GOV-041057
Cover Criteria for Sensitive Claims Policy v19.0
Summary
4.0 Consent
a Mental injury that may have occurred as a result of
Objective
consensual activity is not generally covered. Section
Refer to this guidance to determine cover for a mental injury
128A of the Crimes Act 1961 explains some circums-
caused by a sexual offence.
tances where a person may have engaged in some activ-
ity but, in a criminal law context at least, they have not
consented to it. This includes where a victim is mistaken
Owner
[Out of Scope]
as to the nature and quality of the activity.
Expert
b If you are unsure whether the client consented or the
[Out of Scope]
events are within an offence listed in Schedule 3, please
seek guidance from Technical Services. Technical Ser-
Policy
vices may refer the query on to the Complex Mental
1.0 Eligibility
Injury Panel if required.
a A client has cover under Accident Compensation Act
Guidance document for considering a schedule 3
2001, section 21 if the following apply:
event
c In cases where consent is in question, you may want to
• the client was the victim of an act listed in Accident
consider some of the cases and examples outlined
Compensation Act 2001, Schedule 3
below.
• there is a mental injury arising from that act
NOTE Example: Non-disclosure of HIV status
In cases where a person does not disclose their
• the act occurred in New Zealand or, if the act occurred
HIV status to the person with whom they are
outside New Zealand, the client was ordinarily resident in
having sexual relations before engaging in
New Zealand at the time of the act.
sexual activity, this deception changes the nature
and quality of the act, and therefore it could not
be said that the victim freely gave their informed
consent.
2.0 Schedule 3 of the Accident Compensation Act
2001
NOTE Example: Where sexual relations are only
agreed to on the basis of condom use
a Schedule 3 provides a list of major sex offences covered
In cases where intercourse is consented to only
by the Crimes Act 1961. No one needs to be charged
on the basis of condom use, the removal of the
with or convicted of the offence listed for a victim to get
condom means there is no consent. This is true
cover.
both, i) in instances of 'stealthing' where the
b ACC accepts that “caused by” means the event(s) in
condom is removed without the other part's
question was a material or significant cause of the
knowledge and, ii) where the other party is
claimed mental injury.
aware but is unable to stop the sexual relations
c
from proceeding.
This means that when multiple causes are identified, the
event in question while not being the predominant cause
NOTE Example: A person's partner falsely tells
of the mental injury does need to be a significant factor
them they have had a vasectomy
rather than have minimal significance.
The person falls pregnant and the pregnancy is
unwanted. As in the previous scenarios, the
person has been deceived about the nature and
3.0 Considering cover for schizophrenia as a
quality of sexual relations with their partner and
mental injury caused by sexual abuse
there is no consent.
a All claims for cover of schizophrenia as a mental injury
caused by sexual abuse need to be referred to the Com-
5.0 Date of injury
plex Mental Injury Panel (CMIP).
b
a The date the client first receives treatment for a mental
Any decision to grant cover for schizophrenia as a mental
injury known to be caused by sexual abuse is regarded
injury caused by sexual abuse will need to meet the ACC
as the date of injury, as per section 36(1) of the Accident
definition of 'caused by', ie the events in question was a
Compensation Act 2001.
material or significant cause of the claimed mental injury
c When cover is requested for schizophrenia as a mental
This can be satisfied by the date that any treatment is
injury caused by sexual abuse, providers need to be sent
provided, and that treatment or counselling can be ac-
a summary of ACC’s externally peer reviewed evidence-
cepted in retrospect to have been provided for a mental
based report: Childhood Adversity and Psychotic Dis-
injury due to the underlying sexual abuse, even if a sche-
orders.
dule 3 event was not disclosed at that time. This includes
disclosure to or treatment from a counsellor or nurse at
Childhood Adversity and Psychotic Disorders..pdf
the school where the client attends/attended.
ACC > Claims Management > Manage Claim Registration and Cover Decision > Operational Policies > Cover Decision > Sensitive Claims > Cover Criteria for Sensitive Claims
Policy
Uncontrolled Copy Only : Version 19.0 : Last Edited Friday, 19 April 2024 12:01 pm : Printed Friday, 4 July 2025 12:20 pm
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GOV-041057
b If the sexual abuse was not disclosed, ACC will continue
to accept an earlier deemed date of injury if the clinical
evidence demonstrates:
• the client had consulted with a treatment provider for
the same condition which ACC has accepted for cover on
the sensitive claim
• the treatment provider kept clinical notes recording the
mental injury and what treatment was recommended
• the overall evidence suggests the client was consulting
the treatment provider in relation to the sexual abuse
even though the sexual abuse wasn’t explicitly mentioned
to the treatment provider at that time
c You can seek the opinion of a Psychology Advisor to
determine whether the symptoms identified are symp-
toms of the covered mental injury.
NOTE The legislative definition of treatment pro-
vider applies
It is not sufficient grounds to change the date of
injury because the client discussed the sexual
abuse or symptoms of mental injury with a social
worker or priest.
d For claims lodged under the 1972 and 1982 Acts, the
date of the injury is the date of the abuse event, not the
date when treatment was first received.
6.0 Timeframes for cover decision
a A sensitive claim is regarded as a complicated claim
under the AC Act and ACC is allowed extra time to make
a decision. See Timeframes to determine cover for more
information.
Timeframes to determine cover Policy
7.0 Links to legislation
Accident Compensation Act 2001, section 21 Cover
for mental injury caused by certain criminal acts
http://www.legislation.govt.nz/act/public/2001/0049/latest/DLM100693.html
Accident Compensation Act 2001, Schedule 3 Cover
for mental injury caused by certain acts dealt with in
Crimes Act 1961
http://www.legislation.govt.nz/act/public/2001/0049/latest/DLM105476.html
Timeframes
None Noted
ACC > Claims Management > Manage Claim Registration and Cover Decision > Operational Policies > Cover Decision > Sensitive Claims > Cover Criteria for Sensitive Claims
Policy
Uncontrolled Copy Only : Version 19.0 : Last Edited Friday, 19 April 2024 12:01 pm : Printed Friday, 4 July 2025 12:20 pm
Page 2 of 2
