GOV-032585
BUSINESS RULE
Enterprise Business Rules Portal
Complicated claim definition
Business Rule
Rule Purpose
This ensures claims are identified accurately as complicated
claims so that ACC makes a cover decision within the relevant
legislative timeframes.
A claim must be considered to be a complicated claim if at least one of the
following is true:
the claim type assigned to the claim is any of the following:
a treatment injury complex claim type
a sensitive complex claim type
a work-related mental injury complex claim type
a work-related gradual process complex claim type
the date of lodgement of the claim is greater than 12 months from the
date of injury of the client for that claim
Business Terms
Date of lodgement Date of injury
Work-related mental injury complex claim type
Work-related gradual process complex claim type Claim
Claim type Complex claim type Complicated claim
Treatment injury complex claim type
Sensitive complex claim type
GOV-032585
Tags
Claim: Cover Decision CovDec Claim Type Timeframes
Related Policy
Timeframes to determine cover
Other Data
Owner
Approvers
[Out of Scope]
[Out of Scope]
Feedback
Approval Date: 24/12/2018
GOV-032585
BUSINESS TERM
Business Terms Glossary
Maximum cover decision timeframe Business Term
Synonyms
cover decision timeframe
The greatest amount of time permitted for ACC to make a cover decision on a
claim.
Tags
Deemed cover Claim: Cover Decision
Source
Accident Compensation Act 2001, s57
Accident Compensation Act 2001, s56
GOV-032585
Owner
Approvers
[Out of Scope]
[Out of Scope]
Feedback
Approval Date: 24/12/2018
Document Outline
