ACC’s handling of Permanent Injury Compensation (PIC), ACC18 medical certificates, and repetitive review processes
SPENCER JONES made this Official Information request to Accident Compensation Corporation
Response to this request is long overdue. By law Accident Compensation Corporation should have responded by now (details and exceptions). The requester can complain to the Ombudsman.
From: SPENCER JONES
Subject: Request for Information – Permanent Injury Compensation, ACC18 Validation, and Systemic Entitlement Transparency Failures.
Pursuant to the Official Information Act 1982, I request the following information relating to the assessment, disclosure, and administration of Permanent Injury Compensation (PIC) entitlements, and the handling of medical incapacity evidence and review processes.
Part 1: Entitlements and Transparency Obligations
1. Disclosure Policies:
• All internal ACC policies, guidelines, manuals, or directives describing the legal obligation to disclose a full list or breakdown of entitlements available to a claimant under a covered claim.
• How and when this information must be communicated to claimants in writing, particularly for those in long-term claim or review status.
2. Client Access to Entitlement Information:
• Systems or databases used to store and track claimant entitlements.
• How claimants can obtain a full breakdown of their individual entitlements and legislative basis.
• Audit trails or access logs kept to confirm this information was shared.
Part 2: Use and Recognition of ACC18 Medical Certificates
3. Validation of Medical Evidence:
• All current policies and operational guidance (including training materials, workflows, or protocols) describing how ACC18 certificates are reviewed and validated in support of incapacity or PIC claims.
• Criteria or thresholds for overriding an ACC18 certificate signed by a registered medical professional.
• How ACC ensures clinical recommendations are not arbitrarily dismissed.
4. Historical Data:
• Number of PIC-related decisions between 2020–2025 that resulted in a 0% impairment rating despite an ACC18 certificate confirming incapacity.
Part 3: Review Processes and Repetition of Assessments
5. Repetitive Review Handling:
• Policies or SOPs on repetitive/successive reviews following declined PIC claims.
• Criteria for requiring new evidence versus reusing prior assessments.
• Limits or escalation procedures for repeated internal reviews.
6. Timeframes and Delays:
• KPIs or benchmarks for resolving PIC entitlement reviews.
• Anonymised data on average time from PIC lodgement to ICRA resolution (2020–2024).
Part 4: Systemic Issues and Complaints
7. Ombudsman & Complaint Tracking:
• Number of complaints (since 2020) referred to the Ombudsman or Privacy Commissioner regarding entitlement transparency or dismissal of ACC18s.
• Outcome summaries or resolution categories (anonymised).
8. Internal Reporting on Systemic Failures:
• Internal audits, QA reviews, or executive summaries identifying systemic issues in:
- Entitlement disclosure;
- Use or dismissal of ACC18 evidence;
- Procedural fairness in PIC reviews.
Format and Response
Please provide all information in accessible electronic formats (PDF, DOCX, or CSV). If any part of this request may be refused under sections 18(d), 18(f), or 18(g), please consult with me to refine the scope.
Clarifying Context. This request supports mediation process and reflects a broader need to understand about systemic practices within ACC. I am seeking transparency and procedural fairness under the Accident Compensation Act 2001 and Privacy Act 2020.
Yours faithfully,
SPENCER JONES
From: Government Services
Accident Compensation Corporation
Kia ora,
Thank you for contacting ACC’s Government Services inbox.
If your request falls within scope of the Official Information Act, we
will endeavour to respond as soon as possible, and no later than 20
working days after receipt of your request. If we are unable to respond
within the statutory timeframe, we will notify you of an extension.
The information you have requested may involve documents which contain the
names and contact details of individuals. Please let us know whether you
are seeking that information as part of your request. We may need to
consult before deciding whether we can release this information, and this
may take a bit more time. If we do not hear from you, we will assume that
you do not require it.
For more information about Official Information Act requests, please
visit: [1]Ombudsman New Zealand | Tari o te Kaitiaki Mana Tangata.
If your request relates to your claim, or you’d like more information
about lodging a claim, please contact ACC’s claims team at 0800 101 996
or [2][email address].
For personal information requests or privacy matters,
please visit [3]Request for personal information (acc.co.nz).
For general queries, please visit: [4]Contact us (acc.co.nz).
Ngâ mihi,
Government Services
PO Box 242 / Wellington 6011 / New Zealand / [5]www.acc.co.nz
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From: Government Services
Accident Compensation Corporation
Kia ora
Please find attached our response to your official information request
dated 26 May 2025. If you have any questions about the response you can
contact us at this [1]address, for all other matters please use our
contact form at: [2]https://www.acc.co.nz/contact/ alternatively give us
a call on 0800 101 996.
If you are having trouble viewing the PDF, please ensure you have the
latest version of Adobe Acrobat Reader. To download this freeware please
click [3]here.
Ngâ mihi
Christopher Johnston (he/him)
Manager | OIA Services
* PO Box 242, Wellington 6011
ACC cares about the environment – please don’t print this email unless it
is really necessary. Thank you.
show quoted sections
From: SPENCER JONES
Dear Government Services,
Follow-up OIA Request: Clarification and Refinement of FYI Request #31103 – Permanent Injury Compensation (PIC), ACC18 Override Criteria, and Review Processes
This request is submitted as a formal follow-up to my earlier Official Information Act request lodged via FYI.org.nz on 26 May 2025 (ref: #31103), and ACC’s response dated 25 June 2025 (GOV-040419).
Further to that response, I now seek clarification and refinement on the following matters, in accordance with sections 12, 14, and 23 of the Official Information Act 1982. Where parts of my initial request were declined under section 18(f) due to substantial collation, I have narrowed the scope to facilitate meaningful disclosure.
⸻
🔹 Refined Request for Information
1. Override of ACC18 Medical Certificates
Please provide the following:
• Any written criteria, policies, clinical guidelines, internal memos, or standard operating procedures used by ACC to override, disregard, or substitute the clinical opinion of a treating provider recorded in an ACC18 medical certificate—particularly in relation to:
• Permanent Injury Compensation (PIC) decisions;
• Section 113 suspensions;
• Assessment of ongoing incapacity or stable impairment.
• If no such written criteria exist, please explicitly confirm this.
2. Repetitive or Recurrent Use of Reassessments and Independent Clinical Advice (ICA)
Please provide:
• Any internal ACC guidance, policy, or limits on the frequency of reassessments, ICA referrals, or repeat specialist reviews in relation to the same condition or claim.
• If no frequency limit or procedural safeguard exists, please state this clearly.
3. Audit Trails and Decision Transparency
• Please confirm whether the Eos system used by ACC includes audit logs or access trails recording when and how entitlements, claim decisions, and medical certificate overrides are communicated to clients.
• If available, please provide the policy or technical description of how such audit trails are maintained and reviewed.
4. Internal Audits or Reviews Related to ACC18 Handling and PIC Decision-Making (2020–2024)
• Please provide the executive summaries, findings, or redacted excerpts from any internal audits or quality assurance reviews since 1 January 2020 that:
• Address the handling of ACC18 medical certificates;
• Review the consistency, fairness, or integrity of PIC decision-making or reassessment practices;
• Relate to complaints received by the Ombudsman or Privacy Commissioner in this context.
⸻
🟨 Notes on Scope and Format
To assist in managing workload, you may:
• Limit all disclosures to the period 1 January 2023 – 31 December 2024;
• Provide redacted excerpts or executive summaries where full reports are voluminous;
• Treat this as a refinement under section 14 of the OIA in light of the s18(f) refusals cited in your June 25 response.
I request that all information be provided in electronic form via FYI.org.nz, with appendices or file uploads attached as appropriate.
⸻
⚠️ Public Interest Statement
This request relates to systemic decision-making within ACC that materially affects the rights and welfare of claimants—especially those subject to ongoing impairment assessments. There is significant public interest in ensuring that:
• Clinical evidence is not arbitrarily dismissed;
• Reassessment processes are fair and not abusive or repetitive;
• Claimants receive accurate, transparent communication of their entitlements.
⸻
Thank you for your time and continued engagement on this important matter. I look forward to your response within the statutory timeframe.
Kind regards,
Spencer Jones
Via FYI.org.nz (OIA Request #31103)
From: Government Services
Accident Compensation Corporation
Kia ora,
Thank you for contacting ACC’s Government Services inbox.
If your request falls within scope of the Official Information Act, we
will endeavour to respond as soon as possible, and no later than 20
working days after receipt of your request. If we are unable to respond
within the statutory timeframe, we will notify you of an extension.
The information you have requested may involve documents which contain the
names and contact details of individuals. Please let us know whether you
are seeking that information as part of your request. We may need to
consult before deciding whether we can release this information, and this
may take a bit more time. If we do not hear from you, we will assume that
you do not require it.
For more information about Official Information Act requests, please
visit: [1]Ombudsman New Zealand | Tari o te Kaitiaki Mana Tangata.
If your request relates to your claim, or you’d like more information
about lodging a claim, please contact ACC’s claims team at 0800 101 996
or [2][email address].
For personal information requests or privacy matters,
please visit [3]Request for personal information (acc.co.nz).
For general queries, please visit: [4]Contact us (acc.co.nz).
Ngâ mihi,
Government Services
PO Box 242 / Wellington 6011 / New Zealand / [5]www.acc.co.nz
ACC cares about the environment – please don’t print this email
unless it is really necessary. Thank you.
Disclaimer:
"This message and any attachments may contain confidential and privileged
information. If you believe you have received this email in error, please
advise us immediately by return email or telephone and then delete this
email together with all attachments. If you are not the intended
recipient, you are not authorised to use or copy this message or any
attachments or disclose the contents to any other person."
References
Visible links
1. https://www.ombudsman.parliament.nz/
2. mailto:[email address]
3. https://www.acc.co.nz/contact/request-fo...
4. https://www.acc.co.nz/contact/
5. http://www.acc.co.nz/
http://www.acc.co.nz/
From: Government Services
Accident Compensation Corporation
Kia ora
Please find attached our response to your official information request
dated 25 June 2025. If you have any questions about the response you can
contact us at this [1]address, for all other matters please use our
contact form at: [2]https://www.acc.co.nz/contact/ alternatively give us
a call on 0800 101 996.
If you are having trouble viewing the PDF, please ensure you have the
latest version of Adobe Acrobat Reader. To download this freeware please
click [3]here.
Ngā mihi
Christopher Johnston (he/him)
Manager | OIA Services
* PO Box 242, Wellington 6011
ACC cares about the environment – please don’t print this email unless it
is really necessary. Thank you.
show quoted sections
From: SPENCER JONES
Dear Government Services,
Tēnā koe,
This is a refined follow-up to my earlier OIA request #31103, following ACC’s refusal to provide aggregate data under section 18(f). I now seek more specific, time-limited information to clarify the scale and oversight of the issues raised.
Under the Official Information Act 1982, I request the following information:
⸻
1. Repetitive ACC18 Issuance – Long-Term Claims
For each of the last five calendar years (2020–2024), please provide:
a. The number of active claims that were 2 years or more in duration
b. Of those, how many had been issued with:
• 3 or more ACC18 medical certificates
• 5 or more ACC18 medical certificates
• 10 or more ACC18 medical certificates
c. Of those with 5 or more ACC18s issued, how many had:
• A confirmed Whole Person Impairment (WPI) assessment
• A final Permanent Injury Compensation (PIC) decision issued
⸻
2. PIC Application and Decision Delays
Please provide:
a. The average time (in months) from injury stabilisation to WPI assessment for all claims assessed for PIC in 2022–2024.
b. The number of cases where a PIC application was declined on the basis that the injury had not stabilised, despite being in receipt of 5 or more ACC18s.
c. Any internal audit, review, or quality assurance documents from the past 5 years examining delays or barriers to accessing PIC for long-term claimants.
⸻
3. Support and Escalation Mechanisms
Please provide a copy of any current:
• Internal guidance or SOPs (standard operating procedures) for case managers relating to escalation of long-term claims to PIC or IMA assessment
• Criteria or policy thresholds that guide when a long-term claimant should be referred for WPI/PIC evaluation
⸻
Background & Public Interest Justification:
This request seeks to clarify whether repetitive short-term certification is functioning, in practice, as a barrier to PIC for long-term injured persons. The request is limited in timeframe (5 years), specific in scope (claims >2 years, ACC18 counts, PIC status), and seeks only aggregated or existing internal review documents. There is a strong public interest in ensuring fairness and transparency in how ACC handles permanent injury entitlements.
If any part of this request remains too burdensome, I respectfully request that you contact me to assist in refining the scope, as required under section 13 of the OIA.
⸻
Yours sincerely,
SPENCER JONES
From: Government Services
Accident Compensation Corporation
Kia ora,
Thank you for contacting ACC’s Government Services inbox.
If your request falls within scope of the Official Information Act, we
will endeavour to respond as soon as possible, and no later than 20
working days after receipt of your request. If we are unable to respond
within the statutory timeframe, we will notify you of an extension.
The information you have requested may involve documents which contain the
names and contact details of individuals. Please let us know whether you
are seeking that information as part of your request. We may need to
consult before deciding whether we can release this information, and this
may take a bit more time. If we do not hear from you, we will assume that
you do not require it.
For more information about Official Information Act requests, please
visit: [1]Ombudsman New Zealand | Tari o te Kaitiaki Mana Tangata.
If your request relates to your claim, or you’d like more information
about lodging a claim, please contact ACC’s claims team at 0800 101 996
or [2][email address].
For personal information requests or privacy matters,
please visit [3]Request for personal information (acc.co.nz).
For general queries, please visit: [4]Contact us (acc.co.nz).
Ngâ mihi,
Government Services
PO Box 242 / Wellington 6011 / New Zealand / [5]www.acc.co.nz
ACC cares about the environment – please don’t print this email
unless it is really necessary. Thank you.
Disclaimer:
"This message and any attachments may contain confidential and privileged
information. If you believe you have received this email in error, please
advise us immediately by return email or telephone and then delete this
email together with all attachments. If you are not the intended
recipient, you are not authorised to use or copy this message or any
attachments or disclose the contents to any other person."
References
Visible links
1. https://www.ombudsman.parliament.nz/
2. mailto:[email address]
3. https://www.acc.co.nz/contact/request-fo...
4. https://www.acc.co.nz/contact/
5. http://www.acc.co.nz/
http://www.acc.co.nz/
SPENCER JONES left an annotation ()
Date: 14 July 2025
To: Office of the Ombudsman
From: Spencer Jones
Subject: Complaint under the Official Information Act – ACC Refusal to Provide Aggregate Data (OIA #31103 via FYI.org.nz)
Summary of Complaint
I am writing to lodge a formal complaint against the Accident Compensation Corporation (ACC) under the Official Information Act 1982 (OIA), in relation to their refusal to supply requested information in response to my OIA request dated 6 June 2025, submitted via FYI.org.nz (Request #31103).
ACC refused part of my request under section 18(f) (substantial collation or research required), without offering assistance to refine the request as required by section 13 of the Act. This complaint seeks investigation and, if appropriate, a recommendation that ACC reconsider the request or disclose partial data or policy documentation within scope.
Background
My original request sought information about:
1. The use of repeated ACC18 medical certificates in long-term claims;
2. Whether this practice was acting as a barrier to Permanent Injury Compensation (PIC);
3. Internal policies or data on repetitive review cycles;
4. Statistics on the number of long-term claimants receiving multiple ACC18s but denied PIC.
ACC responded on 9 July 2025, stating they were “unable to provide the data you are seeking” because it would require substantial manual collation and research, invoking section 18(f).
However:
- No attempt was made to assist me to narrow or refine the request (s13);
- No alternative or partial information (e.g. examples, policy summaries, internal dashboards, or sample years) was offered;
- No clear explanation was given as to why even high-level aggregate data on ACC18 and PIC assessments could not be produced, despite ACC being a data-intensive agency.
Issues for Investigation
1. Failure to Comply with Section 13 (Duty to Assist)
- The Ombudsman’s published guidance confirms that agencies are expected to proactively assist requesters to refine OIA requests that may initially appear broad. ACC did not contact me to discuss refinement or scope narrowing.
2. Overbroad Use of Section 18(f)
- Section 18(f) should only be invoked after genuine consideration of alternatives. ACC’s response appears to function as a blanket refusal, which frustrates the purpose of the OIA and undermines public transparency.
3. Avoidance of Legitimate Public Interest Inquiry
- My request raised questions of natural justice, systemic delay, and potential misuse of procedural mechanisms (e.g. repetitive medical certification) to defer permanent injury entitlements. Avoiding substantive engagement on these issues is contrary to the OIA’s objectives.
Relief Sought
I respectfully request that the Ombudsman:
- Investigate whether ACC’s refusal under s18(f) was justified in the circumstances;
- Determine whether ACC met its obligation to assist under s13;
- Recommend that ACC reconsider the request in full or part;
- Encourage the proactive release of internal policy documents and/or de-identified statistical summaries (e.g. number of claims with >5 ACC18s and PIC status).
I would welcome the opportunity to clarify or refine my request further in consultation with ACC.
Link to original request: https://fyi.org.nz/request/31103
Kind Regards,
Spencer Jones
Veteran Advocate | Disabled Consumer
Things to do with this request
- Add an annotation (to help the requester or others)
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SPENCER JONES left an annotation ()
⚖️ Comment on ACC’s Response – Public Interest and OIA Concerns
Thank you for your response, but I remain concerned that the core issue raised has been avoided.
This request was not simply about ACC18 forms or isolated case data—it sought clarity on whether repetitive use of short-term medical certification (ACC18s) is being used systematically to delay or deny Permanent Injury Compensation (PIC) to long-term or permanently impaired claimants.
Key issues with ACC’s response:
• Avoidance of Systemic Question: The reply reiterates the technical purpose of the ACC18 but fails to address whether its repeated use functions as a de facto gatekeeping mechanism preventing eligible claimants from accessing permanent compensation. This concern relates to natural justice, delay, and equity under the ACC scheme.
• Failure to Provide Requested Data: ACC refused to release aggregate data on repetitive reviews and long-term PIC denial under s18(f) of the OIA, claiming collation would be too burdensome. However, no assistance was offered to refine or narrow the request, as required under section 13 of the OIA. No sample or partial data was provided. This is inconsistent with good OIA practice and public transparency obligations.
• Lack of Policy or Oversight Information: ACC did not confirm whether it holds any internal guidance, audit findings, or systemic reviews on this issue. The absence of such documentation raises further concern about procedural consistency and oversight.
There is significant public interest in understanding how long-term claimants are treated—especially those whose injuries have stabilised but who are still required to undergo repeated short-term assessments. The withholding of relevant information undermines confidence in the fairness and transparency of the permanent injury compensation process.
A complaint to the Office of the Ombudsman is being prepared.
⸻
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