Arrange Whole Person Impairment Assessment peer 
review v17.0
PIC10 Seeking peer review - Client
Summary
Objective
2.0 Check peer review
To refer an American Medical Association Whole Person Impair-
Treatment and Support Assessor
ment assessment report for peer review.
a Receive peer review and check that it is complete.
Background
NOTE What is required for completeness?
When a Whole Person Impairment assessment report is re-
• The peer reviewer has accepted or disputed
ceived from a contracted assessor it is sometimes necessary to 
the impairment percentage.
request that it be peer reviewed. A request might be initiated by 
• The peer reviewer has combined the impair-
the original assessor, client, advocate or by Resolution Services 
ment percentages if there was more than one
where a decision is at review.
impairment assessment report (e.g. a Chapter
Owner
14 and a physical assessment).
[Out of Scope]
• The peer reviewer has sent a copy of their find-
Expert
[Out of Scope]
ings to the impairment assessor and signed off 
on any recommended amendments.
Procedure
NOTE What if the peer review is not complete?
Return it to the peer reviewer asking them to pro-
1.0 Organise peer review
vide any missing information.
Treatment and Support Assessor
a
NOTE What if the peer reviewer states the report is 
Choose a peer reviewer with the credentials to assess 
valid and should be accepted by ACC?
the client's particular injury type from the PIC Impairment 
Assessment Referral Tool
Proceed to 'Assess Eligibility for Lump Sum / 
Independence Allowance and Election Offer'.
PIC Impairment Assessment Referral Tool
PROCESS Assess Eligibility for Lump 
https://accnz.sharepoint.com/sites/Group-PermanentI
Sum / Independence Allowance 
NOTE What credentials are required for peer 
and Election Offer
review?
NOTE What if the peer reviewer states the original 
The peer reviewer must be a senior assessor 
report is invalid and amendments should be 
with the appropriate physical injury and mental 
made by the impairment assessor?
injury (Chapter 14 Assessor) credentials.
• The peer reviewer will discuss their concerns
Requirements for an assessor to perform an impair-
with the impairment assessor in the first instance
ment assessment peer review
and suggest any amendments they believe are
necessary.
Impairment assessment peer review requirement
• The impairment assessor must consider the
b Open the PIC Peer Reviews page in sharepoint and 
peer reviewer's comments, and where appro-
update the 'Peer Reviewer' and 'Sent this week' columns 
priate provide an amended report.
as required.
• If there is disagreement, you may recommend
that the peer reviewer and impairment assessor
PIC Peer Reviews
seek external advice from the impairment asses-
https://accnz.sharepoint.com/sites/Group-PermanentI
sor trainer to arbitrate their discussion.
c
• The peer reviewer must give final sign-off on
From the ACC45 in Eos, create and authorise a purchase 
the report once any amendments have been
order for the impairment assessment peer review from 
made by the impairment assessor.
the 'General + QE' tab using code IA20.
NOTE What if, after the peer reviewer suggests 
NOTE What if you need to add an additional entitle-
amendments, an impasse is reached and the 
ment to the purchase order?
impairment assessor refuses to amend their 
Refer to the "add a new entitlement to a claim 
report?
and add to an existing PO" system steps below 
• Request a clinical comment on the impairment
and follow step 3 onward.
assessment and peer review via the 'Seek Inter-
Creating purchase orders using general + QE
nal Guidance' Process.
• Ask the clinical advisor to comment on whether
Add a new entitlement to a claim and add to an 
or not the impairment assessment report is
existing PO
flawed or should be accepted by ACC.
d Generate, edit and send the relevant letter and docu-
PROCESS Seek Internal Guidance
ments to the peer reviewer.
NOTE What if the clinical advisor's opinion is that 
NOTE What documents are required?
the impasse report is valid and should be ac-
• A completed 'PIC26 Peer Review Request -
cepted by ACC?
vendor' letter, including any specific instructions
Proceed to 'Assess Eligibility for Lump Sum / 
as required.
Independence Allowance and Election Offer'.
• The impairment assessment report(s).
PROCESS Assess Eligibility for Lump 
• Any relevant medical records.
Sum / Independence Allowance 
PIC26 Peer Review Request - Vendor
and Election Offer
e Create and send the 'PIC10 Seeking peer review' letter to 
the client.
ACC > Claims Management > Manage Client Payments > Manage Permanent Injury Compensation > Arrange Whole Person Impairment Assessment peer review
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NOTE What if the clinical advisor's opinion is that 
the impasse report is flawed and should not 
be accepted by ACC?
Provide the report and comment to your team 
leader to make a decision on whether or not the 
risk of accepting the report outweighs the costs 
and difficulties associated with restarting the 
impairment assessment process.
NOTE What if my team leader recommends the im-
passe report is accepted?
Proceed to 'Assess Eligibility for Lump Sum / 
Independence Allowance and Election Offer'.
PROCESS Assess Eligibility for Lump 
Sum / Independence Allowance 
and Election Offer
NOTE What if my team leader recommends we ar-
range a new assessment to resolve the im-
passe?
Return to 'Arrange a Whole Person Impairment 
Assessment'
PROCESS Arrange Whole Person Impair-
ment Assessment
b Close the 'At Assessment' task in the Permanent Injury 
Compensation subcase.
PROCESS
Assess Eligibility for Lump Sum / 
Independence Allowance and Elec-
tion Offer
Treatment and Support Assessor
Timeframes
None Noted
ACC > Claims Management > Manage Client Payments > Manage Permanent Injury Compensation > Arrange Whole Person Impairment Assessment peer review
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Impairment assessors Policy v9.0
Summary
3.0 Training and mentoring for assessors
a The initial training is usually about eight hours of tuition 
Objective
and practice in using the AMA Guides, assessment me-
ACC must appoint and pay an appropriate assessor in acc
 
or-
thods, calculating impairment, and report formatting. An 
dance with the Accident Compensation Act 2001, Schedule 1, 
assessor must satisfactorily complete several sample 
part 3, clause 58.
case studies before they undertake assessments. The 
training is followed by a period of one-to-one support, 
when new assessors discuss their cases and reports with 
an experienced assessor and have regular quality re-
Owner
[Out of Scope]
views.
Expert
[Out of Scope]
Initial training is followed by a period of mentorship and 
collegial oversight from ACC’s Senior Medical Advisor 
Policy
(SMA), who is independently trained in the use of the 
AMA Guides in Australia, and has experience in con-
1.0 Contracts
ducting, peer reviewing, and instructing doctors in the 
a As per the contract specifications, approved Assessors 
formal assessment of impairment and proportional attri-
must:
bution in New Zealand and Australia. The SMA provides 
support in the application of the Guides and Handbook/
• be approved by ACC to provide the Assessment Ser-
Guidelines to individual cases and advice on report 
vice; and
formatting until the assessor’s reports are consistently 
• be Medical Practitioners with at least general regis-
compliant with the Assessment Tool.
tration and three years' post-registration clinical expe-
rience; and
Subsequently, a proportion of all assessment reports are 
• have satisfactorily completed ACC’s training course on 
‘peer reviewed’ by an experienced assessor to ensure 
the Assessment Tool and post-course test in the use and 
compliance and quality, with direct feedback to asses-
application of the Assessment Tool.
sors.
The Assessment Tool is currently the AMA Guide to the 
Evaluation of Permanent Impairment (4th Edition) in con-
junction with the The ACC User Handbook to AMA4, and 
4.0 Keeping up training
any additional guidance promulgated in the ACC Opera-
a Annual ‘refresher’ training is provided for all assessors at 
tional Guidelines.
regional meetings, at which assessors can raise issues 
for clarification, and interval guidance on consistency of 
ACC’s initial training course encompasses correct 
approach is provided via the publication of Operational 
interpretation and use of the Guides with the NZ-specific 
Guidelines, and an ACC newsletter. The annual refresher 
variations described in the ACC Handbook.
training covers a whole day (about two hours each of 
physical and mental injury, plus two hours of ‘general’ 
Requirements for an assessor to perform an impair-
themes).
ment assessment
The approved NZ trainers are currently three doctors who 
Impairment Assessments - Service Schedule
themselves have appropriate training and experience in 
the use of the ACC Handbook and the AMA Guides.
2.0 AMA Guides
a The AMA Guides are explicit but not intuitive, and are de-
signed to require training in their use and application, as 
5.0 Types of assessment
well as clinical judgement and expertise. The Guides pro-
a Assessors may only carry out those types of assessment 
vide a framework for minimising interobserver variation in 
that they are listed as being able to undertake in Part A 
assessing impairment, so that compensation is awarded 
Clause 3.
consistently, correctly, and equitably. The Guides provide 
assessment methods for the different body systems and 
The types of assessment are:
the way that impairments can be ‘rated’ and combined so 
that a ‘whole person’ impairment rating can be achieved. 
• General assessments for physical injury; and
There are also rules around how non-covered conditions, 
• Chapter 14 assessments for behavioural and mental 
which may be contributing to overall impairment, can be 
impairment.
accommodated and appropriately excluded from the final 
rating. Within the ACC context, the interpretation and 
Assessors must complete training in their listed assess-
application of the Guides are supported by the ACC 
ment types and are listed with ACC as being able to pro-
Handbook, which provides additional material so that the 
vide impairment assessments under these vocational 
Guides are relevant to the NZ situation. Impairment rating 
scopes.
reports are also subject to ‘peer review’ by expert medical 
assessors as part of ACC’s quality assurance program.
Timeframes
None Noted
ACC > Claims Management > Manage Client Payments > Operational Policies > Independence Allowance & Lump Sum > Impairment assessors Policy
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Assessment (IA and Lump Sum) Policy v16.0
Summary
ACC2189 Extended discretion assessments over-
seas
Objective
When ACC deems a client eligible to have their impairment 
 
4.0 Assessments on medical records
assessed, a medical practitioner rates their impairment using 
the American Medical Association Guides to the Evaluation of 
a In certain circumstances a client may not be able to 
Permanent Impairment, Fourth Edition (the AMA Guides), and 
attend an examination.
The ACC User Handbook to AMA4, then writes an impairment 
assessment report.
This can be because they are overseas or are physically 
unable to attend due to injury or illness. They may also 
Owner
[Out of Scope]
suffer from a rapidly deteriorating condition such as 
mesothelioma, where they are physically unwell and the 
Expert
[Out of Scope]
assessment must be done in a timely manner.
Policy
In these cases we can ask the assessor to complete the 
assessment based on the medical records.
1.0 Assessors
a ACC must appoint and pay an appropriate assessor in 
The assessor must be duly qualified for the type of 
accordance with the Accident Compensation Act 2001, 
assessment (where possible use a Medical Advisor 
Schedule 1, clause 58.
(MA)).
A medical practitioner must be trained in the use of the 
The assessor will determine and advise ACC whether an 
AMA Guides and contracted to provide assessments for 
accurate assessment of their level of impairment can be 
ACC before they can carry out an AMA assessment and 
completed from these medical records.
produce an AMA report.
If an impairment involves mental or behavioural disorders 
5.0 Rapid Response assessment process for 
the assessor must be able to provide ‘Chapter 14’ 
clients at imminent risk of death
assessments
a Under ACC's legislation, a client needs to be alive when 
Accident Compensation Act 2001, Schedule 1, 
assessed for Lump Sum compensation.
clause 58
b In 2004, a 'rapid response' process was developed to 
http://www.legislation.govt.nz/act/public/2001/0049/lat
process IA/Lump Sum applications with more urgency 
where a client's covered injury is recognised as immi-
nently fatal.
2.0 Assessment timeframes
c For more information, see Clients with rapidly deteri-
a The vendor must contact the client to arrange an assess-
orating conditions
ment within 10 working days of receiving the referral.
Clients with rapidly deteriorating conditions - Policy
b The vendor must assess the client within 30 working 
days of receiving the referral, or notify ACC if this is not 
possible.
6.0 Overseas mental injury assessments
c The vendor must see the client at their impairment 
a Clients who live overseas and need a mental and beha-
assessment appointment within 30 minutes, or else give 
vioural impairment assessment can choose to either:
the client an explanation of why they were made to wait.
• be assessed over the phone by a New Zealand asses-
d The vendor must supply an impairment assessment 
sor based on an up-to-date psychiatric report
report to ACC within 10 working days of assessing the 
• return to New Zealand for a face-to-face assessment.
client.
To be assessed over the phone:
• the client must be comfortable and give their consent
3.0 Assessments overseas
• we must have an up-to-date psychiatric report that 
meets our requirements
a In certain circumstances we have discretion to either 
• the report must be from a psychiatrist who meets our 
obtain an assessment or report overseas or pay for a 
requirements for an overseas psychiatrist
client to return to NZ for an assessment.
the assessor must be contracted to provide 'Chapter 14' 
You must use discretion if a client needs to obtain addi-
assessments and be satisfied that it is clinically appro-
tional medical information in order to have their impair-
priate to complete the assessment over the phone, ie the 
ment assessment completed.
client will not be left in an ‘unsafe’ psychological state 
without existing local support
Before filling out a request for discretion you must ask the 
client if they have had tests or specialist opinions, eg 
spirometry tests, orthopaedic opinion, x-rays.
You must use the ACC2189 Extended discretion assess-
ments overseas(127K) form to make a submission to the 
Operational Risk Unit for extended discretion.
ACC > Claims Management > Manage Client Payments > Operational Policies > Independence Allowance & Lump Sum > Independence allowance > Assessment (IA and
Lump Sum) Policy
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7.0 Referring care indicated clients
11.0 Additional assessments with new information
a When you need an impairment assessment for a care 
a If we discover that new information about a client was 
indicated client you must advise the provider why the 
available at the date of an assessment or reassessment, 
client may pose a risk, ask whether they wish to conduct 
but wasn’t made available to the assessor at the time 
an assessment and whether they would like a security 
they conducted and rated the impairment of the client, we 
guard present.
can arrange an additional assessment to include the new 
information so that it can be considered.
For more information, see 
 
Assessing a client's risk level.
If a new assessment based on the new information con-
Assessing a clients risk level
firms a change in their level of impairment, the client’s 
eligibility and support may also be revised, without being 
considered a reassessment. The Accident Compensation 
8.0 Peer reviewers
Act 2001, Section 65 advises that we can revise incorrect 
a All peer reviewers must be trained to use the AMA 
decisions at any time, regardless of the reason for the 
Guides and The ACC User Handbook to AMA4.
error.
Accident Compensation Act 2001, Section 65 -
Peer review is not a legislative requirement but Treat-
Corporation may revise decisions
ment and Support Assessors may consider it appropriate 
http://www.legislation.govt.nz/act/public/2001/0049/lat
if a second opinion is required, eg for any of the following 
apply:
• mental injury and physical injury
• head injury and a mental injury
12.0 Additional assessments when there is no new 
• asbestos claims other than mesothelioma
information
• treatment injury
a A client can arrange for an additional assessment at any 
• apportionment applied by the assessor
time at their own cost. If there are any points of difference 
• multiple impairments (complex assessments)
as a result of this assessment, we will assess them fur-
• accredited employer (AE) assessments
ther.
• significant increase or decrease in impairment from the 
previous assessment
• new impairment assessors
• sensitive claims.
13.0 Challenged assessment decisions
a After we notify the client about their assessment results, 
See Peer review guidelines .
and provide them with the AMA report and peer review 
Peer review guidelines - Reference
when applicable, the client can challenge these results if 
they:
Impairment assessment peer review requirement
• disagree with the decision
Requirements for an assessor to perform an impair-
ment assessment peer review
• do not understand the reasons for the decision. This 
particularly applies to those who have only previously 
been assessed using the Functional Limitations Profile 
9.0 Peer review timeframes
(FLP) questionnaire
a The vendor must return a standard peer review to ACC 
within 5 working days of receiving the referral.
• want to be sure that the decision is accurate.
b The vendor must return a complex peer review to ACC 
You must advise the client that any review application 
within 10 working days of receiving the referral.
should be lodged as soon as possible and within three 
c The vendor must also inform ACC if the impairment 
months. See ACC255 Working together (21K).
assessor has taken longer than five working days to 
amend an impairment assessment report.
A client may delay the formal hearing process if, for ex-
ample, it appears their concerns could be resolved by 
seeking further information. They may discuss their con-
10.0 Multiple assessments
cerns with ACC to try and resolve them. However, if there 
is no new information for us to consider the client may 
a We need two separate assessments by two appropriately 
seek an independent opinion at their own expense.
qualified assessors when both of the following apply:
• a client suffers injuries that mean they need a physical 
ACC255 Working together, Kōrero mai - get in touch
assessment and a mental and behavioural assessment
• there is no assessor available and qualified to conduct 
both assessment types.
14.0 Non-attendance fee
a If a client fails to attend an assessment the assessor can 
charge a non-attendance fee as per their contract. They 
can only charge this fee once for any assessment, even if 
the client misses more than one appointment.
To claim the non-attendance fee the vendor must submit 
copies of relevant correspondence with the client, or 
copies of file notes recording communication with the 
client, dated at least seven days before the scheduled 
appointment date.
Clinic framework - Did Not Attend Clients (DNAs)
ACC > Claims Management > Manage Client Payments > Operational Policies > Independence Allowance & Lump Sum > Independence allowance > Assessment (IA and
Lump Sum) Policy
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Timeframes
None Noted
 
ACC > Claims Management > Manage Client Payments > Operational Policies > Independence Allowance & Lump Sum > Independence allowance > Assessment (IA and
Lump Sum) Policy
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Document Outline

• Arrange Whole Person Impairment Assessment peer review
• Impairment assessors Policy (1)
• Assessment (IA and Lump Sum) Policy (1)
• Requirements for an assessor to perform an impairment assessment peer review
• Impairment Assessment Peer Review guidelines
• Impairment assessment peer review requirement

---