GOV-040419
Rules for Medical Certificates for Inability to Work
Policy v13.0
Summary
2.0 Legislation related to the activities of health
practitioners and the certification ACC will
Objective
accept from health practitioners
This guidance outlines the information that ACC require from
a Legislative changes mean suitably qualified health practi-
a medical health professional when they issue an acceptable
tioners will be able to carry out some activities that could
medical certificate confirming the client is unable to work. This
previously only be done by medical practitioners (doc-
guidance covers retrospective, and forward-dated medical
tors). Refer to the Health Practitioners (Replacement of
certificates. Refer to this guidance to determine whether a med-
Statutory References to Medical Practitioners) Bill in
ical certificate contains the information we require to confirm
Activity 6.0.
inability to work.
b One of these involves a change to the Holidays Act 2003.
The Holidays Act allows an employer to require an em-
1) Rules: medical practitioners issuing medical certificates for
ployee to produce proof of sickness or injury. The Act pre-
inability to work
viously stated that this proof may include ‘a certificate
2) Legislation related to the activities of health practitioners and
from a medical practitioner’. The recent amendment
the certification ACC will accept from health practitioners
changes this to ‘a certificate from a health practitioner’.
3) Acceptance of certificates
4) Retrospective medical certificates
c ACC’s legislation has not changed and the requirement
5) Forward-dated medical certificates
for an assessment of inability to work remains by a med-
6) Links to guidelines and legislation
ical or nurse practitioner.
Owner
[Out of Scope]
d However, ACC can accept a health practitioner’s certif-
icate for the purposes of determining the first date the
Expert
[Out of Scope]
client became unable to work, if they had taken time off
work to be treated by the health practitioner. ACC would
Procedure
also require confirmation that the client was absent from
work to attend that treatment. The treatment would have
1.0 Rules: medical practitioners issuing medical
to be one that ACC is liable to provide and is necessary
certificates for inability to work
for the client’s covered injury.
a A medical practitioner (or nurse practitioner) can confirm
NOTE Medical Incapacity via a Medical Report
whether a client is unable to perform their employment
Incapacity noted in a Medical Report signed off
duties through issuing a medical certificate. A medical
by a GP / Specialist is from a legal perspective
certificate can be any of the following:
as equally acceptable as incapacity noted in an
• an ACC045 ACC injury claim form
ACC18.
• an ACC018 Medical Certificate
As long as the medical report contains all the
• electronically created medical certificate
information requested in an ACC18, as listed
• inability to work included within a report from a medical
below:
practitioner (or nurse practitioner).
- Patient details
b The medical certificate should be provided by the medical
- Injury details
practitioner (or nurse practitioner) the client consulted
- Fitness for Work
about the injury when they became unable to work.
- Other Assistance
c For ACC to accept the certificate, it must refer to the
- Declaration
injury in question and clearly identify the client’s restric-
tions due to the injury.
If all this information is provided in the report
then there is no need to ask the client to provide
d Electronically created medical certificates can only be ac-
ACC with an ACC18 medical certificate
cepted from medical practitioners (or nurse practitioners)
who have had their certificates approved by Corporate
Office and numbers allocated.
e If that doctor is not available, a medical practitioner (or
3.0 Acceptance of certificates
nurse practitioner) from the same practice can provide
a
the certificate, if details of the consultation can be con-
Certificates that result in the granting of support may be
firmed.
accepted by fax or direct from a provider electronically.
f
b
If a public hospital provided treatment to the client but did
All medical certificates must be signed by the relevant
not complete a certificate, it can be completed later, pro-
provider, or, in the case of an eACC18, must be appro-
vided the medical practitioner (or nurse practitioner) com-
priately authorised by the provider. The patient does not
pleting the certificate has the hospital notes. If required,
need to sign either the ACC18 or eACC18.
contact this medical practitioner (or nurse practitioner) to
c When we receive a manual ACC18 Medical Certificate it
check that the hospital notes were available to them.
must have a valid provider ID to ensure that the certif-
g See the Medical Council of New Zealand's guidelines on
icate can be approved for payment.
medical certification for more information on doctors'
d Provider detail is a mandatory field in Eos, as they must
professional obligations when completing certificates.
exist to process a manual ACC18 and/or eACC18. How-
ever, Vendor and Facility fields are optional.
e If the Provider ID is showing as invalid, then you will need
to search for the correct Provider or use the dummy
number K95229.
ACC > Claims Management > Manage Client Payments > Operational Policies > Weekly Compensation > Incapacity > Rules for Medical Certificates for Inability to Work Policy
Uncontrolled Copy Only : Version 13.0 : Last Edited Friday, 8 April 2022 12:02 pm : Printed Tuesday, 24 June 2025 12:48 pm
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GOV-040419
4.0 Retrospective medical certificates
Holidays Act 2003
a Medical certificates that cover a period before the date of
http://www.legislation.govt.nz/act/public/2003/0129/45.0/DLM236387.html
consultation are less convincing proof of inability to work
and may not be acceptable. In this case:
Timeframes
• obtain further medical information before deciding
whether to accept a retrospective certificate
None Noted
• determine the basis on which the retrospective medical
certificate has been given. This can be sought from the
medical practitioner (or nurse practitioner)
• obtain confirmation from the client’s employer that they
had time off work due to their inability to work due to the
injury.
b It may also be helpful to get comments from a Medical
Advisor before deciding.
c Retrospective certificates by a medical practitioner (or
nurse practitioner) may be more compelling when read
alongside a Health Practitioner’s certificate particularly
where the client has been treated by them in the inter-
vening period.
5.0 Forward-dated medical certificates
a Medical certificates specifying a period of inability to
work, that starts sometime after the date of consultation,
can be accepted depending on the circumstances of
each case. Factors to be considered in deciding whether
to accept a forward-dated medical certificate include:
• the reason for the certificate being forward-dated, e.g. if
surgery is expected, or a current certificate of inability to
work is due to expire
• gap between the date the certificate was completed and
the specified start date for the period that the client was
unable to work (this must only be a few days)
• the duration of inability to work is specified, particularly
where the certificate is forward-dated because surgery is
planned
• the medical details of the injury and inability to work, i.e.
if the available facts clearly support that the person would
be unable to work
• the basis on which the forward-dated medical certificate
has been given should be determined. This may be
sought from the medical practitioner (or nurse practi-
tioner).
b It may also be helpful to get comments from a Medical
Advisor before deciding.
c Where ACC does accept a forward-dated medical certif-
icate, the period of inability to work is taken from the ‘date
specified on the certificate’, not the date the certificate is
completed.
d Ensure the reasons for accepting or rejecting a forward-
dated medical certificate are recorded on Eos Contacts
Log.
6.0 Links to guidelines and legislation
Medical Council of New Zealand's guidelines on
medical certification
https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=2ahUKEwj23PG9vN_gAhWDV30KHQe8AL4QFjAAegQIChAC&url=https%3A%2F%2Fwww.mcnz.org.nz%2Fassets%2FNews-and-Publications%2FStatements%2FMedical-certification.pdf&usg=AOvVaw3KjCXxcxD8x1Y5Ma555auc
Health Practitioners (Replacement of Statutory
References to Medical Practitioners) Bill
http://www.legislation.govt.nz/bill/government/2015/0036/23.0/DLM6514118.html
ACC > Claims Management > Manage Client Payments > Operational Policies > Weekly Compensation > Incapacity > Rules for Medical Certificates for Inability to Work Policy
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GOV-040419
Medical Certification for Serious Injury Claims - per-
manent incapacity v19.0
b
Summary
A further decision can be made at a later date, if required
by:
Objective
• the client undertaking vocational rehabilitation, including
Serious injury claims are managed using a disability approach,
the Initial Occupational Assessment/Initial Medical
this is a different service approach than for non-serious injury
Assessment process
claims.
• the client’s condition or level of compliance changing
Owner
[Out of Scope]
• identification that the status of their inability to work is
Expert
likely to, or needs to, be altered.
[Out of Scope]
This process complies with the legislation and removes
Procedure
the unnecessary burdens of the process for non-serious
1.0 Rules
injury clients for this group. It removes the financial
burden to clients, of attending a doctor just for an ACC
a In relation to medical certification, serious injury clients
medical certificate and allows ACC to withdraw from their
differ because:
lives, thereby enhancing any ongoing relationship with
ACC. The process also reduces the administrative
• they have sustained a significant and permanent impair-
burden for staff.
ment
Issues around Fraud and return to work expectations will
• once their condition is stable, a one time determination
be managed outside of the medical certification process.
can usually be made on their ability to return to their pre-
c Once the process is complete - see document for detail.
injury employment
In EOS: Party - Edit - "Stop Notification" (see "notifi-
cation" Promapp page for more detail).
• they will usually have a long term treatment relationship
with one or more medical practitioners.
The process chart below sets out the overall process for
Timeframes
Serious Injury clients.
Medical Certification SI Permanent Incap process
None Noted
chart.pptx
2.0 Key Points of the Process
a An initial decision is made while the client is in post-acute
rehabilitation, or soon after, about whether ongoing med-
ical certificates are required. This decision involves the
Recovery Team Member consulting with the team Leader,
and if required an appropriate Clinical Advisor, and is
made based on if:
• the disability arising from the impairment has reached a
point from which it is unlikely to significantly improve.
• the client is unable to return to the employment they
had at the time of the injury
• the client is participating, or planning to participate in
vocation rehabilitation, including the Initial Occupational
Assessment/Initial Medical Assessment process
• there is any indication the client will be non-compliant
with necessary treatment requirements, or with the Indi-
vidual Planning process.
ACC > Claims Management > Manage Client Payments > Operational Policies > Weekly Compensation > Incapacity > Medical Certification for Serious Injury Claims -
permanent incapacity
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GOV-040419
Complete ACC18 Medical Certificate Request v30.0
NOTE What if you receive an ACC18 task that was
Summary
put on hold?
Confirm that you have received the ACC45 form.
Objective
If received, register the claim and go to step 2.0
How Lodgement Administrators should handle a ACC18 medical
of the process.
certificate request when it arrives in the Lodgement space and if
required, forward to the correct person or team.
If not received, contact the provider again to get
the ACC45 claim form.
Background
If unsuccessful, put the task on hold for another
When Lodgement Administrators receive an ACC18 via:
48 hours.
• Fax Folder (Edocs)
• [email address]
When receiving the ACC18 task that was put on
• Task
hold, follow up with provider to get the ACC45
claim form. If unsuccessful after the second at-
The Lodgement team checks the purpose of the request and
tempt, discuss with your Team Leader.
depending on the purpose, updates the status of the diagnosis,
or forwards to the more appropriate team.
b Review the Rules for Medical Certificates for Incapacity
and Medical Certification for non-Serious Injury claims
Policies, if required.
Owner
[Out of Scope]
Rules for medical certificates for incapacity Policy
Expert
[Out of Scope]
Medical Certification for non-Serious Injury claims
Policy
Procedure
1.0 Determine the reason for ACC18
2.0 Assess the ACC18 request
Lodgement Administrator
Lodgement Administrator
a Check the claim number on the ACC18 is registered by
a In Eos, search for the claim and add the additional diag-
entering the number into Eos.
nosis code(s).
NOTE What if the claim is not registered?
b If the claim is or has been managed in another unit:
Identify the client’s party record using details
1. Change the Outcome Status field to Investigating.
from the ACC18 request. Check the Documents
2. Create a General Task saying ‘Please assess addi-
tab for an unlinked claim form.
tional diagnosis’
3. Send the task to that managing unit/team.
• Contact Provider/Client advising the claim has
Go to Step 3 Complete ACC18 request.
not been registered yet with ACC.
However if the task is for a create party we do
c If the claim has not been managed in another unit:
not need to call the provider as DMT have done
1. In Eos, change the Outcome Status field of the diag-
this part of the process.
nosis to Investigating.
• If the request was sent by the same provider
2. Create a NGCM Action Medical Certificate task saying
who initially consulted the client, request they
'please assess additional diagnosis'.
send both the ACC45 claim form and the ACC18
3. Send it to 'Cover assessment - General cover".
form together so the claim can be registered and
4. Go to step 3.0. Complete ACC18 request.
uploaded/filed away appropriately.
NOTE What if the additional diagnosis has been
• If the request was sent by a different provider,
made more than 12 months from the date of
contact the client to get the details of the lodging
accident?
provider or obtain a copy of the ACC45 Claim
Transfer the ACC18 task to the appropriate team
form via e-mail. Then make contact as per the
for assessment ie Cover assessment - General
first point.
cover
PROCESS Contact Client or Provider for
Information at Lodgement
NOTE What if this is for a Maternal Birth Injury
claim in Actioned cases or any other Recov-
NOTE What if the task is for a party record crea-
ery Teams?
tion?
Create an NGCM Action Medical Certificate task
Create a new party record using the details on
and transfer the claim to the MBI queue.
the ACC18 and return to the Hamilton SC -
Administration queue
NOTE What if this is for a Maternal Birth Injury that
is Actively managed by the MBI Supported
Recovery team?
NOTE What should you do with the ACC18 task
Create an NGCM Action Medical Certificate task
when additional information is requested?
and transfer to the MBI Supported Recovery
Put the task on hold for 48 hours.
team.
ACC > Claims Management > Manage Claim Registration and Cover Decision > Register Claim > Complete ACC18 Medical Certificate Request
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GOV-040419
NOTE What if the request is for a diagnosis side or
date of accident update?
We can update the diagnosis side or date of
accident as long as its within 12 months of the
lodgement date.
We cannot amend a late lodged claim, and this
will need to be sent to Cover Assessment for re-
assessment.
3.0 Complete ACC18 request
Lodgement Administrator
a Forward the request to the Document Management team.
ACC45s for Document Management Team
NOTE What if the request has been received via
email or fax?
• Forward the email to [email address].
• If received by fax, transfer the file to "z ACC45
from Rego" folder to be uploaded by DMT.
Timeframes
None Noted
ACC > Claims Management > Manage Claim Registration and Cover Decision > Register Claim > Complete ACC18 Medical Certificate Request
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GOV-040419
Request a Change to a Claim Lodgement Form v4.0
b Complete a Digital Channel Impact Assessment:
Summary
• Assess in an Impact Assessment spreadsheet what sys-
tems or other forms will be impacted by the update.
Objective
• Consider ACC provided self-service channels and exter-
To ensure all necessary factors are considered, the right people
nal connections with Practice Management systems
are consulted and engaged, and the required standards, re-
c Ensure there is sign off from the Head of Department
views and sign offs are followed before the form is updated.
who has made the change request.
This applies to the following forms only:
d Email the Head of Service Operations asking for
• ACC18 Medical Certificate
endorsement to proceed to forming a working-group of
• ACC32 Request for prior approval of treatment
key stakeholders and Subject Matter Experts (SMEs).
• ACC42 Dental Injury Claim Form
• ACC45 ACC Injury Claim Form
• ACC46 ACC Electronic Input Injury Claim Form
2.0 Review and endorse the request
• ACC46N ACC electronic input injury claim form
Head of Service Operations
a Review the proposed changes.
If the form to be updated is not one of these, go to the process
'Triage and Allocate a PART FLIS Request.' linked in Activity 1.0
b Approve the changes.
below.
NOTE What if you do not approve the change?
Background
Email the Form Change Lead with rationale for
The forms are in both printed and digital formats. The digital
declining the proposed change.
form interfaces with ACC digitally, manual forms are printed and
c Send approval to Form Change Lead.
supplied to Providers by True North.
NOTE What if the change is not approved/declined?
Due to the cost and complexity of any updates, there must be a
• If change can be made, requestor can make
priority and material reason to update this form.
changes and go back to 1.0d.
• If change is not material and therefore not
worth carrying out this process, log change re-
Owner
[Out of Scope]
quest in 'change document to consider when the
Expert
[Out of Scope]
form is next updated due to a material change.
Procedure
3.0 Set up a working group
1.0 Engage the form owner and carry out an impact
Form Change Lead
assessment
a Receive approval.
Form Change Lead
b In an appropriate Microsoft Teams SharePoint folder
a Determine what needs to be updated and the priority
(ensure appropriate access), create a new corres-
before requesting endorsement to proceed.
pondence folder.
NOTE What needs to be reviewed before requesting
NOTE What should the correspondence folder con-
endorsement to proceed?
tain?
• What needs to be updated.
• Previous versions
• What is the priority and timeframe
• All email correspondence relating to updating
• Changes proposed that were not previously ap-
the form.
proved, and reason given.
c Identify key SMEs and stakeholders and request they
• The previous change correspondence
attend a meeting to form a working-group.
• Any other background information.
• A cost estimate should be drafted on a State-
NOTE Who do you invite?
ment of Work form (update to paper form), taking
The Form Owner and request a representative
into account all the costs and related budget
from:
holders sign off (Cost Centres and Agile Release
• Rehab and Treatment Portfolio
Train (ART)).
• Privacy and Legal
• Evaluate if a Communication plan is needed.
• Procurement (as cost centre responsible for
NOTE If your change is not for one of the following
paper forms)
digital forms go to 'Triage and Allocate a
• Brand and Identity
PART request' process.
• Communications and Engagement team
• Customer Engagement (if they are not required
• ACC18 Medical Certificate
at the meeting, check when to engage with
• ACC32 Request for prior approval of treatment
them)
• ACC42 Dental Injury Claim Form
• ACC45 ACC Injury Claim Form
• Depending on the change - the Product Man-
• ACC46 ACC Electronic Input Injury Claim Form
ager from the ART that will be involved in the
• ACC46N ACC electronic input injury claim form
update will need to be part of the working group
PROCESS Triage and Allocate a PART
to accept the work and prioritise it in P.I. plan-
FLIS request
ning.
Computer-generated ACC45
d Set up a meeting for the Claim Lodgement Form Change
Working Group.
e Send invite.
ACC > Change Management > Manage Change to an ACC Form > Request a Change to a Claim Lodgement Form
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GOV-040419
4.0 Attend the working group meeting to confirm
the changes
ACC Form Working Group, Form Change Lead
a Set roles, responsibilities and expectations.
b If needed, complete a RASCI (Responsible, Accountable,
Supporting, Consulted and Informed Framework Assess-
ment) to determine additional stakeholders for the
change.
NOTE Which teams could be considered as addi-
tional stakeholders?
Stakeholders on the understand the complexity
of the work, the cost and the timeframe:
• Digital Channel Owners
• Channel Operations
• Procurement
Determine if the following teams should be in-
volved in the work, and to help understand the
organisational impact of the changes.
• Prevention and Partnerships
• Strategy, Engagement and Planning
• Enterprise Change Delivery
• Tūhono Tangata
RASCI Guide
c Confirm changes to be made to the form.
d Determine if the change will mean that existing paper
copies of the form in stock need to be discarded.
e Record outcomes, agreements and considerations.
PROCESS
Update a Claim Lodgement Form
Form Change Lead
Timeframes
None Noted
ACC > Change Management > Manage Change to an ACC Form > Request a Change to a Claim Lodgement Form
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Page 3 of 3
Document Outline
