SOP ACC Excerpts.pdf

Standard Operating
Procedure
Excerpts relating to ACC

Disclosed under the Approved: April 2017
or the Privacy Act 1993

Official Information Act 1982

Health and Disability Commissioner
PART 2: INITIAL CONTACT

2.1
INTRODUCTION: WAYS IN WHICH A PERSON CAN COMPLAIN
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2.1.
2
Telephone
The  Complaints  Assessment  Team  has  dedicated  Helpline  Complaints  Assessors  who  are
primarily responsible for answering HDC’s 0800 number. A large number of initial contacts to
HDC are made through this number.
Process
The  Helpline  Complaints  Assessor  will  make  an  assessment  of  the  call  and,  for  enquirers,
provide information on:
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  How to contact another appropriate agency (WINZ, ACC, providers).
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2.2
FACTORS TO CONSIDER WHEN ASSESSING A CONTACT
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2.2.3
Jurisdiction
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Process
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  Where an OJ complaint concerns the actions of another Government agency (for example,
WINZ or ACC) it is not standard practice to advise the agency about the complaint unless
there is some reason it should be brought to the attention of that agency.
PART 3: ASSESSMENT OF COMPLAINT
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Disclosed under the

3.2
GATHERING INFORMATION: COMPLAINTS ASSESSMENT TEAM
3.2.
1 Section 14(1)(m) requests
or the Privacy Act 1993
…  Official Information Act 1982

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Health and Disability Commissioner
Discussion
Further  information  is  often  gathered  in  order  to  make  a  preliminary  assessment  of  a
complaint (referred to as s14(1)(m) request). Factors to consider when determining whether
to obtain further information include:
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  ACC files
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Process
Relevant points to note when drafting a section 14(1)(m) letter are:
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  It is often useful to obtain information from ACC when a treatment injury claim has been
lodged.1 In this case, the section 14(1)(m) letter needs to be accompanied by an ACC form,
which  includes  check  boxes  for  the  information  required.  In  most  cases,  copies  of  ACC’s
decision  letter  and  any  clinical  or  external  expert  advice  are  requested.  Information
requests to ACC should be sent by email only and copied to the Team Leader.
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PART 4: PRELIMINARY ASSESSMENT DECISIONS

4.1
PRELIMINARY ASSESSMENT DECISIONS AVAILABLE
The decisions available to the Commissioner under section 33 of the Act are set out below. Some of
these decisions have been delegated (see Appendix 3: Delegations):
  Referral  to  an  agency  or  person  in  accordance  with  section  34  or  section  36  (section
33(1)(a)(i)):
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—  ACC — section 34(1)(b) (see 4.3 Referral to ACC )
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4.3
REFERRAL TO ACC
Disclosed under the
See Appendix 11: Referrals and  Notifications.
or the Privacy Act 1993
Under section 34(1)(b) of the Act, the Commissioner may make  a referral to ACC where it appears
from the complaint that the aggrieved person may be entitled to cover under the ACC Act.
Official Information Act 1982

1 A treatment injury claim is applicable only if the injury has been caused by a registered health professional.
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Health and Disability Commissioner
Discussion
In  practice,  this  is  used  by  the  Complaints  Assessment  Team  only  rarely,  as  typically  the
complaint  will  contain  other  issues  that  the  Commissioner  can  address.  The  preferred
approach  is  to  advise  the  complainant  orally,  in  the  acknowledgement  letter  or  in  a  section
38(1) letter, that he or she may wish to lodge a claim with ACC.
Process
  Where the provider has not already been provided with a copy of the complaint, copies of
the complaint should be sent to the provider. The provider should be made aware of the
action taken.
  If formally referring to ACC under section 34(1)(b), a copy of the complaint and letter to the
complainant should also be sent to ACC.
  Under section 35 of the Act, ACC must report back to the Commissioner on any steps taken
as a result of the referral.
Section 34(1)(b) letters
Relevant templates:
  Referring to ACC under s34(1)(b) use:
—  Non-standard letter and write to consumer, provider and ACC.
  If closing but advising complainant to contact ACC use either :
—  s38 letter – early resolution, or
—  OJ letter and write to the consumer and provider.
See Appendix 3: Delegations and Appendix 3a: Delegations Chart
ECDS action:
  Set file stage to Drafting early resolution letters.
  Once the draft letter is appropriate for review, set the file stage as appropriate e.g.
With Team  Leader/senior for  review  or  File with DCCR/DCD/MHC for steer/review
or    File  with  DCCR/DCD/MHC  for  signing  or  Early  resolution  letters  with  Team
Leader for signing.
Disclosed under the
  Once the letters have been sent, give the file to Senior/Team Leader for closing.
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or the Privacy Act 1993
PART 5: SECTION 38(1) AFTER FURTHER INFORMATION OBTAINED
Official Information Act 1982

5.1
DECISION TO TAKE NO FURTHER ACTION
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Health and Disability Commissioner
Discussion
In  addition  to  the  factors  listed  in  the  Act,  factors  relevant  in  deciding  whether  to  take  no
further action include:
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  The complaint would be more appropriately dealt with by another agency under section
59(4) (see PART 11: OTHER REFERRALS). For example:
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—  Complaints  about  reports  written  for  the  purpose  of  an  ACC  claim  or  WINZ
benefit.
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PART 6: NOTIFICATION OF INVESTIGATION
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6.3
CONTACT WITH OTHER AGENCIES
6.3.
1 Coroner
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If  the  complaint  involves  an  injury  that  is  the  result  of  treatment,  the  Investigator  should
consider whether to make a request to ACC to check its involvement.
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PART 7: INVESTIGATION

7.2
SOURCES OF EVIDENCE
The investigator should consider obtaining evidence from a range of sources, including the following:
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  Other agencies, for example, ACC, Coroner, Police, Worksafe, Ministry of Health
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Disclosed under the

7.3
EVIDENCE TO OBTAIN
or the Privacy Act 1993
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The Investigator should request any other relevant information at this stage. For example:
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Health and Disability Commissioner
  Any  information  held  by  other  agencies  relevant  to  the  complaint  (eg,  Coroner,  Police,
WorkSafe, ACC).
PART 9: COMMISSIONER’S REPORT

9.3
REFERRAL TO DIRECTOR OF PROCEEDINGS
9.3.
1
Role of Director of Proceedings
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Damages (other than exemplary damages) are not available where there is ACC cover.
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PART 15: RELATIONSHIPS WITH OTHER AGENCIES
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15.4
COMPLAINTS INVOLVING ACC/WINZ
The Commissioner receives many complaints involving ACC. Principally these take one of two forms:
  Complaints about ACC’s decisions, processes or the actions of a case manager or other ACC
employee. As ACC is not considered to be a provider of health or disability services, these
complaints are outside jurisdiction (see 0 …

15.5 FACTORS TO CONSIDER WHEN ASSESSING A CONTACT
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  2.2.3  Jurisdiction).
  Complaints  about  an  assessment  conducted  by a  health  or  disability  service  provider  for
the  purposes  of  an  ACC  decision.  These  may  be  in  jurisdiction,  but  may  be  more
appropriately dealt with by another body. See discussion below.
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Discussion
Complaints  about  assessments  that  have  been  conducted  by  a  health  provider  for  ACC  or
WINZ are dealt with on a case-by-case basis. Relevant considerations are:
Disclosed under the
  Whether the complaint is more appropriately dealt with by ACC or WINZ through its own
review process (section 38(2)(e)).
or the Privacy Act 1993
  Whether  the  subject  matter  of  the  complaint  is  really  within  the  Commissioner’s
jurisdiction (e.g., is it about the content of the report, rather than the diagnosis?).
  The seriousness of the complaint.
Official Information Act 1982
  The expectations of the complainant.

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Health and Disability Commissioner
 Whether there are other similar complaints about the same provider.
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Disclosed under the
or the Privacy Act 1993
Official Information Act 1982
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