Guide to completing ACC12 File Summary form
This guide is for internal use only. Please use when completing the ACC12 File
Summary form.
PART ONE: BACKGROUND
1. Client details
Heading
Guidelines
Client’s name
Note whether there is a need to check pronunciation.
Check claims history for aliases. Need to avoid barriers being
raised, such as other injuries not being considered by assessors in
Vocational Independence (VI) assessments.
Also good to consider how any injuries sustained post incapacity
were caused, ie what the activities were and whether they are
contraindicated.
Claim number
Autogenerated
Date of Birth (DOB)
Note if the client is nearing New Zealand Superannuation
Qualifying Age (NZSQA) to ensure election reminder (or decision
letter) and WINZ letter are sent as appropriate. Consult Technical
Claims Manager (TCM) if uncertain. Refer to
Informe >
Entitlements, rehabilitation, treatment > Weekly compensation >
Cease due to upper age limits (NZSQA).
Consider the cost effectiveness of providing vocational
rehabilitation, in consultation with Team Manager (TM).
Date of injury (DOI)
If pre 01/07/92 consult TCM re cover criteria. Cover determination
varies under different legislation.
Ethnicity
If not identified check reports on file, especially social
rehabilitation reports. This should prompt us to arrange for
Cultural Advisor to input into the initial panel review.
Date of incapacity
If later than date of injury (ie delayed incapacity) we need to
check what ACC investigated to ensure entitlements were
established correctly, ie what evidence confirms a causal link
between the delayed incapacity and the injury sustained at the
date of injury.
Interpreter required See Informe > Other claimant-related procedures > Interpreters -
this link provides information about using interpreters and
language line.
Primary contact /
ACC Investigation Unit advise this is important if it’s difficult
Primary contact’s
getting hold of the client and/or they have a history of
relationship to
rescheduling appointments.
client
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Preferred contact
Be mindful of written communication if literacy issues are evident.
method
Use telephone to explain any letters sent.
If hearing impaired refer to
Informe > Other claimant-related
procedures > Interpreters for information regarding New Zealand
Relay (NZ Relay) service.
For sight impaired refer to Informe
> Entitlements, rehabilitation,
treatment >
Rehabilitation >
Social rehabilitation >
Entitlements
>
Visual impairment services.
Note if any difficulties with contact, such as no phone coverage,
no access to telephone, PO boxes used. If history of mail going
missing invite client to utilise the ACC free phone 0800 101 996.
Use registered mail for important notices or appointments if
necessary.
Email: Many clients prefer to communicate by email and it does
provide a paper trail. Need to be careful not to breach privacy,
particularly if sending to a group/family email address. If in doubt
use other methods of communication.
2. Injury details
Heading
Guidelines
Cause of injury
What was the mechanism of injury/what are the accident details?
Is there a causal link between this and the original diagnosis and
current diagnosis?
Original diagnosis
Ensure it is clear what injury ACC accepted cover for.
Current diagnosis
If injury diagnosis has changed, ACC needs to ensure the ongoing
incapacity still relates to the injury we accepted cover for. Watch
for additional diagnoses on longer term claims, especially injury
sites changing from one side to another or mental injury
diagnoses being added, such as Post Traumatic Stress Disorder
(PTSD) or Post Concussion Syndrome (PCS).
Less severe injuries at date of accident (DOA) becoming more
symptomatic could be signs of degenerative disease process.
Injuries for which
Review claim file and record details of any consequential
cover has been
injuries/new diagnoses, including mental injury, which have been
approved
accepted for cover.
Current GP
How involved is the GP? Do they see a regular GP or just any GP
available, eg at a larger practice?
PART TWO: ASSESSMENT AND TREATMENT
3. Surgery funded by ACC
Heading
Guidelines
Surgery type
Include surgeries covered by other claims if to the same injury
site, ie previous or new claims. These need to be taken into
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account when considering injury causation – BMA input may be
required.
Comment on End of
Review the End of Care Reports to note outcome, functional
Care Report -
improvements and compliance with treatment. Compare how the
Prognosis
client presented when discharged by the surgeon to how they
present now.
4. Treatment reports
Heading
Guidelines
Comments /
Try to summarise comments in a way that both you as the case
Summary
owner, and other staff reading your summary, can get an idea of
the key findings or recommendations of the reports listed.
Pain management
It’s important to note the type of provider used, eg whether there
is psychologist, medical specialist, occupational therapist (OT) or
physiotherapist involvement.
Comment on engagement with programmes and outcome.
Social rehabilitation
Where social rehabilitation needs have been assessed or
assistance is being provided this can provide information
regarding the client’s activities and support systems.
Vocational rehabilitation
Consider the timing and appropriateness of these interventions.
Indicate in the Comments / Summary section how engaged the
client was or whether any barriers were raised.
Good to list all attempts made here and, in particular, training
courses and whether these were included if an IOA was updated
or repeated.
Other treatment
Consider if there are multiple medical reports and how the
medical evidence is weighted overall. Conflicting medical opinion
is more common with longer term claims and may require some
further clarification.
Need to consider if the most appropriate specialist has been
consulted. Good to have Branch Advisory Psychologist (BAP)
review the claim if any psychology involvement.
Clarify main cause of incapacity if multiple injuries, or if the
diagnosis has changed or other diagnoses have been added over
the years.
Note what medications they are currently prescribed. Are they
ACC funded? If taking multiple medications, do they relate to the
injury for which they are claiming incapacity?
Medications may uncover non-injury related health issues. These
are good to consider in vocational rehabilitation as some
medications may be contraindicated with certain working
environments, eg driving or operating heavy machinery, working
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at heights etc.
Check if ACC funded medications are the most appropriate and
cost effective options. If pain is a barrier to rehabilitation and no
analgesia is being utilised, the best approach and further options
should be discussed with the advisory panel.
PART THREE: REHABILITATION
5. Work history details
Heading
Guidelines
Was the client an
If not, consult TCM to consider if Section 105 of the AC Act
earner at date of
applies. Circumstances such as purchase of time out, cover, or
injury (DOI)?
loss of potential earnings may apply although fairly uncommon.
Occupation at time
If the client was employed in more than one occupation are they
of injury
incapacitated for them all?
Was the client’s
If no work site assessment has been completed we may want to
pre-injury work
consider using work type detail sheets. May also need to have
assessed?
panel provide advice re s103 considerations, depending on pre-
injury role.
Did the client
The s103 test relates to the employment at the time of the
remain in the same
personal injury, not the employment held at date of first
occupation at DOI
incapacity (DOFI) or date of subsequent incapacity (DOSI).
and DOFI/DOSI?
Has the client
Time to check we have applied abatement correctly. What is
worked in any
preventing this client from increasing their work hours or return to
capacity since the
independence?
injury? / Details of
work since injury
6. Vocational rehabilitation details
Heading
Guidelines
Initial Occupational
Always consider whether the work types recommended are
Assessment (IOA)
realistic considering the client, their history and their training,
skills and experience. Ensure literacy/numeracy issues have been
considered.
Date of IOA
Note currency and quality of IOA. Consider consulting TM or TCM
re whether to update or repeat IOA if there are quality issues.
Educational details
Good to cross reference stated assets and strengths in CV with
any perceived barriers from client or others. CVs are valuable for
validating strengths and transferable skills.
Consider questioning if literacy is raised as a barrier as
qualifications gained may contradict this.
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Voluntary activities
Consider functional demands of such activities in relation to
or hobbies relevant
current incapacity for work. It’s important to verify that the client
to vocational
is aware they need to tell us about their activities, including non-
rehabilitation
paid work. This should be flagged to reiterate during re-
engagement appointments/interviews.
Barriers to
Review IOA report and note any barriers to vocational
vocational
rehabilitation or work.
rehabilitation
IOA
Review IOA report and note recommendations made for
recommendations
vocational rehabilitation. Cross reference with work types cleared
for vocational
in the IMA and vocational rehabilitation already completed.
rehabilitation
Initial Medical
Ensure that any recommendations made in this report have been
Assessment (IMA)
considered and completed or rationale provided for not
completing.
Date of latest IMA
Note currency of IMA. Consider whether any surgeries or other
interventions have occurred subsequent to the IMA which may
have impacted on the findings. Consider whether a new IMA may
be required.
IMA
Review IMA for rehabilitation recommendations. Cross reference
recommendations
with rehabilitation interventions already completed.
Are there any non-
Consider what the substantive cause of incapacity is. If necessary,
injury related issues consult with Branch Medical Advisor (BMA), BAP, TCM or case
noted in the IMA?
conference with all.
Work type options
Check quality of IMA and client sentiments as an indicator of
identified as
motivation and confidence.
suitable in the
latest IMA
7. Activities of daily living details
Heading
Guidelines
Current social
Note what activities are not being attempted by the client. More
rehabilitation
importantly, note what activities they are able to manage
entitlements being
functionally and how this capacity might transfer into a work
received
setting.
Caring for young children and large properties requires a good
level of functional ability. The client may want to consider a
lifestyle choice of working and being available for vocational
rehabilitation, or declining to participate in rehabilitation or return
to work and choosing to have their entitlements declined.
Previous significant
Good to acknowledge progress made in the past with increasing
social rehabilitation
independence. If the client has had extensive Training for
entitlements
Independence (TI) programmes, need to consider this in referrals
received
for further social rehabilitation.
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For example, what were the goals that were worked on and how
can these assist in vocational rehabilitation, eg use of public
transport, computer training in the home etc? What equipment
has been funded by ACC?
Injury-related
If the client lives with other people, how many vehicles do they
limitations in
own, ie do they have access to transport or has this access
accessing transport
changed?
Current living
Since DOA have responsibilities of other household members
arrangements and
changed? Consider ‘Added worker effect’ - this is described as the
household
tendency of other household members capable of work to enter
responsibilities
the labour market. Good to consider this if barriers are raised re
childcare or transport.
Consider impact of dependents (may include children, parents,
other relatives.) Note age of children and consider whether it is
reasonable for them to be responsible for assisting with household
tasks, eg teenagers.
Consider level of dependency and any changes to childcare
responsibilities post injury.
Is childcare logistics a barrier for
return to work (RTW)? What were their childcare arrangements
before the injury?
Consider other household members receiving entitlements. Good
to know if a spouse is also receiving ACC or Ministry of Social
Development (MSD) entitlements.
8. Individual rehabilitation plan details
Heading
Guidelines
IRP outcome date / Note Individual Rehabilitation Plan (IRP) outcome date and next
Date of next
monitoring step date for consideration in prioritising actions and
monitoring step
timing of interventions.
Have the GP and
Check to ensure the GP, and employer if applicable, have been
employer been
invited to participate in IRP.
invitied to
participate in the
IRP?
Has the IRP been
Check the quality of the IRP and note areas to discuss with the
updated to include
client in next negotiation.
suitable work types IRPs are important for ensuring we are agreed on the goal of their
and
rehabilitation, and can be used as evidence in litigation.
recommendations
for rehabilitation?
Is there a history
Consider this in planning future meetings and approaches.
of unreasonable
failure or refusal to
negotiate or
comply with ACC’s
requests?
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Is there a history
What were the circumstances?
of deemed IRPs?
PART FOUR: CLAIMS / PAYMENTS
9. Claims history
Heading
Guidelines
Total number of
Be thorough. We do not want to miss any as this can be raised as
claims
a barrier for Vocational Independence (VI) assessments.
Previous incapacity
Good to know if the client has had a history with ACC. What was
for work on any
the relationship like? How did they return to independence from
claims?
that claim or was the incapacity transferred to this claim? Is there
any residual incapacity from other claims to consider? Is their
incapacity still assigned to the correct claim?
Previous work
It’s important to consult your TCM about these clients. Previous
capacity (WCAP),
decisions are important for determining what work types were
Work Rehabilitation
considered sustainable and what pre-injury work type the client
Assessment Process was incapacitated from. We need to confirm what job or work
(WRAP) or
type the client has incapacity for, and their entitlement to loss of
Vocational
earnings.
Independence (VI)
For example, a client might start working in a job very similar to
decisions on any
pre-injury work type once weekly compensation entitlement ends.
claims?
If they have a subsequent injury, what work are they now
incapacitated for / receiving loss of earnings for?
Hearing loss claim
This has been a significant barrier and cause of quashed VI
decisions, due to ACC not considering all injury claims and
contraindications for work types.
Usually there is an audiology report available on these claims
which should be included in referrals to assessors for IMA or
VIMA.
Mild traumatic brain
Consider presentation at time of injury. Severity of Traumatic
injury
Brain Injury is categorised as Mild, Moderate and Severe. Some
moderate, and all severe, brain injuries are managed by our
National Serious Injury Service (NSIS).
Cumulative effects of subsequent brain injuries are thought to
result in increased difficulties and more moderate incapacity and
may need further investigation. If a diagnosis of Post Concussion
Syndrome (PCS) has been made we may need to investigate
further.
Utilise BAP to provide advice for traumatic brain injuries.
Sensitive claims
Need to consider this in regards to VI assessments.
history
Liaise with Sensitive Claims unit to forward relevant assessment
reports to providers.
Liaise with Sensitive Claims unit to determine appropriate
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responsibilities for rehabilitation planning and follow-up.
Utilise BAP for advice.
Subsequent claims
Important to consider activity level post incapacity. How did they
sustain subsequent injuries, ie where, what, how etc?
Has the client had
Consider previous relationship with ACC for re-engagement period
any reviews or
- it may suggest we need to take steps to improve our
appeals?
relationship in order to assist in progressing their rehabilitation.
We may want to agree on the best methods for us to
communicate, ie some ground rules etc.
Rehabilitation can be significantly delayed by excessive litigious or
vexatious behaviour. Consult TM for advice in what is reasonable.
Has there been any
Good to be well informed of any previous issues to assist in
advocacy or legal,
planning contacts and communication.
Office of Complaints
(OCI), ministerial or
MP involvement
with this claim?
10. Financial details
Heading
Guidelines
Compensation
To answer the questions about compensation, extract relevant
data from the Transaction Summary Report (Reporting Portal):
Access to 4.01 Transaction Summary Report from Reporting
Portal
o
Go to: Start/Business Applications/ACC Reporting
Portal/Operational Reports
o
Under EOS Reports click 4.01 Payment Reports
o
Fill in claim number then click Search
o
Confirm the details are correct by clicking the tick box
(bottom of screen)
o
Click Next
o
Enter From date (DOA)
o
Click Run Report
o
File Download PDF box will pop up
o
Click Open
o
Extract relevant data for the file summary
If self employed,
Ask the client, do not assume, and check IPS2 for any declared
has their business
losses.
ceased?
Companies website
You can also check http://www.companies.govt.nz/cms to
checked
determine if a company has been opened in another name if you
know the name of the previous company.
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Have end of year
Consult your TCM to ensure entitlements have been calculated
financial accounts
correctly both originally and ongoing.
been reassessed to
ensure correct
payments of weekly
compensation
(otherwise known
as a “wash-up”)?
PART FIVE: FORMS
11. Mandatory forms
This is a good opportunity to ensure consent form and declaration of responsibilities are
completed and current.
PART SIX: SUMMARY / RECOMMENDATIONS
12. Summary
Answering the summary questions provides an opportunity to consider what information
needs to be clarified or obtained and who you would like to consult for advice.
Co-morbordities, other injuries and related issues could be such things as pre-existing
physical or mental health issues, drug and/or alcohol dependence, smoking (prevents some
surgery), obesity, convictions, history of violence or threatening behaviour, or any other
issues which impact on their recovery and have not been detailed elsewhere in the
summary.
13. Case manager’s recommendations and action plan
This is an opportunity for the Case Manager to document their findings from the intensive
file review and summary, and note their plan of action. This can be useful when consulting
internal experts as it provides them the opportunity to endorse or suggest alternatives for
ongoing management.
14. Panel comments & recommendations
This provides a collective space for various consultants to record their recommendations.
Having reviewed other recommendations it enables a team to summarise and agree on a
cohesive plan for ongoing rehabilitation or assessments. The option is to have the summary
reviewed in a case conference approach or as individual consultations/referrals.
PART SEVEN: SIGNATURES
15. Panel members’ signatures
It’s useful to record who has been consulted – this is to avoid repetition and provide
opportunity to refer back to this summary in the future.
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