTE What if you get a Limited Payment error mes-
NOTE What information do you need to create the
sage when authorising the Purchase Order?
Purchase Order?
If you have received a request to amend a Pur-
Use Entitlement Code: STPR.
chase Order or create a Purchase Order for
If you have questions requiring answering by the
client reimbursements, change the limited pay-
Physiotherapist, Osteopath, Chiropractor or
ment indicator.
Podiatrist use Entitlement Code: MEDR.
1) In Eos, go to the 'Validations' tab, select 'Edit'
*A contracted physiotherapist may request STPR
and update the Limited Payment List Indicator to
when they need to spend significant time re-
'No'.
viewing and redacting information before send-
2) Select 'OK'.
ing the notes to ACC, in which case ACC should
3) Go back to the Purchase Order to authorise.
fund.
Once you have authorised the Purchase Order
After selecting the relevant Entitlement code,
and notified the vendor remember to change the
proceed as follows:
Limited Payment List Indicator to 'Yes'.
d
1) Rehab Action / Claim: Treatment (Search)
Any mention of sexual abuse or sensitive claims needs to
2) Tick the 'Medical Notes/Reports – Tmt (Quick
be changed to “Mental Injury”.
add)
e Generate the ACC2386 - DHB (Vendor) request for copy
3) Quantity Approved: 1
of notes by selecting 'add documents'.
4) Frequency: Quarter
5) Create PO
Admin Template - ACC2386 Clinical Records Re-
6) Purchase method: Non-contracted
quest District Health Board
7) Choose the correct vendor or just type in the
NOTE What if the request relates to a Mental Injury
correct vendor code.
claim?
c Approve the Purchase Order.
Generate the 'ACC2386 DHB request for copy of
notes' letter. Using the instructions in the tem-
NOTE What if you get a Limited Payment error mes-
plate modify the letter for a Mental Injury request.
sage when authorising the Purchase Order?
If you have received a request to amend a Pur-
ACC2386 Clinical Records Request District Health
chase Order or create a Purchase Order for
Board Mental Injury Template
client reimbursements, change the limited pay-
NOTE What if there are questions to be included in
ment indicator.
the request?
Generate the 'MD02c-DHB-Further Info - med-
1) In Eos, go to the 'Validations' tab, select 'Edit'
ical reports - vendor' letter.
and update the Limited Payment List Indicator to
'No'.
Admin Template - MD02c - DHB Further info - Med-
2) Select 'OK'.
ical Reports – Vendor
3) Go back to the Purchase Order to authorise.
NOTE What if the claim is for Mental Injury but
requesting notes for physical injuries only
Once you have authorised the Purchase Order
Follow the task template for physical injury
and notified the vendor remember to change the
records request, use NGCM Email template.
Limited Payment List Indicator to 'Yes'.
Make no mention of any mental injuries.
d Any mention of sexual abuse or sensitive claims needs to
We are not requiring mental health notes, do not
be changed to “Mental Injury”
add this.
e Generate the MD01b Allied - Further info - Medical Notes
- Vendor by selecting 'add documents'.
3.2 Request Other Clinical records ie, Physio-
NOTE What if the request is urgent?
therapist or Allied Health
Under 'Services approved ', update the sentence
Recovery Administrator
'Please forward the requested reporting within 10
a
days' to 5 days.
View the [Add Info] tab in the task.
b
NOTE What if there are questions you need to in-
Create the Purchase Order.
clude?
Creating purchase orders using general + QE
Generate the MD02b Allied - Further info - Med-
ical Notes - Vendor letter.
Admin Template - MD02b Allied Further info - Med-
ical Reports – Vendor
NOTE What if you need to fax the letter?
Generate the 'MD01b Allied - Further info - Med-
ical Notes fax - Provider'.
Admin Template - MD01b Allied Further info - Med-
ical Notes – Vendor
NOTE What if the claim is for Mental Injury but
requesting notes for physical injuries only
Follow the task template for physical injury
records request, use NGCM Email template.
Make no mention of any mental injuries.
We are not requiring mental health notes, do not
add this.
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f Amend the MD01b letter to include the 'from to dates'
NOTE What if you get a Limited Payment error mes-
provided in the task by the Recovery Team member
sage when authorising the Purchase Order?
g Text to include in letters, that haven't been updated in
If you have received a request to amend a Pur-
Eos:
chase Order or create a Purchase Order for
client reimbursements, change the limited pay-
Privacy
ment indicator.
As we are dealing with a client’s medical or clinical
records, it is important that both you and ACC comply
1). In Eos, go to the 'Validations' tab, select 'Edit'
with the requirements of the Privacy Act 2020 and the
and update the Limited Payment List Indicator to
Health Information Privacy Code 2020. ACC asks that
'No'.
you supply only the information we need to make a cover,
2). Select 'OK'.
support or treatment decision about this claim, and do not
3). Go back to the Purchase Order to authorise.
give us any client information that we do not need for that
purpose. Please review any records and remove any
Once you have authorised the Purchase Order
unrelated information before you send files to us.
and notified the vendor remember to change the
Limited Payment List Indicator to 'Yes'.
f Generate the MD02a - GP Further info - Medical Reports
3.3 Request Specialist or other records
letter and modify as per the task. Send an email using
Recovery Administrator
the Medical Notes Request Email template and modify
a
accordingly.
View the [Add Info] tab in the task.
b
Admin Template - MD02a GP Further info - Medical
Any mention of sexual abuse or sensitive claims needs to
Reports – Vendor
be changed to “Mental Injury”.
g Text to include in letters, that haven't been updated in
NOTE What if the claim is for Mental Injury but
Eos and to email template when no PO required:
requesting notes for physical injuries only?
Follow the task template for physical injury
Privacy
records request, use NGCM Email template.
As we are dealing with a client’s medical or clinical
Make no mention of any mental injuries.
records, it is important that both you and ACC comply
We are not requiring mental health notes, do not
with the requirements of the Privacy Act 2020 and the
add this.
Health Information Privacy Code 2020. ACC asks that
c Check if there is a requirement to submit questions to the
you supply only the information we need to make a cover,
vendor.
support or treatment decision about this claim, and do not
give us any client information that we do not need for that
NOTE What if questions are not needed for the
purpose. Please review any records and remove any
information request?
unrelated information before you send files to us.
Proceed to Activity 4.0 (d) Create and send re-
quest.
NOTE What if the Specialist or 'other' does not have
4.0 Create and send request
a verified email address?
Recovery Administrator
If you are requesting notes from a Specialist and
a Edit the documents and letters:
they do not have a verified email address, then:
1) Change the 'Staff Name' from your name to 'ACC'
1) Call and verify as the first option
2) Only if absolutely necessary (if they don't want
2) Copy the document name under the 'Recipient Details'
the request emailed) create a letter to FAX as
heading and paste into the Document Description' box
per the steps in 4.0 e Note 1.
d Create the Purchase Order.
3) Untick 'Record a Contact' and then 'Next' (the docu-
ment will be generated in Word for you to complete)
NOTE What information do you need to create the
Purchase Order?
4) Complete the document using the information provided
Entitlement Code: MEDR
located in the 'Additional Information' tab
Entitlement Type: Intervention Medical Notes /
Reports - Tmt (Quick Add)
5) Check the details you have entered are correct
Quantity: 1
Frequency : In Total
6) Save the document and close.
Purchase Method Non-Contracted
NOTE What if the task includes questions from a
If there are questions for the Specialist vendor,
Recovery Team Member?
select the 'MD02a GP - Further info - Medical
Refer to the NG GUIDELINES Sending Letters in
Notes - Vendor' letter. In this case, select 'In total'
NGCM to confirm whose signature should be
as the [Frequency] when raising the PO, this will
used.
ensure the document template populates the
NG GUIDELINES Sending Letters in NGCM
right quantity. Alternatively, manually amend the
template to change quantity from 0 to 1.
b In Eos, mark the status of the document as complete,
and select OK.
e Approve the Purchase Order.
c Complete privacy checks on the completed documents.
Privacy Check Before Disclosing Information Policy
NG SUPPORTING INFORMATION Inbound and
Outbound Document Checks
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d Create an email using the appropriate template and
NOTE What if you need to send a FAX?
attach the document(s). Add the client's NHI at the begin-
Fax the requests do the following:
ning of the email subject field.
NOTE What email template should you use?
(A) – For users with Fax Access
1). Print/Fax the request using RightFax
If Purchase Order created, use 'Medical Notes
2). Navigate back to Eos
Request (Purchase Order)
3). Add a new contact stating: "MD01a [docu-
If no Purchase Order created, use 'Medical
ment date and time], sent via fax to: [faxnumber]
Notes Request'
on [date and time]".
Modify accordingly.
NOTE A copy of the lodgment form (ACC45/46/42)
(B) – For users without Fax Access
must be sent with every DHB request, or an
1). Create the request
ACC6300 if there is one on file
2). Update the task details with "Please Fax,
Vendor #, Fax #, [Document attached]
3). Link the request to the task
NOTE What if the request relates to a Mental Injury
4). Set the priority as 'High'
claim?
5). Transfer back to the Admin queue
Create an email in outlook. Copy and paste the
following text and modify accordingly:
For guidance on how to use RightFax refer to the
document below.
Kia Ora,
RIghtFax Instructions
ACC have received a claim from *client first
e Perform despatch check.
name* relating to their Mental injury.
NG SUPPORTING INFORMATION Inbound and
We require Mental health information from be-
Outbound Document Checks
tween 00/00/0000 and present, to help us make
f Send the email.
decisions about their claim.
g In Eos, close the task. This will automatically generate a
Our preference is to receive all documentation
Follow up Requested Information task for Recovery
by email, if this is not possible just let us know.
Administration.
NOTE What if the request was set as High Priority?
If you have any queries, please do not hesitate
Edit the Follow Up Requested Information task
to email [email address] or call 0800
and set to 5 business days.
735 566 Ext:87879.
NOTE What if you were requesting records across
Ngā mihi
multiple claims?
NGCM - FINAL Emailing from Eos using a Template
Edit the description in the follow up task to in-
- System Steps
clude a list of all the claim numbers and dates
are requesting records for. Copy the details from
NOTE What if the request is for records across mul-
the task.
tiple claims?
Send the request from the claim where the PO
was created.
5.0 Review clinical records received
NOTE What if the Vendor's address has not been
Recovery Administrator, Recovery Team Member
verified?
a Following the task assignment in Salesforce, navigate to
Go to Verify an Existing Provider, Vendor or
Eos and select 'Do Task' from your task queue.
Facility Email Address.
b Complete privacy checks.
PROCESS Verify an Existing Provider,
Vendor or Facility Email Ad-
dress
NOTE Perform privacy checks.
We get a lot of information coming in from third
NOTE What if the request is URGENT?
parties like GPs and DHBs, and mostly that infor-
State this clearly in the body and subject line of
mation is just what we asked for. However some-
the email.
times we get information we don’t need and don’t
NOTE What if the request relates to a Mental Injury
want, even information about unrelated people.
claim?
Getting unwanted, excessive or irrelevant infor-
If the claim relates to a Mental Injury (e.g. stress
mation from a third party provider isn’t a privacy
related injuries), you will need to manually
breach, but sending it on later very much is. We
remove the injury details from the Medical Notes
have a responsibility to make sure we only send
Admin Email template(s).
out relevant information and to ensure that, we
need to check information as it comes in – if it’s
NOTE: Details of a client's physical injury won't
not what you need or want, either return to the
populate on the Medical Notes Requests email
provider and ask them to resend, or redact the
templates used by Recovery Administration for
unnecessary information and delete the unre-
Purchase Orders or non-Purchase Orders for
dacted version.
Sensitive Claims in the Assisted or Partnered
Recover teams.
NG SUPPORTING INFORMATION Inbound and
Outbound Document Checks
Privacy Check Before Disclosing Information Policy
c In Eos, upload the information to the claim.
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NGCM Filing Away - System Steps
d Update the document and contact properties with an
accurate description of the information received.
NOTE What if you are a Recovery Team Member?
Locate and edit the associated 'NGCM - Follow
up Requested Information' task stating clinical
records have been received. Recovery Admin
will update the 'Information Requested' tab and
close the task.
e Select the 'Information Requested' tab on the Recovery
Plan subcase, mark the request as 'Complete' and state
'Information Received', select OK.
f Close the 'NGCM - Follow up Requested Information'
task stating clinical records have been received. A NGCM
- Review Requested Information task will be auto gen-
erated and assigned to the Recovery Team or Individual
managing the claim.
NOTE What if you receive a Review Requested
Information Task and the information is
incomplete?
Close the task.
Select 'Information Incomplete and click OK.
Add the details of the information that is missing
in the comment box and select a target date.
Click OK. The task will auto-route to Recovery
Administration.
if NGCM - Follow up Requested Information re-
quest was set as High Priority?
after closing and creating Review Requested
Information Task or the information is incomplete
Edit task to high.
6.0 Follow up request for clinical records
Recovery Administrator
a Following the task assignment in Salesforce, navigate to
Eos and select 'Do Task' from your task queue.
b In Eos, check the 'Documents' tab to confirm the re-
quested information has not been received before pro-
ceeding to contact the vendor.
NOTE What if you're unable to locate the infor-
mation in the documents tab?
1) Check the shared inbox to see if the email has
arrived but has not yet been filed away
2) If the information is in the shared inbox, file it
away to the claim
3) Copy and paste the email subject line into the
Salesforce search bar, opens the related task
and close.
4) Check the client's party record under Docu-
ments
5) If the vendor has email ACC back with no
attach notes, File away, update task with tem-
plate below
Response from vendor:
See contact:
Action:
c Contact the vendor to follow up on the requested infor-
mation. Ensure that you check what has previously been
requested and only follow up the request for subsequent
information (using the date ranges on the request form).
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NOTE How many times do you follow up with the
vendor?
*If it a SureMed request, follow the SureMed pro-
mapp pg
Make two attempts to follow up with the Vendor
Check Task date inline with below, if not, correct
the target date (count from Creation Date),
update the task description eg ‘JL 18/09/2019
task date correction’.
DHB, the timeframe is:
• non-urgent request – 21 working days
• urgent request – 6 working days
non-DHB (GP, Medical Centre), the timeframe is:
• non-urgent request – 11 working days
• urgent request – 6 working days
1) The first attempt should be made by phoning
the vendor, to confirm receipt of initial request.
• Unless you are following up a DHB request
email only.(only follow up Urgent DHB notes
before 20 days)
• If you are successful in contacting the vendor,
Update your task with template below:
• If leaving a message, ensure you provide suffi-
cient details for the vendor to identify the client
whose information we require, eg Client full
name, NHI or claim number or ACC45 number,
DOB
Update your task with template below:
When calling:
(Initials)(Date) - Follow up #
Number called:
Person who you spoke with:
Outcome:
Expected timeframe:
Notes will be sent via:
If you are unable to leave message , eg: line
busy, unable to connect or no VM . Put the task
on hold , try 2-3 times during the day to establish
a successful contact or to leave a message . If
unable to make contact, send final email (follow
process 2)
• Reset the follow up task target date and time
(between 10.00-15.00), if said notes already
sent, push task out 3 days (giving time to be re-
ceived/upload); If no timeframe, push task out 2
weeks. (10 working days)
Exceptions: If the vendor has been in touch and
has asked for more time or explained their
circumstances, then adjust accordingly
2) Edit the task description with below template
(do not delete any information from the task)
When emailing:
(Initials)(Date) - Follow up #
Email sent to:
See contact dated:
Additional info:
Response from vendor:
See contact:
Action:
From the Documents tab in Eos, locate the orig-
inal request letter that was sent to the vendor.
Create new email from template and copy and
ACC > Claims Management > Manage Claims > Gather Additional Information or Advice > Request Clinical Records
paste original email (in contacts tab) add the
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additional content below. In the Email subject
line ensure that you include the wording 'Follow
NGCM - FINAL Emailing from Eos using a Template
NOTE What if you are unable to locate the infor-
- System Steps
mation on file?
NOTE What if the vendor has advised that they no
• Check the shared inbox to see if the notes have
longer hold the client's records as the client
been received. If you have received the notes,
has transferred to another GP practice?
file
it away onto the claim, close the salesforce task
Make a note of what the previous vendor has ad-
email task and continue to 8d.
vised on the NGCM – Information Not Received
• Review if there are any correspondences to
task once the NGCM – Follow up Requested
confirm why ACC haven't received the Notes. If
Information task has been closed. Copy in the
you
relevant notes that have been left on the task for
have identified there are correspondences,
the team/RTM to follow.
update the task with the response from the
d Close the 'NGCM - Follow up Requested Information'
vendor,
task.
where the correspondence is and the action
taken.
Information Not Received
• If you have no correspondences or the notes
e Copy and paste the task description from the 'NGCM -
are not on file continue to follow up.
Follow up Requested Information' task into the 'NGCM -
Information Requested not Received' task.
c Contact the vendor to determine why they have been
NOTE What other information should you include?
unable to provide the requested information
Include any other relevant information e.g. 'Voice
NOTE What if the vendor is unable to provide the
Message says the clinic has closed down'.
requested information?
Add the response into the task to notify the
Recovery Team Member. In Eos, record this
7.0 Determine if clinical records are still required
conversation as a contact on the claim.
Recovery Assistant, Recovery Coordinator, Recovery
Partner
Reason: Contact with Provider
a Review the 'NGCM - Information Requested Not Re-
Direction: Outgoing
ceived' task to determine if you still require the medical or
method of Contact: Phone
clinical records.
Description:
NOTE What if you no longer require the medical or
Name: (who you spoke to)
clinical records?
PH#:
Select the NGCM - Information Requested Not
Detail: (of the conversation)
Received task. Follow the systems steps for
Information not Received.
d Close the 'NGCM - Continue to Follow up Requested
This process ends.
Information' task, and select 'Information Requested Not
Received'.
Information Not Received
NOTE What if you still require the medical or clin-
ical records?
9.0 Review clinical records
Close the 'NGCM - Information Requested Not
Recovery Assistant, Recovery Coordinator, Recovery
Received' task.
Partner
a Confirm you have received the records requested.
In the 'Choose Next Step' screen, select option
'Continue to follow-up'.
NOTE What if you need help to interpret the infor-
mation?
An 'NGCM - Continue to Follow up Requested
Go to the Seek Internal Guidance process.
Information' task will automatically generate
PROCESS Seek Internal Guidance
route to Recovery Administration Team.
NOTE What if the records received are incomplete?
Follow the system steps below.
8.0 Continue following up request for clinical
Information Incomplete
records
b Perform privacy checks.
Recovery Administrator
a
Privacy Check Before Disclosing Information Policy
Following the task assignment in Salesforce, navigate to
Eos and select 'Do Task' from your task queue.
NG SUPPORTING INFORMATION Inbound and
Outbound Document Checks
Continue To Follow Up Requested Information
NOTE Set the target date and time (between
10.00-15.00) for a week after (5 working days)
. Exceptions: If the vendor has been in touch
and has asked for more time or explained
their circumstances, then adjust accordingly.
b Review the claim to ensure information is not on file.
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NOTE What if the clinical records require redacting
d In Eos, close NGCM - Incomplete Information Request
or third-party information removed?
task. This will then create the 'NGCM - Follow up Re-
• Email the document for Mental Injury use
quest for Clinical Records' task.
[email address]; for all others use
Check to see if it has generated a Follow Up Requested
[email address].
Information task.
If it has generated a follow up task, make a note on the
• When emailing to Recovery Administration, pro-
task to specify that it is the follow up of the Incomplete
vide clear instructions or highlight Document, on
Information Request task and set the task target date for
the information that needs redacting.
10 working days
from task creation.
NOTE: Do not add any third-party information
NOTE If it hasn’t generated a follow up?
into the task or email because this cannot be re-
• Go to the ‘Task’ tab on the ACC45 Claim.
moved in the future and tasks are provided to a
• Click on the ‘Incomplete Information Request’
client when they request their claim information.
task so it brings it up in the preview space below.
Instead state ‘please remove third party infor-
Do not fully open it.
mation on page xx'.
• Click on the ‘Process View’ tab.
c In Eos, open the 'NGCM – Review Requested Infor-
• Find the blue square.
mation' task, select the option to accept records and
• Click the play button on the right side of the
close the task.
square.
• This should have generated the ‘Follow Up Re-
quested Information’ task.
10.0 Action incomplete request for clinical record, if
• Follow the steps above regarding editing the
required
task and the target date.
Recovery Administrator
e Edit the 'NGCM - Follow up Request for Clinical Records'
a Following the task assignment in Salesforce, navigate to
task and record your initials, today's date, attempt
Eos and select 'Do Task' from your task queue.
number and discussion had with the provider regarding
the missing information.
NOTE What if the original request was submitted
through SureMed
f Go to Activity 6.0, 'Follow up Request for Clinical
Records' if required.
Go to Request GP clinical record- SureMed and
follow step 2.0 NOTE What if information is miss-
ing?
PROCESS Request GP Clinical Records -
SureMed
b Open the 'NGCM - Incomplete Information Request' task
to determine what information is missing. To view the
original information request, go to the [Add Info] tab and
then click on the 'Inherited' tab.
Information Incomplete
c Contact the vendor to obtain the missing information.
NOTE What methods and templates do you use for
this?
Call the vendor to discuss what's missing from
the original request and ask if they can send the
information to ACC. In EOS, record this conver-
sation as a contact on the claim.
NOTE What if the vendor insists on an email?
Using the appropriate Eos template, email the
vendor and attach the original clinical request
and advise the vendor of the missing information
as outlined by the Recovery Team Member in the
task, and then close the task.
An email example could be:
"Thank you for sending the requested medical
information on (insert date). We have reviewed
the medical notes and noticed some information
is missing. Could you please send a copy of
(insert what information is missing here) to us at
your earliest convenience. Thank you"
This will then create the NGCM - Follow up Re-
quest for Clinical Records task.
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Decline or Withdraw Client Authority to Collect Infor-
mation v18.0
Summary
NOTE What if the client declines all authority op-
tions?
Consider the following questions and ensure you
Objective
have answered them with the client before pro-
To decline or withdraw client authority to collect medic
al or other
gressing:
information at the client's request.
- Why do you need to request the information?
Background
- What will the information be used for?
At any stage of a client's journey, they can decline to give au-
- Is it reasonable for you to request it?
thority to ACC to gather information about them. A client can
- Why is the client declining to give authority for
also give authority but then change their mind and withdraw
you to collect the information?
their authority at a later stage.
- Is the client's decline reasonable or unrea-
sonable?
Use this process to support a client who either:
Go to the Seek Internal Guidance process below
- declines to give authority to collect medical and other relevant
to assist you further.
records; or
PROCESS Seek Internal Guidance
- withdraws authority to collect medical and other relevant
NOTE What if the client wants to withdraw their cur-
records.
rent valid authority?
Owner
Out of scope
Go to Activity 2.0 Withdraw client authority.
Expert
Out of
PROCESS
Obtain Client Authority to Collect
Procedure
Information
Cover Assessor, Recovery Assistant,
PROCESS
Obtain Client Authority to Collect
Recovery Coordinator, Recovery Partner,
Information
Senior Cover Assessor
Cover Assessor, Recovery Assistant,
Recovery Coordinator, Recovery Partner,
PROCESS
Senior Cover Assessor
Seek Internal Guidance
Cover Assessor, Recovery Assistant,
Recovery Coordinator, Recovery Partner,
1.0 Consider alternative authority options
Senior Cover Assessor
Cover Assessor, Recovery Assistant, Recovery Coor-
dinator, Recovery Partner, Senior Cover Assessor
2.0 Withdraw client authority
a Discuss with the client why they would like to withdraw or
Cover Assessor, Recovery Assistant, Recovery Coor-
decline their authority. If you are required to collect infor-
dinator, Recovery Partner, Senior Cover Assessor
mation, discuss the information which ACC needs to col-
lect and why it's necessary for that information to be ob-
a Explain that we'll withdraw the authority for this claim.
tained to progress the claim.
Advise them that if we need to obtain further information,
we'll contact them to seek further authority at a future
b Ask the client to review the ACC6300 terms on the paper
date.
form or via MyACC and consider agreeing or providing
alternative authority (conditions).
b In Eos, edit the current Consent Record and change it to
Withdraw.
Privacy - Authority Principles
Edit Consent Conditions
ACC6300 Authority to collect medical and other
records
c Provide the reason the client has withdrawn the authority
on their Recovery Plan notes.
NOTE What if the client agrees to provide au-
thority?
Go to the Obtain Client Authority to Collect Infor-
mation process to complete this. This process
ends.
PROCESS Obtain Client Authority to Col-
lect Information
ACC > Claims Management > Manage Client Information > Update Client Records > Decline or Withdraw Client Authority to Collect Information
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Clinical Advisor
Our vision is to create a unique partnership with every New Zealander,
improving their quality of life by minimising the incidence and impact of injury.
We know that a diverse and inclusive team helps us meet the needs of our customer, and we welcome candidates
from every ethnicity, national origin, gender identity, age, and those with a disability or who have additional mental
health needs. It is important to us that people are free to be themselves at work. Here are some ways we
encourage that:
• Employee networks to support our colleagues from diverse backgrounds.
• The option to explore flexible working that suits your needs and ours.
• Development opportunities in te reo Māori me ngā tikanga.
Position purpose
The Clinical Advisor works collaboratively across teams to provide expert consistent, robust and up to date clinical
and rehabilitation advice to ensure sound, consistent, evidence-based decision making.
In addition, the Clinical Advisor:
• As an expert advisor, ensures the relevant response is provided and/or transferred / escalated as
appropriate to a relevant advisor.
• Leverages their external networks and credibility to lead engagement with allocated health professional
groups and organisations as required.
• Supports provider improvement through relationships, conversations, audit and feedback.
Key Accountabilities and Outcomes
• Provide expert, culturally safe, clearly conveyed advice as part of a multidisciplinary team via phone/face to
face, email and EoS referrals, ensuring first point resolution where possible or a researched, coordinated
response within agreed service levels where more investigation is required.
• Provide expert advice for internal customers across the ACC network for wide range of cover and
entitlement requests , to ensure that the needs of our internal customers are met.
• Work collaboratively as a team player, openly engaging with other advisors and sharing knowledge as part
of a diverse multidisciplinary team.
• Work within ACCs clinical quality framework, clinical standards and guidelines to ensure advice is fit for
ACCs purpose.
• Proactively engage with treatment providers to clarify or seek information to support expert decision
making for client outcomes.
• Provide feedback, coaching and participate in education sessions for advisor colleagues and decision
makers to continuously improve referral quality.
• Supports and mentors the Triage and Workflow team when required to help them to triage requests to the
appropriate channel.
• Build and maintain relevant clinical knowledge through effective internal and external networks, reviewing
relevant information available within ACC and undertaking desktop research if required.
• Report clinical business issues identified and participate in continuous improvement initiatives to address
these to minimise future risk.
• Support the Clinical Quality and Governance function to identify new publications and education initiatives
and up-skilling opportunities to enhance ACC’s evidence-based decision making.
• Adhere to agreed service levels proactively and effectively manage all workflow to ensure optimal
outcomes for customers.
• Ensure appropriate documentation of all queries is completed (including face to face) to ensure accurate
reporting and analytics on workflow and emerging trends and/or needs.
• Provide expert representation on panels as required.
• Participate in clinical audit activity as part of the continuous quality improvement programme, and to
support the performance management of external providers as required.
• Contribute to Provider and Injury Prevention design work and other projects and activities where required.
Experience and Qualifications
• 5 years of experience dealing with clients/patients in a health service-based environment desirable.
• Proven ability to effectively manage varied workloads to meet service levels.
• Ability to work in a dynamic, collaborative, responsive and continuous improvement environment.
• Clinical qualification, experience and knowledge in one or more of the following areas – Occupational
Therapy, Physiotherapy, Osteopathy, Chiropractic, Pharmacy or Nursing.
• Current annual practicing certificate, evidence of indemnity insurance and a comprehensive and up to date
understanding of relevant rehabilitation practices and clinical knowledge and conditions.
• Ability to think logically and have a key eye for detail.
• Strong communication, collaboration, relationship management and coaching skills including the ability to
explain conditions, treatment options and ACC decision rationale to others in an easy to understand
manner. This would include in writing and verbal, including telephone-based communication
• Proven ability to interpret and critically evaluate appropriate information to determine appropriate advice.
ACC Behaviours
Accountable: He tangata pono
I make considered decisions; I’m responsible for my actions, and I take practical steps to overcome challenges.
Inclusive: He tangata kotahitanga
I encourage others; I respect different perspectives; I collaborate and make it easy for ideas to be shared.
Curious: He tangata mahira
I am open to new ideas; I welcome feedback and seek opportunities to improve.
Customer focused: He tangata aro kiritaki
I enable my customers to achieve the right outcomes by being responsive, clear and transparent.
Seek Internal Guidance v126.0
Summary
NOTE What if you need additional guidelines, tools
and information to support case manage-
ment?
Objective
Refer to the Te Whāriki site to search.
To assist in making decisions by receiving internal specialist
guidance from a number of different areas:
Te Whāriki Home Page
NOTE What if you need to obtain approval for ser-
• Clinical Services
vices/costs outside of your delegation?
• Technical Services
Refer to the Delegations Framework to deter-
• Practice Mentors
mine whether you can approve. If approval is
• Payments
needed, refer to Activity 3.1 to Request Written
• Technical Overpayments
Guidance
• Privacy
Delegations Framework
Background
Seeking internal guidance is a three tiered process:
c Attempt to problem solve the issue with your Team
Leader prior to seeking guidance, and that you have put
Tier 1 - Self-Service: Using the information available on Pro-
together a question that is appropriate for clinical or tech-
mapp and Te Whāriki to make a decision
nical guidance.
Tier 2 - Hotline Guidance: Guidance provided by a short (less
NOTE What kind of query is considered not appro-
than 15 minutes) phone call
priate for clinical or technical services?
Tier 3 - Written Guidance: Comprehensive guidance provided
Ensure you are not contacting an advisor or spe-
within a written guidance form in Salesforce, which creates a
cialist asking "What are the next steps on a
transcript in Eos
claim", or "Whether or not ACC can fund some-
Owner
thing", you must attempt to provide more infor-
Out of scope
mation relevant to the client's injury.
Expert
Out of
Procedure
2.0 Determine Appropriate Type of Guidance
Cover Assessor, Recovery Administrator, Recovery
1.0 Complete Self-Service Guidance
Team Member, Specialist Cover Assessor, Treatment
Cover Assessor, Recovery Administrator, Recovery
and Support Assessor
Team Member, Specialist Cover Assessor, Treatment
a Use the Recovery Support Decision Tree tool linked
and Support Assessor
below to determine what kind of guidance you need.
a Review the following on the client's claim:
Recovery Support Decision Tree
• claim history and current circumstances
NOTE What if you are still unsure what type of guid-
• read and consider relevant documents
ance is needed?
• check for and review previous guidance
Attempt to run through the decision tree tool
• check for and review outstanding investigations
alongside your Team Leader. If you are still
• check for outstanding reports and/or records
unsure, contact a Practice Mentor to discuss
b Refer to Promapp to check if next steps can be identified
your issue and the best way forward.
in using one or more of the following:
NOTE What if you need to request guidance on a
Surgery claim?
• Process pages - having knowledge of the objective,
If you require guidance on a Surgery claim, there
background and expected outcome of the range of ser-
are two channels, ensure you use the decision
vices provided by ACC could help you determine the next
tree tool to determine which one to use:
steps to progress your client's recovery.
• For invoicing and coding queries that are
appropriate for hotline guidance, email your
• Policy pages - having knowledge of legislation, pay-
query to [email address]
ments and legal aspects of the services and supports
• For written guidance queries:
provided by ACC could help you determine the next steps
• If you are seeking guidance from a Principal
to progress your client's recovery.
Clinical Advisor (CAP referral), refer to the CAP
referral process document under activity 3.1 (a)
• Service pages - having knowledge of the services pro-
• For invoicing and coding queries that are
vided by contracted Providers could help you determine
appropriate for written guidance on a Surgery
the next steps to progress your client's recovery.
claim, use the written guidance request form in
NOTE What if you are trying to make a cover deci-
Salesforce. Once you’ve submitted your guid-
sion?
ance request, update the task description with
Refer to the processes in the Make Cover Deci-
the code “TACDUN”
sion group in Promapp or refer to the Cover Traf-
fic Light tool to assist in determining cover for
particular injuries or injury types.
Make Cover Decision
TOOL - Add or change diagnosis decision traffic light
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NOTE What if you are working in the Remote Claims
b If calling from Genesys Cloud, call the 'Recovery Support'
Unit or requiring guidance on a Staff claim or
queue.
High Profile claim?
Refer to the knowledge article below on how to
Otherwise, dial extension 50118 and select one of the fol-
request Hotline and Written Guidance for the
lowing options:
above scenarios.
• Select option 1 for Clinical Services. You will then be
For written guidance on a Staff claim, do not
asked to select from the following options:
raise this in Salesforce, these tasks must be
1 - for Clinical Advisors
created in Eos. Use the Written guidance tem-
2 - for Psychology Advisors - sensitive claims
plate below and refer to the system steps for
3 - for Psychology Advisors - physical injuries
creating/sending the task.
4 - for Pharmaceutical Advisors
6 - for Sensitive Claim Medical Advisors
Remote claims, Staff and High Profile claims - Seek
internal guidance
• Select option 2 for Technical Services. You will then be
Written guidance template for non-Salesforce
asked to select from the following options:
users.docx
1 - for Transport for Independence Specialists
2 - for Housing Modifications Specialists
NOTE What if a provider is requesting to speak di-
3 - for Technical Accounting Specialists
rectly with a Psychology Advisor?
4 - for Technical Specialists in relation to a Sensitive
The following external Psychology hotline num-
Claim
bers can be shared with providers: Sensitive
5 - for General Technical Specialists
claims: 09 354 8425 Physical injury: 09 354 8426
• Select option 3 for Practice Mentors.
This is for PROVIDERS ONLY and must not be
released to clients.
• Select option 4 for Payments Assessors. You will then
b Go to Activity 3.0 to request Hotline Guidance, or Activity
be asked to select from the following options:
3.1 to request Written Guidance.
1 - Sensitive Claims Payments
2 - Travel
3 - All Other Client Reimbursements
4 - Payments Assessor
3.0 Request Hotline Guidance
Cover Assessor, Recovery Administrator, Recovery
• Select option 5 for Privacy Advisors
Team Member, Specialist Cover Assessor, Treatment
and Support Assessor
• Select option 6 for Client Administration Support related
a Prepare for requesting guidance using ISBAR (Identify,
to a physical injury
Situation, Background, Accident, Request). Continue to
refer to the Recovery Support Decision Tree tool for addi-
• Select option 7 for Client Administration Support related
tional things to remember/consider and tips for best prac-
to a mental injury
tice.
NOTE What if my query is regarding a mental injury
claim?
Ensure you provide your full name when requesting hot-
line guidance.
All requests for guidance on mental injury claims
must go to a Psychology Advisor.
Hotline ISBAR.PNG
NOTE What if the Hotline is not answered?
Recovery Support Decision Tree
Keep trying the Hotline. If, after a few more at-
tempts, there is still no answer add a note to the
task in Eos (or update the description in Sales-
force) and try again at your earliest convenience.
If you are working in Assisted Recovery, update
the description to say "Attempt to call the Hotline
again", before putting the task on hold so you
can pull another one from the queue. Aim to
complete any on hold tasks by the end of the
day, taking them off hold and returning them to
the queue if you're unable to do so.
NOTE What if you need advice from a Practice
Mentor about a Mental Injury (MI) claim?
Recovery Partners (MI) can book a 1x1 session
with a Practice Mentor ahead of time using the
link after this note.
If you need advice from a Practice Mentor right
away you can call ring Recovery Support, select
Option 3 and the Practice Mentor will take the
claim number of the claim you need support on.
This will then be passed on to the Practice
Mentor with Mental Injury capability to get in con-
tact with you.
Knowledge & Capability Bookings Calendar
c Go to activity 4.0 to action the Hotline Guidance.
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c In Salesforce, select the 'Recovery Support' tab and
3.1 Request Written Guidance
'Create Guidance'. Follow the steps and complete the
Cover Assessor, Recovery Team Member, Specialist
fields on the written guidance form.
Cover Assessor, Treatment and Support Assessor
a
If there are relevant documents on file you want the ad-
Prepare for requesting guidance using ISBAR (Identify,
visor/specialist to review, collate them into a document
Situation, Background, Accident, Request). Refer to the
group entitled 'Written Guidance document group' in Eos,
Recovery Support Decision Tree tool for additional things
and reference the name and date in the 'Documents or
to remember/consider and tips for best practice.
contacts relating to the request' section. Ensure you also
note if documents from multiple claims have been added
The Decision Tree Tool references key medical infor-
to the group.
mation that must be on file prior to submitting a written
guidance request, ensure you have attempted to request
If there are relevant contacts on file you want the advisor/
this information. Clinical and Technical staff will not be
specialist to review, ensure you specify the date and con-
able to provide written guidance if there is insufficient
tact description in the 'Documents or contacts relating to
information on file.
the request' section.
Recovery Support Decision Tree
If you need to add any particular information regarding
NOTE What are the standards needed when seeking
who the guidance request should go to (i.e. If this needs
guidance?
to go to a specific specialist discipline), specify this infor-
Refer to the Standards for Seeking Guidance
mation in the 'Triage Written Guidance' task description.
and Written Guidance Questions below.
(This is located inside the 'information' heading, ensure
Standards for Seeking Guidance
you save the change to the description)
Written Guidance Questions
NOTE What if the claim is for maternal birth injury?
Type "#MBI" in the 'information' heading of the
NOTE What does a quality referral look like?
'Triage written guidance' task description.
Refer to the Written guidance example below.
Recovery Support FAQs.docx
Written guidance example
NOTE What priority should I select for my Written
NOTE What if you need written guidance from a
Guidance request?
Principal Clinical Advisor (PCA) for a Surgery
Check the Written Guidance Priority Categories
claim?
document to see whether or not your request
Refer to the CAP referral process (SF) guide
falls into one of the P1/P2 categories. Speak with
below.
your Team Leader if you are unsure whether or
CAP referral process (SF)
not a certain scenario falls into a P1/P2 category.
If your reason for escalation does not meet the
NOTE What if you need to request written guidance
P1/P2 categories, but your Team Leader agrees
where there is a CAP referral in progress?
your request should be escalated, then please
Call the Surgery team on 83566 to discuss
email [email address] with your Team
whether additional question(s) can be added to
Leader approval and reason for requesting esca-
the existing CAP referral. Note: CAP will not
lation.
answer questions regarding ongoing incapacity.
Principal Clinical Advisor consideration list
Written Guidance requests falling into a P1/P2
category should be submitted as follows:
Delegations Framework
• Select 'P1 - High' or 'P2 - Medium' under
b Check the necessary supporting documents and infor-
'What's the priority for this request?'
mation is on the claim.
• Select relevant drop down option under 'Why is
the request urgent?'
NOTE What if there are documents and/or infor-
mation missing on the claim?
Written Guidance requests not falling into a P1/
Refer to the Request Clinical Records process.
P2 category should be submitted as P3 - Low.
PROCESS Request Clinical Records
High and Medium Priority Categories for Written
Guidance Requests
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NOTE What if you want to cancel, save as a draft, or
NOTE What if you require written guidance on a
add additional information to your guidance
Mental injury claim or disentitlement for a
request?
Wilfully Self-inflicted (WSI)/suicide claim?
• To cancel: Go to the guidance request you
If you require guidance on the below:
have submitted and select 'Cancel Written Guid-
ance,' then provide a reason for cancellation (i.e.
• Work-related Mental Injury (WRMI) claims, and
if other client information was entered in the re-
Treatment Injury Mental Injury (TIMI) claims
quest, select the reason as 'Cancelled due to
error').
• Complex mental injury caused by sexual abuse
Note - the information submitted in the form is
(MICSA) and complex mental injury caused by
not discoverable by the client until the written
physical abuse (MICPI) claims, for example,
guidance has been accepted and a transcript is
where a combination of clinical, legal and tech-
created in Eos, if you cancel, there will be no
nical factors complicates the decision, for in-
record of it on the client's file
stance: multiple related claims involving tech-
nical and medico-legal complexity; where the
• Save as draft: At the bottom of the written guid-
causal link to injury is unclear or contentious;
ance form select the tick box labelled ‘Save as
and/or the diagnosis is unusual or contentious.
Draft’ then click 'Next', then when you are ready
to complete your guidance request, go back to
• Wilfully self-inflicted (WSI)/suicide claims where
the written guidance request in salesforce and
the evidence to support a decision is unclear or
select ‘Edit Written Guidance’
equivocal; and/or there are clinical, legal or tech-
nical complexities that complicate the decision.
If you are saving the request as a draft because
you are awaiting some additional information:
Request written guidance from a Psychology ad-
visor, and complete the forms as outlined below.
For claims assessment staff - create a follow up
You need to fill out the relevant sections on
task in Eos to revisit the draft guidance request
either an ACC1517 (Mental Injury Cover form) or
once the information has been received
ACC6178 (Disentitlement for WSI or suicide
claims). Ensure you leave the document as
For Recovery team members – create a re-
incomplete.
minder action in salesforce to revisit the draft
guidance request once the information has been
Complete the written guidance request form as
received
per the current process (if you have completed
an ACC6178 you can still select the tick box for
• If you need to add additional information to a
'Have one of the above ACC documents been
Written Guidance request that has been sent to
completed') and indicate in your summary 'Refer
Triage or allocated to an advisor – select ‘Addi-
to the ACC1517 (or ACC6178) document up-
tional Information to a Guidance request’ on the
loaded on XX/YY/ZZZZ'.
guidance request in salesforce
The PA will then arrange a Complex Mental
NOTE What if you are a non-Salesforce user and
Injury Panel (CMIP) comment via Technical Ser-
you require written guidance?
vices. Once the Psychology Advisor and CMIP
Ensure you request your guidance via the 'Com-
have completed their comments in the ACC1517/
plete Internal Referral' task and then transfer the
ACC6178, complete these documents and action
task into the Regional Clinical Advice - CEN-
the recommendations.
TRAL queue or the Operations Support queue.
You can refer to the delegations spreadsheet
Please use the referral template document
below which shows what types of claims need to
below.
be referred to the Complex Mental Injury panel.
Written guidance template for non-Salesforce
Delegations Framework
users.docx
NOTE What if you require written guidance from a
NOTE What if you require written guidance on a
Technical Accounting Specialist?
claim not migrated to Salesforce?
Refer to the following page for more information
There is a system error which means Recovery
on Technical accounting and what information
Team Members cannot access Salesforce in
needs to be included with a written guidance re-
order to make referrals on very old claims.
quest.
For very old claims where you are unable to
NB: Due to the complexity of these requests
access Salesforce in order to make a request for
there is a 3 day Service Level Agreement for
clinical advice, please action the referral using
urgent (client is in financial distress) tasks and a
the NGCM pathway (see below systems steps)
20 day Service Level Agreement for all other re-
on EOS and mark the task as “OLDER EOS
quests.
CLAIM, SF unavailable”.
PROCESS Referring to the Technical
Accounting Specialists for
This label will ensure the Triage Team does not
Advice
return the task due to being submitted in the
wrong queue.
(NGCM) Create Request for Written Guidance
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NOTE What if you require guidance on a claim
4.0 Action Hotline Guidance
where weekly compensation has been paid
Cover Assessor, Recovery Administrator, Recovery
for less than six months and you're consi-
Team Member, Specialist Cover Assessor, Treatment
dering suspending entitlements, as the cov-
and Support Assessor
ered injury has resolved?
a Consider the advice documented by the Advisor, Spe-
Submit written guidance to clinical only (there is
cialist or Assessor and undertake the next steps.
no need to tick coordinated guidance). However,
if due to the complexity of the client or their situ-
NOTE What if you need to clarify the guidance pro-
ation, and technical guidance is still required,
vided by the Advisor, Specialist or Assessor?
then tick the box for coordinated guidance.
Message or call the Advisor, Specialist or Asses-
NOTE What if you are working on a claim that is in
sor directly to clarify the guidance.
‘Actioned Cases’?
NOTE What if you want an Advisor, Specialist, or
Written Guidance must be requested on ‘active’
Practice Mentor hotline comment to be re-
claim, you will need to transfer this into the
moved from file or amended?
appropriate queue/name.
The only instances a clinical or technical com-
d Go to Activity 4.1 'Action Written Guidance' once you
ment should be removed/ deleted is when the
have received your guidance.
guidance is on the wrong claim. In rare instances
the Advisor may need to amend or add an
NOTE What if you have already submitted your writ-
addendum to the guidance. Only an Advisor’s or
ten guidance request, and you need to
Specialist’s manager can delete their own com-
update the priority?
ment, neither a frontline staff member or another
If you have received new information that
advisor can delete your comment.
changes the priority of the request, complete the
steps below:
If the comment needs to be removed/amended
• Open the claim in Salesforce.
ensure you reach out to the advisor or specialist
• Click on the ‘Recovery Support’ tab and then
who provided the guidance and include their
click on the relevant Guidance Number to open
manager in the discussion.
it.
Receive Written Guidance (Recovery Team Member)
• Now you should be on the ‘Details’ page. Click
on the ‘Update Guidance Priority’ button to
change the priority of the request.
• Check the Written Guidance Priority Categories
4.1 Action Written Guidance
document to see which category your request
Cover Assessor, Recovery Team Member, Specialist
meets.
Cover Assessor, Treatment and Support Assessor
• Select 'P1 - High' or 'P2 - Medium' under
a In Salesforce, review the guidance provided on the Writ-
'What's the priority for this request?'
ten Guidance request by selecting the 'details' tab.
• Select the relevant drop-down P code option
under 'Why is the request urgent?'
NOTE What if you are requested to provide clari-
• If your reason for escalation does not meet one
fication on a guidance request?
of the pre-set categories, you should email
If this is via IM or call, clarify the question directly
[email address] with your Team Leader
with them.
approval and reason for requesting escalation.
If this is via Salesforce, open the Guidance Re-
FYI – If you wanted to check the progress of the
quest and click 'Provide Clarification on Guid-
task, you can click on the ‘Related’ tab and then
ance Request', read the clarification question
click on the open task number:
and provide the clarification. If you need to
• If the guidance is still with the Triage team, it
cancel or put the request on hold you can do this
will be the ‘Triage Written Guidance request’ task
at this step.
type.
• If it has already been triaged and allocated to
If you need to request additional information in
an Advisor queue, it will be the ‘Provide Written
order to clarify the request, use the Request
Guidance’ task type.
Clinical Records process. In Salesforce, extend
the target date of the clarification task to later
High and Medium Priority Categories for Written
than the due date of the medical notes task.
Guidance Requests
Ensure you update the task description to reflect
you have requested additional information (if you
are in Assisted Recovery and are returning this
PROCESS
Provide Internal Guidance - Hotline
to the queue, update the description when you
Clinical Team Member, Payments Asses-
do this).
sor, Practice Mentor, Privacy Advisor,
Technical Team Member
PROCESS
Provide Internal Guidance - Written
Clinical Team Member, Senior Triage and
Workflow Coordinator, Technical Team
Member
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NOTE What if the written guidance is on a claim not
NOTE What if guidance indicates it's appropriate to
migrated to Salesforce?
suspend entitlements where weekly compen-
For very old claims where you are unable to
sation has been paid for less than six
access Salesforce in order to make a request for
months, as the injury has resolved?
clinical advice, a written guidance referral would
Copy and complete the decision rationale tem-
have been actioned using the NGCM pathway in
plate below and paste this into a NGCM General
EOS.
Task (in Eos). Assign it to a leader from your
hub. Message them to let them know it’s there.
- If you decide to accept the written guidance or
to ask for clarification on the written guidance
• Decision type SUSPEND ENTITLEMENTS
provided, use the Review Written Guidance
DECISION
system steps below.
• Who was consulted [eg. Recovery Support hot-
line guidance from Practice Mentor received
- If the Advisor had asked for clarification within
10/03/23 and Written guidance from Clinical Ad-
the written guidance, use the Respond to Clari-
visor received 24/03/23]
fication Request from Advisor system steps
• Rationale for the final decision [(e.g. Suspend
below.
all entitlements as Clinical guidance has con-
firmed the client's covered injury has resolved) or
Receive Written Guidance (Recovery Team Member)
(Suspend all entitlements as Clinical guidance
Respond to Clarification Request from Advisor
has confirmed the client's covered injury has re-
(Recovery Team Member)
solved and the reason for ongoing incapacity is
b
non-injury related)]
Accept the guidance provided by selecting 'Accept Guid-
ance', or request clarification if required.
The leader will review and send the task back to
NOTE What if the advice is unclear or the questions
you within 24 hours - with either their support or
are unanswered?
if they wish to discuss further.
Select 'Clarification Required on Guidance Pro-
vided' and input your clarification question(s).
Once your Team Leader has endorsed the deci-
sion, create a new Salesforce contact action and
NOTE What if you want an Advisor or Specialist's
copy the body of the NGCM General Task into
written guidance to be removed from file or
the Outcome Summary of your Salesforce con-
amended
tact. Close the NGCM General Task.
Comments within a Written Guidance form
cannot be deleted or edited once the Advisor or
Follow the relevant steps in the below page for
Specialist has submitted their guidance.
"Stop Supports".
PROCESS Stop Supports
If the wrong client’s information has been in-
cluded, please cancel the guidance in Salesforce
NOTE What if guidance indicates I have sufficient
and submit a new request.
information to issue a decision?
NOTE What if your request for written guidance was
See the below page for "Issue Recovery Deci-
related to transferring weekly compensation
sion"
to a different claim for a further injury?
PROCESS Issue Recovery Decision
Return to 'Determine Transfer of Weekly
NOTE What if I'm unable to locate my Written Guid-
Compensation to a new claim due to Further
ance request?
Injury' and continue the process.
The Written Guidance process is a cog process
PROCESS Determine Transfer of Weekly
meaning that when one action is completed it
Compensation to a new claim
creates a new task in the process to be actioned.
due to Further Injury
Add an Eform
For example: Once the triage process is com-
pleted, the 'Triage Written Guidance' task will be
c Once the guidance has been accepted a transcript will be
closed and a 'Provide Written Guidance Task' is
created in Eos.
automatically created which is then assigned to
the appropriate advisor.
The instructional video below provides an over-
view of the Recovery Support Written Guidance
process in Salesforce and EOS and support in
locating the various tasks in this cog process.
An overview of the Recovery Support Written Guid-
ance process in Salesforce and EOS
5.0 Provide and Review feedback
Cover Assessor, Recovery Administrator, Recovery
Team Member, Specialist Cover Assessor, Treatment
and Support Assessor
a If applicable, provide feedback on the guidance received.
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NOTE How do you provide feedback on the Hotline
guidance you have received?
In Salesforce, navigate to the Recovery Support
tab and select the ‘Provide Feedback’ option.
On the Provide Feedback form, complete the
mandatory question and comments sections,
and submit your feedback.
NOTE How do you provide feedback on written
guidance?
When you accept the written guidance in Sales-
force, you will get the option to provide feedback,
select this option, and complete the mandatory
fields.
b If applicable, review feedback on the guidance request
you submitted.
NOTE What if you want to review some feedback
you have received?
You will be notified you have received feedback
by getting an alert notification from the “bell” icon
in Salesforce. If you select this you will be able to
review the feedback.
Alternatively, if you select the nine dots in the top
left corner of the Salesforce window, and search
for “Feedback”, you can select this Feedback
option.
From here you can select the drop down arrow
to show different list views which display feed-
back from a range of dates.
NOTE What if you are a Team Leader and you want
to subscribe to a feedback report?
Complete the steps below in Salesforce:
• Select 9 dots to the left of “Work Load Manage-
ment”
• Type in “Reports”
• Select “All Folders’ and then “Feedback Re-
ports”
• Open the new report “ My Team’s Feedback –
Last 7 days”
• Click the down arrow at the top right of the
report and select subscribe
• Schedule when you want the report subscrip-
tion email e.g. 9am on a Monday every week.
Confirm recipient being added and run report as
= “Me”
• Result will be an email to your inbox at that
time/day, with a link to the report in Salesforce
• Last step will be to use the Team Leader filter,
to narrow the results to your team members i.e.
use the name your Salesforce user is set up with
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Cover criteria for pre-existing conditions Policy v10.0
Summary
3.0 Obtaining medical information
a When obtaining medical information you must:
Objective
If a client has a pre-existing condition and suffers a personal
• establish the cause of injury, to determine whether the
injury, the personal injury may be covered but the pre-existing
injury is the result of an accident
condition will not. However, if the pre-existing condition has pre-
• get a description of any significant pre-existing con-
viously been accepted for cover, the worsened condition may be
dition.
covered under the existing claim.
You should collect the following information to get a full
The AC Act 2001, Section 26(4) states that personal injury does
picture of a client’s condition:
not include personal injury caused wholly or substantially by the
ageing process.
• full diagnosis of the condition claimed for
• likely prognosis of the condition
• description of any significant pre-existing medical con-
Owner
Out of scope
dition that may have caused or contributed to the injuries
claimed for
Expert
Out of
• details of any other medical practitioner consulted about
either the injuries or a pre-existing medical condition that
Policy
may be related to the injuries claimed for
• copies of any medical reports, x-rays or clinical test re-
1.0 Taking a person as they are
sults that may be related to the injuries claimed for
a If a person with a pre-existing condition has an accident,
• information about any unusual features of the injuries.
they may sustain more serious results from the accident
than a healthy person. They have a right to compensation
If you contact medical practitioners by phone, make sure
for the more serious results. See Examples of pre-
you get a written response from them as well.
existing conditions.
You may sometimes hear this referred to as the "eggshell
skull principle" or the "thin skull rule". It means that we
consider all claims for cover on their own merits, without
4.0 Adjacent Segment Disease
giving weight to any pre-existing conditions.
a Adjacent Segment Disease (ASD) is a term describing
pathology that has become symptomatic following a
spinal fusion. When a person has one or more levels of
their spine fused surgically to treat disc pathology caused
2.0 Aggravation or acceleration of pre-existing
by a covered back injury, the adjacent disc level above or
damage
below the fused segment may be subject to extra load
and stress because those levels are now the lowest re-
a We will not cover the aggravation or acceleration of pre-
maining mobile segments.
existing damage that is a natural step in the process of
deterioration, without evidence of a fresh injury.
b Only spinal fusion surgery has the potential to cause
adjacent segment disease. The way in which disc pro-
lapses contribute to ASD is not scientifically well estab-
lished.
Cover for ASD is not available if a fusion accelerates the
progression of pre-existing degeneration at an adjacent
level.
ASD arising from non-ACC funded fusions would not be
covered unless the disease met the criteria for a treat-
ment injury.
The fact that ACC has funded an earlier fusion which, in
turn, is alleged to have caused ASD is not enough in
itself to determine causation.
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5.0 Examples of pre-existing conditions
f Example 6
a Example 1
Brent is an active diabetic who slips while cutting fire-
wood and a splinter pierces his foot. The injury, because
Paul is being treated for cancer. While undergoing a
of his pre-existing poor circulation, leads to gangrene in a
course of radiotherapy, he falls and fractures his knee.
part of the foot. This has to be excised in two separate
His claim will be accepted for cover for the knee fracture,
operations.
but not for the pre-existing cancer.
Brent’s claim will be accepted for cover for the splinter
Paul’s entitlements are limited to the separate conse-
incident and his entitlements extend to the two separate
quences of the knee fracture. For instance, ACC may
operations. However, ACC has no responsibility for other
contribute towards the cost of treatment of the fracture by
measures that are required, for example a vein trans-
an orthopaedic surgeon, but not towards any cost of fur-
position, which is a prophylactic measure undertaken to
ther radiotherapy.
improve the blood circulation to what remains of Brent’s
b Example 2
foot.
g Example 7
Ann is aged 85 years and lives in a rest home. She falls
and fractures the neck of her femur.
Brenda has always been inclined to minor depression,
but did not need any treatment other than rest. She sus-
The fracture heals but Ann does not become as mobile
tains serious chest injuries and other abrasions in a
again. A year later, when the fracture is healed, she con-
motor vehicle accident. As a result of these physical inju-
tracts pneumonia and dies. Because there is no direct
ries Brenda suffers a post-traumatic stress disorder
causal link between the fracture and Ann’s death, ACC is
(PTSD).
not responsible for any costs arising from the pneumonia
and death.
The PTSD needs medical treatment, which prevents
c Example 3
Brenda from working for a time. ACC will accept the claim
for cover for the PTSD and for her physical injuries.
Carl is aged 85 years and lives in a rest home. He falls
and fractures the neck of his femur.
Because of the fracture, Carl is immobilised in bed and
cannot even sit up. Within a few weeks, he has conges-
tion in his lungs because of his immobility. Carl contracts
pneumonia and dies.
The claim for cover will be accepted for Carl’s death, be-
cause there is a clear chain of causation. The fall caused
the fracture, which caused the immobilisation, causing
the congestion in the lungs. The congestion led to pneu-
monia, which caused Carl’s death.
d Example 4
Scott, aged 52, has an osteoarthritic hip joint. He is still
reasonably mobile, but it is anticipated that, at some time,
he will need a replacement joint.
While swinging his golf club one day, Scott twists his hip
joint. His claim will be accepted for cover for the twisting,
but not for the underlying osteoarthritis.
e Example 5
Cath has suffered from the effects of Scheuermann’s dis-
ease (an osteochondritis of the spine) since her teenage
years. This will gradually deteriorate so she will not be
able to flex part of her spine.
When lifting a bolt of material, Cath severely strains her
back muscles. Her claim for the muscle strain will be ac-
cepted for cover, and she can receive appropriate entitle-
ments while the strain heals. But as soon as the deteri-
orating osteochondritis becomes the substantial cause of
Cath’s back problems she will lose her entitlements.
ACC > Claims Management > Manage Claim Registration and Cover Decision > Operational Policies > Cover Decision > Personal Injury Eligibility > Cover criteria for pre-
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Provide Internal Guidance - Written v12.0
Summary
NOTE What if you need to reassign a task to anoth-
er Advisor or Specialist?
Check the tick box in the relevant queue, and
Objective
transfer it by selecting [Change Owner]. This can
To provide guidance to frontline staff via a Written Guidance
also be done for multiple tasks.
eForm in Salesforce or Eos.
Background
This can also be done directly from the task, by
Written Guidance is available for any of the following areas:
Selecting [Change owner] from the 'Provide Writ-
ten Guidance' task and entering the appropriate
• Clinical Services
owner/department queue.
• Technical Services
NOTE What if a written guidance request needs to
be returned to the requesting staff member
Owner
Out of scope
due to the HASTEN initiative?
Expert
1. Select [Return Request Due to HASTEN Initi-
Out of scope
ative] and provide a reason for this.
Procedure
2. The HASTEN initiative has been implemented
1.0 Triage and Allocate requests for Written Guid-
to unnecessary written clinical advice requests
that can be more appropriately answered with
ance
Promapp “self service” knowledge products,
Senior Triage and Workflow Coordinator
seeking advice from Team Leader and/or Prac-
a In Salesforce, open the next 'Triage Written Guidance re-
tice Mentor channels.
quest' task or the next 'Triage Request for Clarification'
task.
3. When you receive written guidance requests
from frontline staff, and you are aware of self
NOTE For additional information about the Written
service content that is available to answer their
Guidance process refer to the FAQ document
query, or if the query is better suited for a Team
below.
Leader, or Practice Mentor, ensure you provide
this information to the requestor.
Recovery Support FAQs.docx
b Assign the task to the relevant staff member or queue. If
NOTE What if you are working out of an Eos queue?
you need to add any particular details to the request,
Depending on the business unit who sent the
enter this into the description field of the task once its
task, allocate this to an appropriate Clinical or
been assigned. Refer to the relevant Triage salesforce
Technical staff member in Eos.
report, to confirm how many tasks each advisor has in
their queue.
Recovery Support Decision Tree
NOTE What if there is not enough information and
clarification is required?
2.0 Provide Written Guidance
For minor clarification, attempt to contact the re-
Clinical Team Member, Technical Team Member
questor directly via call or IM. The requesting
a In Salesforce, select the next task in either 'My Assigned
staff member will then update the relevant infor-
Tasks - Recovery Support', or the applicable department
mation on the Guidance Request by selecting
queue to your role. Review the provide written guidance
[Add additional Information to a Guidance Re-
task, then select [Provide or Clarify Guidance].
quest].
NOTE For additional information about the Written
For major clarification, or if minor clarification at-
guidance process refer to the FAQ document
tempt was unsuccessful, select [Request Clari-
below.
fication] while in the Triage Written Guidance re-
quest task.
Recovery Support FAQs.docx
If there already appears to be a guidance re-
NOTE What if you are picking up a task from a
quest on file that is addressing the requestor's
shared queue?
query, send the request back for clarification and
When you select [Provide or Clarify Guidance],
determine if the guidance transcript uploaded on
the task will automatically go into your name.
XX/YY/ZZZZ addresses their query.
You can still change the ownership of the task by
selecting [Change Owner], but this is not re-
NOTE What if you get a written guidance request
quired.
from a Surgery or Additional Treatment staff
member with the description TACDUN?
NOTE What if you are picking up a task from an Eos
Allocate to the Clinical Advisor queue keeping
queue?
the task description as TACDUN.
If you are receiving a request for written guid-
ance via Eos, you will need to complete the guid-
ance in Eos.
There are a number of teams who will not be
requesting guidance via Salesforce i.e: Remote
claims, Review requests, TPA and Technical
Accounting
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Page 1 of 3
NOTE What if you need to transfer the task to a new
NOTE What if the guidance request is related to a
owner?
decision-making authority?
Check the tick box in the relevant queue, and
For Technical Services: Ensure you select the
transfer it by selecting [Change Owner]. This can
tick box at the bottom of the Written Guidance
also be done for multiple tasks.
form labelled 'Decision making authority'.
This can also be done directly from the task, by
If the request is relevant to a shared delegation,
Selecting [Change owner] from the 'Provide Writ-
ensure you have discussed the decision with the
ten Guidance' task and entering the appropriate
clinical staff member.
owner/department queue.
If the delegation requires a higher level decision-
NOTE What if you are a Clinical Advisor and you
making authority, contact the relevant person
have received a request regarding Surgical
requesting them to add their comment onto the
guidance via the
client's file, then ensure they have contacted you
[email address] inbox?
to confirm this is completed.
1. These requests come via the Surgery and
Additional Treatment team at ACC. Ensure you
If the delegation sits with Clinical, ensure you
document this as a record of Hotline Guidance in
specify this in your clinical summary.
Salesforce.
For information on delegations, refer to the
2. If you believe this query needs to be sent as a
spreadsheet below.
Written Guidance request inform the requestor
and ask them to re-submit the request.
Delegations Framework
3. Advise the requestor to use the decision tree
NOTE What if you need to save a draft of your guid-
tool when trying to determine whether or not to
ance request to complete later?
send requests via the above email address vs
At the bottom of the written guidance form select
the written guidance form in salesforce.
the tick box labelled [Save as Draft] then click
NOTE What if you get a written guidance request for
[Next]
a Mental injury claim or disentitlement for a
When you are ready to complete your guidance
Wilfully Self-inflicted (WSI) or suicide claim?
request, go back to the written guidance request
Guidance must be provided by a Psychology ad-
in salesforce and select [Edit Written Guidance],
visor, and may need to go to the Complex Mental
to complete your guidance.
Injury Panel. Refer to the document below to
NOTE What if the requestor has cancelled the re-
determine what claims need to go to the Panel,
quest for Written Guidance?
and what the referral process is.
You will receive a notification via the bell icon on
CMIP process for Advisors and Specialists
the top right hand corner of the screen. If this is
b
the case, close out of the guidance request and
Select the previous tab in Salesforce to launch the
move onto another task.
client's Eos claim, using the [Launch Eos claim] button.
c
NOTE What if the requestors query is located in an
Determine if you have all the relevant information to pro-
ACC document (eg. ACC1517 Determining
vide Written Guidance. Then, enter your Qualifications,
cover for a mental injury claim)?
Analysis and Recommendations into the relevant fields in
the eform or ACC document, to complete your guidance.
Before selecting [Provide or Clarify Guidance],
Select [Launch EOS Claim] and enter your guid-
NOTE What if there is not enough information and
ance into the document stated in the request.
clarification is required?
For clarifications that can be provided the same
Then in Salesforce, select [Provide or Clarify
day, contact the requestor directly via call or IM.
Guidance] and complete the written guidance
form and in your recommendations enter "Guid-
If required, the requesting staff member will then
ance provided in ACC form (Specify the docu-
update the relevant information on the Guidance
ment)".
Request by selecting [Add additional Information
NOTE What if additional advice is required from
to a Guidance Request].
another team/advisor or specialist?
For clarifications that cannot be provided the
Select [Yes], when presented with this question,
same day, select [Clarification Required] then
then select the relevant role and add your com-
specify what you need from the requestor in the
ments.
'Clarification Questions' free text box.
NOTE What if you are considering referring the
client for a Medical Case Review?
Before providing your recommendation, refer to
the documents below
Recovery Support to Determine Need for a Medical
Case Review (MCR)
MCR Quick Reference - Question Selection
NOTE What if you want to seek advice from Legal
Services?
Refer to the Legal Services team space below
Legal Services team space
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NOTE What if you need to add images to support
your analysis?
Images can be inserted into the guidance you
provide in Salesforce. For information on what
images are supported and how to ensure they
display correctly, please refer to the document
‘Adding images in Salesforce’ below.
Adding images in Salesforce
NOTE What if you have entered incorrect infor-
mation into the guidance you've provided?
Please make sure to review the guidance you
provide before submitting as there is no way to
remove once it has been saved and sent through
to the next team and/or requester.
Where the guidance has been submitted and
you’ve included the incorrect client details, you
will need to request that the front line team
cancel the request and submit a new one.
3.0 Provide and Review feedback
Clinical Team Member, Technical Team Member
a If applicable, provide feedback on the guidance request.
NOTE How do you provide feedback on the guid-
ance request?
Once you have submitted your guidance, you will
be given the option to provide feedback on the
guidance request. If you want to provide feed-
back, select this option and complete the man-
datory fields.
b If applicable, review feedback on the guidance provided.
NOTE What if you want to review some feedback
you have received?
You will be notified you have received feedback
by getting an alert notification from the “bell” icon
in Salesforce. If you select this you will be able to
review the feedback.
Alternatively, if you select the nine dots in the top
left corner of the Salesforce window, and search
for “Feedback”, you can select this Feedback
option.
From here you can select the drop down arrow
to show different list views which display feed-
back from a range of dates.
NOTE What if you are a Team Leader and you want
to subscribe to a feedback report?
Complete the steps below in Salesforce:
• Open the new report Folder “Feedback Re-
ports”
• Open the new report “ My Team’s Feedback –
Last 7 days”
• Click the down arrow at the top right of the
report and select subscribe
• Schedule when you want the report subscrip-
tion email e.g. 9am on a Monday every week.
Confirm recipient being added and run report as
= “Me”
• Result will be an email to your inbox at that
time/day, with a link to the report in Salesforce
• Last step will be to use the Team Leader filter,
to narrow the results to your team members i.e.
use the name your Salesforce user is set up with
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Causal Link Policy v11.0
Summary
3.0 Failure to provide treatment, or to provide treat-
ment in a timely manner
Objective
a To determine cover for a personal injury due to failure to
Use this guidance to help you establish a causal link between
provide treatment, or failure to provide treatment in a
the treatment and the injury.
timely manner, the injury must meet the following criteria:
• there has been a failure to provide treatment or to pro-
vide treatment in a timely manner
Background
• there is a personal injury, over and above the natural
For a claim to have cover for a treatment injury there must be a
consequences of the underlying condition for which the
causal link between the treatment and the injury. See Scenarios
treatment was sought
for treatment injury and the Accident Compensation Act 2001,
Section 33.
• had the condition been diagnosed or treatment received
earlier, the personal injury would have been prevented or
Owner
Out of scope
lessened.
Expert
Out of
See Accident Compensation Act 2001, Section 33(1)(d).
Policy
To assess whether there has been a failure to provide
treatment, or a delay to treat or diagnose in a timely
1.0 Determining the link between the cause and
manner, you must consider the following factors:
effect
a When determining a causal link you must consider the
• based on the client’s presentation, including complexity
following questions using your clinical knowledge and all
of presentation and any co-morbidities present, and clin-
available case information:
ical knowledge at the time of treatment, should a different
diagnosis reasonably have been made, or a different
• Did the cause precede the effect? How long did it take
treatment path reasonably have been undertaken, at an
for the effect to appear?
earlier point in time in the case of delay?
• Is there a strong relationship between the cause and
effect?
• if a different diagnosis or treatment path was indicated,
• Has the relationship between cause and effect been ob-
and if it had been followed, would this, on the balance of
served repeatedly, by different people and in different
probabilities, have led to a different outcome, i.e. would it
times and places?
have prevented or altered the progression of the injury?
• Does a variation in cause produce a variation in effect?
Accident Compensation Act 2001, Section 33, Treat-
• Is the relationship between cause and effect consistent
ment
with clinical knowledge?
http://www.legislation.govt.nz/act/public/2001/0049/lat
• Does the removal of the cause result in a decreased
risk?
• Does one cause produce one effect?
4.0 Do not apply hindsight
Causal link cannot be established where:
a You must investigate what treatment was actually re-
quired, based on the client’s presentation at the time
• the personal injury is wholly or substantially caused by
rather than on what was subsequently proved to be the
an underlying health condition
case with the benefit of hindsight.
• the personal injury is the result of unreasonably with-
holding or delaying consent to undergo treatment.
NOTE Example
In the case of Baker 70/2009, Mrs Baker pre-
sented to her General Practitioner (GP) with flu-
2.0 Unreasonably withholding or delaying consent
like illness including headache and vomiting. Her
GP provided treatment according to her presen-
to undergo treatment
tation. Her health deteriorated over several
a A person can only make a reasonable decision not to
weeks and she was eventually diagnosed with
consent to the recommended treatment when they have
herpes simplex encephalitis (HSE), which re-
enough information to make an informed decision. Before
sulted in Mrs Baker suffering from right visual
declining cover under this provision, check that the client
field defect and right-sided hyperaesthesia.
had enough information at the time they withheld their
Treatment for HSE was not required for Mrs
consent.
Baker’s original presentation, as this diagnosis
was only discovered after the drastic step of a
You must fully examine the client’s reasons for with-
brain biopsy
holding or delaying their consent. In some situations the
b In summary, just because a client goes on to have a
decision may have been reasonable, given all the
more severe diagnosis confirmed at a later date, this
circumstances of the treatment.
does not automatically mean that there was a delay or
failure to treat the client for that diagnosis at the time of
the original presentation, if there were no indications
pointing to the more severe condition at that time.
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