(1) This section and sections 40 to 47, 265, and 274(3) come into force on the day after the date on which this Act receives the Royal assent.

(2) Clauses 56(5) and 64(2) of Schedule 1 come into force on 1 April 2003.

(3) The rest of this Act comes into force on 1 April 2002.

The purpose of this Act is to enhance the public good and reinforce the social contract represented by the first accident compensation scheme by providing for a fair and sustainable scheme for managing personal injury that has, as its overriding goals, minimising both the overall incidence of injury in the community, and the impact of injury on the community (including economic, social, and personal costs), through—

• (a) establishing as a primary function of the Corporation the promotion of measures to reduce the incidence and severity of personal injury:

• (b) providing for a framework for the collection, co-ordination, and analysis of injury-related information:

• (c) ensuring that, where injuries occur, the Corporation's primary focus should be on rehabilitation with the goal of achieving an appropriate quality of life through the provision of entitlements that restores to the maximum practicable extent a claimant's health, independence, and participation:

• (d) ensuring that, during their rehabilitation, claimants receive fair compensation for loss from injury, including fair determination of weekly compensation and, where appropriate, lump sums for permanent impairment:

• (e) ensuring positive claimant interactions with the Corporation through the development and operation of a Code of ACC Claimants' Rights:

• (f) ensuring that persons who suffered personal injuries before the commencement of this Act continue to receive entitlements where appropriate.

In general terms, this Act is arranged as follows:

• (a) Part 1 deals with preliminary matters such as the purpose of the Act and definitions:

• (b) Part 2 determines whether a person has cover:

• (c) Part 3 provides—

  • (i) for the preparation and approval of a Code of ACC Claimants' Rights; and

  • (ii) how to make a claim under this Act for cover and entitlements, and the process the Corporation must follow in deciding claims:

• (d) Part 4 sets out what the entitlements are and Schedule 1 sets out the detail of the entitlements:

• (e) Part 5 provides for the resolution of disputes about decisions:

• (f) Part 6 provides for the management of the Scheme and for the setting and collection of levies:

• (g) Part 7 continues the Accident Compensation Corporation and governs its operations:

• (h) Part 8 relates to the management of injury-related information:

• (i) Part 9 sets out miscellaneous provisions such as provisions about offences and penalties, and regulation-making powers:

• (j) Part 10 provides for the continuation of an orderly transition from the competitive provision of workplace accident insurance:

• (k) Part 11 provides transitional provisions for cover, entitlements, reviews and appeals, and financial matters relating to former Acts.

This Act binds the Crown.

(1) In this Act, unless the context otherwise requires,—

(2) An example used in this Act is only illustrative of the provision it relates to. It does not limit the provision.

Acute treatment, in relation to a claimant, means—

• (a) the first visit to a treatment provider for treatment for a personal injury for which the claimant has cover; and

• (b) the following treatments if, in the treatment provider's reasonable clinical judgment, the need for the treatment is urgent (given the likely clinical effect on the claimant of any delay in treatment):

  • (i) any subsequent visit to that treatment provider for the injury referred to in paragraph (a); and

  • (ii) any referral by that treatment provider to any other treatment provider for the injury referred to in paragraph (a).

(1) When this Act says a claimant has cover, it means that the claimant has cover for a personal injury—

• (a) under any of sections 20, 21, or 22, for a personal injury suffered on or after 1 April 2002; or

• (b) under Part 10 or Part 11, for a personal injury suffered before that date.

(2) When this Act says that an injury is covered by this Act, it means that the injury is a personal injury for which a claimant has cover.

(1) Earnings as an employee, in relation to any person and any tax year, means all PAYE income payments of the person for the tax year.

(2) This section is subject to sections 10 to 13.

(1) Earnings as an employee, in relation to any person and any tax year, does not include any amount paid to the person (person A) for services he or she performs for his or her spouse or partner (person B), as person B's employee or otherwise.

(2) However, subsection (1) does not apply if person B, in order to calculate his or her income for the purposes of the Income Tax Act 2007, has made a written application for, and obtained, the Commissioner's consent to a deduction being made for any amounts paid by person B to person A for the services person A performs.

(3) If subsection (2) applies, account must be taken of the following in determining person A's weekly earnings for as long as the Commissioner's consent relates to the services and to the amounts paid:

• (a) the services performed by person A after the date on which the Commissioner receives person B's application; and

• (b) any amounts paid after the date on which the Commissioner receives person B's application.

(4) The Corporation may accept that there has been sufficient compliance with subsection (2), and levies are payable accordingly, if—

• (a) person A provides services to person B; and

• (b) person B submits or has submitted a return of income to the Commissioner; and

• (c) person B shows the amounts paid to person A for such services in the return as an expense incurred in the production of income for the purposes of the Income Tax Act 2007; and

• (d) person A includes the amounts paid to him or her by person B for such services in a return of income submitted to the Commissioner; and

• (e) person A pays or has paid tax (if appropriate) on such amounts.

(1) Earnings as an employee, in relation to any person and any tax year, does not include—

• (a) any income-tested benefit, veteran's pension, New Zealand superannuation, living alone payment, or schedular payment; or

• (aa) any parental leave payments paid under Part 7A of the Parental Leave and Employment Protection Act 1987; or

• (b) any student allowance established in accordance with regulations made under section 303 of the Education Act 1989; or

• (c) any amount allocated to a person or persons, other than the person who is the employee in question, under sections CD 11, CW 63, DB 58, GB 23, and GB 24 of the Income Tax Act 2007; or

• (d) any amount deemed to be a dividend paid by any person, to the person who is the employee in question, under section GB 25 of the Income Tax Act 2007; or

• (e) any redundancy payment; or

• (f) any retiring allowance; or

• (g) any pension from a superannuation scheme or pension fund not registered under the Superannuation Schemes Act 1989; or

• (h) any pension that is paid in the circumstances set out in any of the following provisions:

  • (i) section DF 4 of the Income Tax Act 1994 or section DC 2 of the Income Tax Act 2004 or section DC 2 of the Income Tax Act 2007:

  • (ii) section DF 8A or section DF 8B of the Income Tax Act 1994 or section DC 3 of the Income Tax Act 2004 or section DC 3 of the Income Tax Act 2007:

  • (iii) sections FB 11 and FB 12 of the Income Tax Act 2007.

(2) In this section, income-tested benefit, veteran's pension, New Zealand superannuation, living alone payment, and schedular payment have the same meanings as in section YA 1 of the Income Tax Act 2007.

For the purpose of calculating the Work Account levy payable under section 168, earnings as an employee does not include any payment of—

• (a) first week compensation; or

• (b) weekly compensation.

The Corporation must treat the earnings of a private domestic worker as earnings as an employee.

(1) Earnings as a self-employed person, in relation to any person and any tax year,—

• (a) means A minus B, A being the amount described in subsection (2) and B being the amount described in subsection (3); and

• (b) does not include any earnings as an employee or earnings as a shareholder-employee.

(2) A is the amount of income (if any)—

• (a) that the person derives in the tax year for the purposes of the Income Tax Act 2007; and

• (b) that is dependent on the person's personal exertions.

(3) B is all amounts that the person is allowed as deductions for the purposes of the Income Tax Act 2007 because of the person deriving the income described in subsection (2).

(1) Earnings as a shareholder-employee, in relation to a person who is a shareholder-employee and any tax year, means—

• (a) the amount described in subsection (2) (the subsection (2) amount); or

• (b) the amount described in subsection (3) (the subsection (3) amount), if the Corporation decides that the subsection (2) amount is not a reasonable representation of the person's earnings as a shareholder-employee in the tax year.

(2) The subsection (2) amount is—

• (a) all PAYE income payments of the person for the tax year derived from a company of which the person is a shareholder-employee; and

• (b) all income of the person that is deemed to be income derived otherwise than from PAYE income payments under section RD 3(2) to (4) of the Income Tax Act 2007.

(3) The subsection (3) amount is an amount determined by the Corporation in the following way:

• (a) first, determine each of the following amounts:

  • (i) an amount that represents reasonable remuneration for the services that the person provides to the company as an employee of the company in the tax year; and

  • (ii) an amount that represents reasonable remuneration for the services that the person provides as a director of the company in the tax year; and

• (b) second, add the amounts described in paragraph (a)(i) and (ii), and the result is the subsection (3) amount.

(4) The earnings as an employee of the person as an employee of the company are the amount described in subsection (3)(a)(i).

(5) The director's fees of the person as a director of the company are the amount described in subsection (3)(a)(ii).

(6) The dividend of the person as a shareholder of the company is determined by the Corporation in the following way:

• (a) first, determine the total amount the company pays or provides to the person in any capacity in the tax year; and

• (b) second, deduct the subsection (3) amount from that total amount, and the result is the dividend of the person as a shareholder of the company and is not earnings of the person.

(1) New Zealand means—

• (a) the North Island, the South Island, Stewart Island, the Chatham Islands, and all other land territories, islands, and islets lying between the 162nd degree of east longitude and the 173rd degree of west longitude and between the 33rd and 53rd parallels of south latitude; and

• (b) those islands situated in the South Pacific Ocean lying between the 177th and 180th degrees of west longitude and between the 29th and 32nd parallels of south latitude, commonly known as the Kermadec Group; and

• (c) those parts of the internal waters of New Zealand (as defined by section 4 of the Territorial Sea, Contiguous Zone, and Exclusive Economic Zone Act 1977) adjacent to the land territories, islands, and islets referred to in paragraphs (a) and (b); and

• (d) those parts of the territorial sea of New Zealand (as defined by section 3 of the Territorial Sea, Contiguous Zone, and Exclusive Economic Zone Act 1977) adjacent to the land territories, islands, and islets referred to in paragraphs (a) and (b); and

• (e) any installation or drilling rig that—

  • (i) is constructed, erected, placed, or used in, on, or above those parts of the continental shelf adjacent to the land territories, islands, and islets referred to in paragraphs (a) and (b); and

  • (ii) has the purpose of the exploration of the continental shelf or the exploitation of the mineral or other natural non-living resources of the continental shelf.

(2) In subsection (1)(e),—

• (a) continental shelf has the meaning given to it in section 2(1) of the Continental Shelf Act 1964:

• (b) installation and drilling rig include—

  • (i) any installation or drilling rig, whether permanent or temporary:

  • (ii) any aircraft, floating platform, ship, or other device that is for the time being in, on, or above the continental shelf and is being used in connection with any installation or drilling rig.

(3) A person remains in New Zealand when he or she—

• (a) embarks in New Zealand on an aircraft or ship or some other means of conveyance by air or sea—

  • (i) to travel from one place in New Zealand to another place in New Zealand; or

  • (ii) to return to his or her place of embarkation without disembarking at any other place; and

• (b) does not go beyond a limit of 300 nautical miles from any point or points in New Zealand.

(1) A person is ordinarily resident in New Zealand if he or she—

• (a) has New Zealand as his or her permanent place of residence, whether or not he or she also has a place of residence outside New Zealand; and

• (b) is in one of the following categories:

  • (i) a New Zealand citizen:

  • (ii) a holder of a residence class visa granted under the Immigration Act 2009:

  • (iii) a person who is a spouse or a partner, child, or other dependant of any person referred to in subparagraph (i) or (ii), and who generally accompanies the person referred to in the subparagraph.

(2) A person does not have a permanent place of residence in New Zealand if he or she has been and remains absent from New Zealand for more than 6 months or intends to be absent from New Zealand for more than 6 months. This subsection overrides subsection (3) but is subject to subsection (4).

(3) A person has a permanent place of residence in New Zealand if he or she, although absent from New Zealand, has been personally present in New Zealand for a period or periods exceeding in the aggregate 183 days in the 12-month period immediately before last becoming absent from New Zealand. (A person personally present in New Zealand for part of a day is treated as being personally present in New Zealand for the whole of that day.)

(4) A person does not cease to have a permanent place of residence in New Zealand because he or she is absent from New Zealand primarily in connection with the duties of his or her employment, the remuneration for which is treated as income derived in New Zealand for New Zealand income tax purposes, or for 6 months following the completion of the period of employment outside New Zealand, so long as he or she intends to resume a place of residence in New Zealand.

(5) A person is not ordinarily resident in New Zealand if he or she is in New Zealand unlawfully within the meaning of the Immigration Act 2009. Any period during which a person is in New Zealand unlawfully is not counted as time spent in New Zealand for the purposes of subsection (3).

(1) Spouse means a person (person A) to whom the claimant is legally married.

(2) However, person A is not the spouse of a claimant if—

• (a) person A and the claimant are living apart; and

• (b) the claimant is not contributing financially to person A's welfare.

(3) Subsection (2) does not apply if the circumstances set out in the subsection occurred principally because of the health, imprisonment, or employment obligations of either person A or the claimant.

(4) Spouse, in relation to a deceased claimant, means a person (person B) to whom the deceased claimant was legally married immediately before his or her death.

(5) However, person B is not the spouse of a deceased claimant if, at the time of the deceased claimant's death,—

• (a) person B and the deceased claimant were living apart; and

• (b) the deceased claimant was not contributing financially to person B's welfare.

(6) Subsection (5) does not apply if the circumstances set out in the subsection occurred principally because of the health, imprisonment, or employment obligations of either person B or the deceased claimant.

(1) Partner means a person (person A) with whom the claimant is in a civil union or a de facto relationship.

(2) However, person A is not the partner of a claimant if—

• (a) person A and the claimant are living apart; and

• (b) the claimant is not contributing financially to person A's welfare.

(3) Subsection (2) does not apply if the circumstances set out in the subsection occurred principally because of the health, imprisonment, or employment obligations of either person A or the claimant.

(4) Partner, in relation to a deceased claimant, means a person (person B)—

• (a) with whom the deceased claimant was in a civil union immediately before his or her death; or

• (b) with whom the deceased claimant was in a de facto relationship immediately before his or her death.

(5) However, person B is not the partner of a deceased claimant if, at the time of the deceased claimant's death,—

• (a) person B and the deceased claimant were living apart; and

• (b) the deceased claimant was not contributing financially to person B's welfare.

(6) Subsection (5) does not apply if the circumstances set out in the subsection occurred principally because of the health, imprisonment, or employment obligations of either person B or the deceased claimant.

This Part uses and defines the following key terms:

(1) A person has cover for a personal injury if—

• (a) he or she suffers the personal injury in New Zealand on or after 1 April 2002; and

• (b) the personal injury is any of the kinds of injuries described in section 26(1)(a) or (b) or (c) or (e); and

• (c) the personal injury is described in any of the paragraphs in subsection (2).

(2) Subsection (1)(c) applies to—

• (a) personal injury caused by an accident to the person:

• (b) personal injury that is treatment injury suffered by the person:

• (c) treatment injury in circumstances described in section 32(7):

• (d) personal injury that is a consequence of treatment given to the person for another personal injury for which the person has cover:

• (e) personal injury caused by a work-related gradual process, disease, or infection suffered by the person:

• (f) personal injury caused by a gradual process, disease, or infection that is treatment injury suffered by the person:

• (g) personal injury caused by a gradual process, disease, or infection consequential on personal injury suffered by the person for which the person has cover:

• (h) personal injury caused by a gradual process, disease, or infection consequential on treatment given to the person for personal injury for which the person has cover:

• (i) personal injury that is a cardiovascular or cerebrovascular episode that is treatment injury suffered by the person:

• (j) personal injury that is a cardiovascular or cerebrovascular episode that is personal injury suffered by the person to which section 28(3) applies.

(3) Subsections (1) and (2) are subject to the following qualifications:

• (a) section 23 denies cover to some persons otherwise potentially within the scope of subsection (1):

• (b) section 24 denies cover to some persons otherwise potentially within the scope of subsections (1) and (2)(e).

(4) A person who suffers personal injury that is mental injury in circumstances described in section 21 has cover under section 21, but not under this section.

(1) A person has cover for a personal injury that is a mental injury if—

• (a) he or she suffers the mental injury inside or outside New Zealand on or after 1 April 2002; and

• (b) the mental injury is caused by an act performed by another person; and

• (c) the act is of a kind described in subsection (2).

(2) Subsection (1)(c) applies to an act that—

• (a) is performed on, with, or in relation to the person; and

• (b) is performed—

  • (i) in New Zealand; or

  • (ii) outside New Zealand on, with, or in relation to a person who is ordinarily resident in New Zealand when the act is performed; and

• (c) is within the description of an offence listed in Schedule 3.

(3) For the purposes of this section, it is irrelevant whether or not the person is ordinarily resident in New Zealand on the date on which he or she suffers the mental injury.

(4) Section 36 describes how the date referred to in subsection (3) is determined.

(5) For the purposes of this section, it is irrelevant that—

• (a) no person can be, or has been, charged with or convicted of the offence; or

• (b) the alleged offender is incapable of forming criminal intent.

(1) This section applies to persons who suffered personal injury that is mental or nervous shock suffered as an outcome of any act of any other person, which act—

• (a) was performed on, with, or in relation to the claimant (but not on, with, or in relation to any other person); and

• (b) was within the description of any offence listed in Schedule 1 of the Accident Rehabilitation and Compensation Insurance Act 1992 (the 1992 Act); and

• (c) was performed before 1 July 1992 (including before 1 April 1974) and was performed—

  • (i) in New Zealand; or

  • (ii) outside New Zealand, and the claimant was ordinarily resident in New Zealand within the meaning of the 1992 Act when the act was actually performed.

(2) For the purpose of subsection (1),—

• (a) the personal injury is deemed to have been suffered on the date of the first treatment that the claimant received for that personal injury as that personal injury; and

• (b) that first treatment must have been received on or after 1 July 1992 and before 1 July 1999; and

• (c) the treatment must have been of a kind for which the Corporation was required or permitted to make payments either directly under regulations made under the 1992 Act or under an agreement or contract or arrangement under section 29A of the 1992 Act, irrespective of whether or not it made any payment in the particular case.

(3) For the purposes of subsection (1), it is irrelevant—

• (a) that no person can be, or has been, charged with or convicted of the offence; or

• (b) that the alleged offender is incapable of forming criminal intent; or

• (c) whether or not the person who suffered the personal injury was ordinarily resident in New Zealand within the meaning of the 1992 Act when the personal injury is deemed to have been suffered.

(4) Persons to whom this section applies are deemed to have had cover under the 1992 Act for the personal injury described in subsection (1), and the following provisions apply:

• (a) payments made by or through the Corporation (or a subsidiary of the Corporation) or the Department of Labour to those persons for a personal injury described in subsection (1), whether made before or after the commencement of this section, are deemed to be entitlements paid under the 1992 Act to the extent that the correct amounts were paid:

• (b) for the purpose of paragraph (a), it does not matter whether or not the payment is a payment made in the belief that section 8(3) of the 1992 Act provided cover:

• (c) entitlements available as a result of cover deemed by this section are subject to Part 13 of the Accident Insurance Act 1998 and Part 11 of this Act:

• (d) Part 5 applies to decisions made by or on behalf of the Corporation between 15 July 2003 and the commencement of this section on claims made under section 8(3) of the 1992 Act for which cover is deemed by this section, and Part 5 applies as if those decisions had been made on the date of the commencement of this section.

(5) However, the following provisions apply to civil proceedings brought before or after the commencement of this section seeking general damages for mental or nervous shock suffered by a person as an outcome of any act described in subsection (1) (the proceedings):

• (a) if the plaintiff received judgment in the proceedings, in his or her favour, before the commencement of this section, the plaintiff does not have cover under this section for the injury or injuries to which the proceedings relate:

• (b) if the proceedings were filed, but not heard, before the date of introduction of the Injury Prevention, Rehabilitation, and Compensation Amendment Act (No 2) 2005, nothing in this section prevents the proceedings from being heard or prevents a court from awarding the plaintiff general damages for the mental or nervous shock:

• (c) if the plaintiff continues the proceedings, the plaintiff must declare to the court any payments and entitlements received from the Corporation for the personal injury for which damages are sought, and the court must take those payments and entitlements into account in awarding the plaintiff any damages:

• (d) on the date judgment is given in the proceedings, the plaintiff—

  • (i) does not have cover under this section for the injury or injuries to which the proceedings relate; and

  • (ii) must advise the Corporation of the judgment:

• (e) if the plaintiff loses cover by virtue of paragraph (a) or paragraph (d), the Corporation may not recover any part of an amount that is deemed by subsection (4)(a) to be an entitlement paid to the plaintiff under the 1992 Act.

(1) A person has cover for a personal injury that is a work-related mental injury if—

• (a) he or she suffers the mental injury inside or outside New Zealand on or after 1 October 2008; and

• (b) the mental injury is caused by a single event of a kind described in subsection (2).

(2) Subsection (1)(b) applies to an event that—

• (a) the person experiences, sees, or hears directly in the circumstances described in section 28(1); and

• (b) is an event that could reasonably be expected to cause mental injury to people generally; and

• (c) occurs—

  • (i) in New Zealand; or

  • (ii) outside New Zealand to a person who is ordinarily resident in New Zealand when the event occurs.

(3) For the purposes of this section, it is irrelevant whether or not the person is ordinarily resident in New Zealand on the date on which he or she suffers the mental injury.

(4) Section 36(1) describes how the date referred to in subsection (3) is determined.

(5) In subsection (2)(a), a person experiences, sees, or hears an event directly if that person—

• (a) is involved in or witnesses the event himself or herself; and

• (b) is in close physical proximity to the event at the time it occurs.

(6) To avoid doubt, a person does not experience, see, or hear an event directly if that person experiences, sees, or hears it through a secondary source, for example, by—

• (a) seeing it on television (including closed circuit television):

• (b) seeing pictures of, or reading about, it in news media:

• (c) hearing it on radio or by telephone:

• (d) hearing about it from radio, telephone, or another person.

(7) In this section, event—

• (a) means—

  • (i) an event that is sudden; or

  • (ii) a direct outcome of a sudden event; and

• (b) includes a series of events that—

  • (i) arise from the same cause or circumstance; and

  • (ii) together comprise a single incident or occasion; but

• (c) does not include a gradual process.

(1) A person has cover for a personal injury if—

• (a) he or she suffers the personal injury outside New Zealand on or after 1 April 2002; and

• (b) the personal injury is any of the kinds of injuries described in section 26(1)(a) or (b) or (c) or (e); and

• (c) the person is ordinarily resident in New Zealand when he or she suffers the personal injury; and

• (d) the personal injury is one for which the person would have cover if he or she had suffered it in New Zealand.

(2) Subsection (1) applies subject to subsection (3).

(3) A person has cover for treatment injury if he or she suffers the personal injury on or after 1 July 2005 as a result of treatment given to him or her while outside New Zealand, but only if the circumstances described in subsection (4) exist.

(4) The circumstances are—

• (a) the treatment is given by a person who has qualifications that are the same as or equivalent to those of a registered health professional; and

• (b) the personal injury would be personal injury caused by treatment if the treatment were given by or at the direction of the equivalent of a registered health professional and the person suffered the injury in New Zealand; and

• (c) the person is ordinarily resident in New Zealand when the treatment is given (whether or not he or she is ordinarily resident in New Zealand on the date on which he or she suffers the personal injury).

(5) Section 38 describes how the date on which the person suffers the personal injury referred to in subsection (4)(c) is determined.

(6) A person who suffers personal injury that is mental injury in circumstances described in section 21 has cover under section 21, but not under this section.

(7) A person who suffers personal injury that is work-related mental injury in circumstances described in section 21B has cover under section 21B, but not under this section.

(1) A person not ordinarily resident in New Zealand does not have cover for a personal injury if he or she suffers it while he or she—

• (a) is on board a ship or aircraft or other means of conveyance described in subsection (2); or

• (b) is embarking or disembarking from any such ship or aircraft or conveyance.

(2) Subsection (1)(a) relates to the ship, aircraft, or conveyance on which the person—

• (a) comes to New Zealand; or

• (b) leaves New Zealand; or

• (c) comes to New Zealand, is carried and accommodated in the course of visiting New Zealand, and leaves New Zealand.

(3) For the purposes of subsection (1)(b),—

• (a) embarking begins as soon as a person is on a gangway, air bridge, or other thing attached to or laid against a ship, aircraft, or other conveyance and available for use in embarking:

• (b) disembarking finishes as soon as a person has left any gangway, air bridge, or other thing attached to or laid against a ship, aircraft, or other conveyance and available for use in disembarking.

(1) A person does not have cover for a personal injury caused by a work-related gradual process, disease, or infection if—

• (a) he or she suffers the personal injury because, before 1 April 1974, he or she performed a task, or worked in an environment, in the circumstances described in section 30(2); and

• (b) he or she performed the task, or worked in the environment, outside New Zealand; and

• (c) he or she was not ordinarily resident in New Zealand when he or she performed the task or worked in the environment (whether or not he or she is ordinarily resident in New Zealand on the date on which he or she suffers the personal injury).

(2) Section 37 describes how the date referred to in subsection (1)(c) is determined.

(1) Accident means any of the following kinds of occurrences:

• (a) a specific event or a series of events, other than a gradual process, that—

  • (i) involves the application of a force (including gravity), or resistance, external to the human body; or

  • (ii) involves the sudden movement of the body to avoid a force (including gravity), or resistance, external to the body; or

  • (iii) involves a twisting movement of the body:

• (b) the inhalation of any solid, liquid, gas, or foreign object on a specific occasion, which kind of occurrence does not include the inhalation of a virus, bacterium, protozoan, or fungus, unless that inhalation is the result of the criminal act of a person other than the injured person:

• (ba) the oral ingestion of any solid, liquid, gas, fungus, or foreign object on a specific occasion, which kind of occurrence does not include the ingestion of a virus, bacterium, or protozoan, unless that ingestion is the result of the criminal act of a person other than the injured person:

• (c) a burn, or exposure to radiation or rays of any kind, on a specific occasion, which kind of occurrence does not include a burn or exposure caused by exposure to the elements:

• (d) the absorption of any chemical through the skin within a defined period of time not exceeding 1 month:

• (e) any exposure to the elements, or to extremes of temperature or environment, within a defined period of time not exceeding 1 month, that,—

  • (i) for a continuous period exceeding 1 month, results in any restriction or lack of ability that prevents the person from performing an activity in the manner or within the range considered normal for the person; or

  • (ii) causes death.

(2) However, accident does not include—

• (a) any of those kinds of occurrences if the occurrence is treatment given,—

  • (i) in New Zealand, by or at the direction of a registered health professional; or

  • (ii) outside New Zealand, by or at the direction of a person who has qualifications that are the same as or equivalent to those of a registered health professional; or

• (b) any ecto-parasitic infestation (such as scabies), unless it is work-related; or

• (c) the contraction of any disease carried by an arthropod as an active vector (such as malaria that results from a mosquito bite), unless it is work-related.

(3) The fact that a person has suffered a personal injury is not of itself to be construed as an indication or presumption that it was caused by an accident.

(1) Personal injury means—

• (a) the death of a person; or

• (b) physical injuries suffered by a person, including, for example, a strain or a sprain; or

• (c) mental injury suffered by a person because of physical injuries suffered by the person; or

• (d) mental injury suffered by a person in the circumstances described in section 21; or

• (da) work-related mental injury that is suffered by a person in the circumstances described in section 21B; or

• (e) damage (other than wear and tear) to dentures or prostheses that replace a part of the human body.

(1A) Personal injury includes any degree of hearing loss that is 6% or more of binaural hearing loss caused by a personal injury described in section 20(2).

(1B) Personal injury does not include any degree of hearing loss caused by—

• (a) a personal injury other than a personal injury described in section 20(2); or

• (b) the ageing process; or

• (c) any other factors.

(2) Personal injury does not include personal injury caused wholly or substantially by a gradual process, disease, or infection unless it is personal injury of a kind described in section 20(2)(e) to (h).

(3) Personal injury does not include a cardiovascular or cerebrovascular episode unless it is personal injury of a kind described in section 20(2)(i) or (j).

(4) Personal injury does not include—

• (a) personal injury caused wholly or substantially by the ageing process; or

• (b) personal injury to teeth or dentures caused by the natural use of those teeth or dentures.

(5) For the purposes of subsection (1)(e) and to avoid doubt, prostheses does not include hearing aids, spectacles, or contact lenses.

Mental injury means a clinically significant behavioural, cognitive, or psychological dysfunction.

(1) A work-related personal injury is a personal injury that a person suffers—

• (a) while he or she is at any place for the purposes of his or her employment, including, for example, a place that itself moves or a place to or through which the claimant moves; or

• (b) while he or she is having a break from work for a meal or rest or refreshment at his or her place of employment; or

• (c) while he or she is travelling to or from his or her place of employment at the start or finish of his or her day's work, if he or she is an employee and if the transport—

  • (i) is provided by the employer; and

  • (ii) is provided for the purpose of transporting employees; and

  • (iii) is driven by the employer or, at the direction of the employer, by another employee of the employer or of a related or associated employer; or

• (d) while he or she is travelling, by the most direct practicable route, between his or her place of employment and another place for the purposes of getting treatment for a work-related personal injury, if the treatment—

  • (i) is necessary for the injury; and

  • (ii) is treatment of a type that the claimant is entitled to under Part 1 of Schedule 1.

(2) In subsection (1)(d), most direct practicable route does not include those parts of a route that deviate unreasonably from, or interrupt, a journey for purposes unrelated to the employment or the treatment.

(3) Work-related personal injury includes a cardiovascular or cerebrovascular episode suffered by a person, if the episode is caused by physical effort or physical strain, in performing his or her employment, that is abnormal in application or excessive in intensity for the person.

(4) Work-related personal injury includes personal injury caused by a work-related gradual process, disease, or infection.

(4A) Work-related personal injury includes work-related mental injury that is suffered in the circumstances described in section 21B.

(5) Work-related personal injury includes personal injury suffered by a person resulting from treatment for a work-related personal injury as defined in subsections (1), (3), or (4), whether or not the injury is a treatment injury as defined in section 32.

(6) Work-related personal injury does not include personal injury suffered by a person when all the following conditions exist:

• (a) the personal injury is suffered in any of the circumstances described in subsection (1); and

• (b) the personal injury is suffered in the circumstances described in section 21; and

• (c) the person elects to have the personal injury regarded as a non-work injury, in which case that personal injury is a non-work injury.

(7) It is irrelevant to the decision whether the person suffered a work-related personal injury that, when the event causing the injury occurred, he or she—

• (a) may have been acting in contravention of any Act or regulations applicable to the employment, or in contravention of any instructions, or in the absence of instructions; or

• (b) may have been working under an illegal contract; or

• (c) may have been indulging in, or may have been the victim of, misconduct, skylarking, or negligence; or

• (d) may have been the victim of a force of nature.

(8) This section is subject to section 29 (personal injuries that are both work-related and motor vehicle injuries).

(1) An injury is a work-related personal injury, and is not a motor vehicle injury, if it—

• (a) falls within the definitions of both work-related personal injury and motor vehicle injury; but

• (b) is suffered in the circumstances described in section 28(1)(c) or (d) that relate to travel to or from employment or a place of treatment.

(2) An injury is a motor vehicle injury, and is not a work-related personal injury, if it—

• (a) falls within the definitions of both motor vehicle injury and work-related personal injury; but

• (b) is suffered in the circumstances described in section 28(1)(a) or (b).

(3) However, a person is entitled to first week compensation if either subsection (1) or subsection (2) applies.

(1) Personal injury caused by a work-related gradual process, disease, or infection means personal injury—

• (a) suffered by a person; and

• (b) caused by a gradual process, disease, or infection; and

• (c) caused in the circumstances described in subsection (2).

(1A) [Repealed]

(2) The circumstances are—

• (a) the person—

  • (i) performs an employment task that has a particular property or characteristic; or

  • (ii) is employed in an environment that has a particular property or characteristic; and

• (b) the particular property or characteristic—

  • (i) causes, or contributes to the cause of, the personal injury; and

  • (ii) is not found to any material extent in the non-employment activities or environment of the person; and

  • (iii) may or may not be present throughout the whole of the person's employment; and

• (c) the risk of suffering the personal injury—

  • (i) is significantly greater for persons who perform the employment task than for persons who do not perform it; or

  • (ii) is significantly greater for persons who are employed in that type of environment than for persons who are not.

(2A) [Repealed]

(3) Personal injury caused by a work-related gradual process, disease, or infection includes personal injury that is—

• (a) of a type described in Schedule 2; and

• (b) suffered by a person who is or has been in employment—

  • (i) that involves exposure, or the prescribed level or extent of exposure, to agents, dusts, compounds, substances, radiation, or things (as the case may be) described in that schedule in relation to that type of personal injury; or

  • (ii) in an occupation, industry, or process described in that schedule in relation to that type of personal injury.

(3A) To avoid doubt, where a claim is lodged for cover for a work-related gradual process, disease, or infection, section 57 applies to require, among other things, the Corporation to investigate the claim at its own expense.

(4) Personal injury of a type described in subsection (3) does not require an assessment of causation under subsection (1)(b) or (c).

(4A) This Act covers personal injury caused by a work-related gradual process, disease, or infection only if—

• (a) the exposure to the gradual process, disease, or infection actually occurred in New Zealand; or

• (b) the person concerned was ordinarily resident in New Zealand when the exposure actually occurred.

(5) Personal injury caused by a work-related gradual process, disease, or infection does not include—

• (a) personal injury related to non-physical stress; or

• (b) any degree of deafness for which compensation has been paid under the Workers' Compensation Act 1956.

(6) Subsection (7) applies if, before 1 April 1974, the person—

• (a) performed an employment task that had a particular property or characteristic; or

• (b) was employed in an environment that had a particular property or characteristic.

(7) The circumstances referred to in subsection (6) do not prevent the person's personal injury from being personal injury caused by a work-related gradual process, disease, or infection, but he or she does not have cover for it if section 24 or section 361 applies to him or her.

(1) Treatment injury means personal injury that is—

• (a) suffered by a person—

  • (i) seeking treatment from 1 or more registered health professionals; or

  • (ii) receiving treatment from, or at the direction of, 1 or more registered health professionals; or

  • (iii) referred to in subsection (7); and

• (b) caused by treatment; and

• (c) not a necessary part, or ordinary consequence, of the treatment, taking into account all the circumstances of the treatment, including—

  • (i) the person's underlying health condition at the time of the treatment; and

  • (ii) the clinical knowledge at the time of the treatment.

(2) Treatment injury does not include the following kinds of personal injury:

• (a) personal injury that is wholly or substantially caused by a person's underlying health condition:

• (b) personal injury that is solely attributable to a resource allocation decision:

• (c) personal injury that is a result of a person unreasonably withholding or delaying their consent to undergo treatment.

(3) The fact that the treatment did not achieve a desired result does not, of itself, constitute treatment injury.

(4) Treatment injury includes personal injury suffered by a person as a result of treatment given as part of a clinical trial, in the circumstances described in subsection (5) or subsection (6).

(5) One of the circumstances referred to in subsection (4) is where the claimant did not agree, in writing, to participate in the trial.

(6) The other circumstance referred to in subsection (4) is where—

• (a) an ethics committee—

  • (i) approved the trial; and

  • (ii) was satisfied that the trial was not to be conducted principally for the benefit of the manufacturer or distributor of the medicine or item being trialled; and

• (b) the ethics committee was approved by the Health Research Council of New Zealand or the Director-General of Health at the time it gave its approval.

(7) If a person (person A) suffers an infection that is a treatment injury, cover for that personal injury extends to—

• (a) person A's spouse or partner, if person A has passed the infection on directly to the spouse or partner:

• (b) person A's child, if person A has passed the infection on directly to the child:

• (c) any other third party, if person A has passed the infection on directly to that third party:

• (d) person A's child or any other third party, if—

  • (i) person A has passed the infection directly to his or her spouse or partner; and

  • (ii) person A's spouse or partner has then passed the infection directly to the child or third party.

(1) For the purposes of determining whether a treatment injury has occurred, or when that injury occurred, treatment includes—

• (a) the giving of treatment:

• (b) a diagnosis of a person's medical condition:

• (c) a decision on the treatment to be provided (including a decision not to provide treatment):

• (d) a failure to provide treatment, or to provide treatment in a timely manner:

• (e) obtaining, or failing to obtain, a person's consent to undergo treatment, including any information provided to the person (or other person legally entitled to consent on their behalf if the person does not have legal capacity) to enable the person to make an informed decision on whether to accept treatment:

• (f) the provision of prophylaxis:

• (g) the failure of any equipment, device, or tool used as part of the treatment process, including the failure of any implant or prosthesis (except where the failure of the implant or prosthesis is caused by an intervening act or by fair wear and tear), whether at the time of giving treatment or subsequently:

• (h) the application of any support systems, including policies, processes, practices, and administrative systems, that—

  • (i) are used by the organisation or person providing the treatment; and

  • (ii) directly support the treatment.

(2) Subsection (1) does not affect the application of the definition of treatment in section 6(1) for purposes other than those stated in subsection (1).

(3) Subsection (2) is for the avoidance of doubt.

(1) This section applies to—

• (a) claims for cover for personal injury caused by medical misadventure that were lodged with the Corporation before 1 July 2005, but have not been determined; and

• (b) claims for cover for personal injury caused by medical misadventure that were declined by the Corporation before 1 July 2005, but are lodged again on or after that date as claims for cover for treatment injury (and not lodged as claims referred to in subsection (4)).

(2) Claims lodged in the circumstances described in subsection (1) must be determined under the relevant provisions in force immediately before 1 July 2005.

(3) Reviews and appeals must be dealt with under the relevant provisions of Part 5 in force immediately before 1 July 2005, if the decision being reviewed or appealed—

• (a) was made before 1 July 2005; or

• (b) is one to which subsection (2) applies.

(4) Subsection (1)(b) does not apply in relation to a claimant if,—

• (a) before 1 July 2005, the Corporation declined the claimant's claim for cover for personal injury caused by medical misadventure because there was no personal injury; and

• (b) on or after 1 July 2005, the claimant lodges a claim for cover for treatment injury in respect of a personal injury that—

  • (i) occurred after the decision to decline the earlier claim (whether before or after 1 July 2005); and

  • (ii) arises out of the circumstances on which the earlier claim was based.

(1) Motor vehicle injury—

• (a) means—

  • (i) a personal injury suffered because of the movement of a motor vehicle; or

  • (ii) a personal injury suffered because of a stationary motor vehicle being struck by another motor vehicle or some other means of conveyance; but

• (b) does not include a personal injury that is a work-related mental injury.

(2) However, motor vehicle injury does not include a personal injury suffered—

• (a) in the course of loading, unloading, repairing, or servicing a motor vehicle; or

• (b) in the course of any use of a motor vehicle other than as a means of conveyance; or

• (c) in the course of off-road use of a motor vehicle.

(3) In subsection (2)(c), off-road use does not include use that is off-road as a direct result of the motor vehicle being out of control or having been involved in an accident.

(4) This section is subject to section 29 (personal injuries that are both work-related and motor vehicle injuries).

(1) The date on which a person suffers mental injury in the circumstances described in section 21 or 21B is the date on which the person first receives treatment for that mental injury as that mental injury.

(2) The date on which a person suffers mental injury because of physical injuries suffered by the person is the date on which the physical injuries are suffered.

(3) In subsection (1), treatment means treatment of a type that the person is entitled to under this Act or a former Act.

(4) This section does not apply for the purposes of clause 55 of Schedule 1.

(1) The date on which a person suffers personal injury caused by a work-related gradual process, disease, or infection is the earlier of the following dates:

• (a) the date on which the person first receives treatment from a medical practitioner or nurse practitioner for that personal injury as that personal injury:

• (b) the date on which the personal injury first results in the person's incapacity.

(2) Subsection (1) applies subject to subsection (3).

(3) A person suffers his or her personal injury on the date specified in subsection (4) if he or she suffers the personal injury because, before 1 April 1974, he or she performed a task, or was employed in an environment, in the circumstances described in section 30(2).

(4) A person to whom subsection (3) applies must be regarded as having suffered his or her personal injury on 1 July 1992, unless he or she actually suffers it on a date later than 1 July 1992 determined under subsection (1).

(5) This section is subject to clause 55(2) of Schedule 1 (which relates to the entitlement to lump sum compensation for personal injury caused by a work-related gradual process, disease, or infection in circumstances described in that provision).

(1) The date on which a person suffers a treatment injury is the date on which the person first seeks or receives treatment for the symptoms of that personal injury.

(2) Subsection (1) applies even if it was not known, at the time the treatment was first sought or received for the symptoms, that previous treatment was the cause of the symptoms.

(3) In subsection (1), treatment (where that term appears for the second time) means treatment of a type that the person is entitled to under this Act or a former Act.

(4) This section is subject to clause 55(3) of Schedule 1 (which relates to the entitlement to lump sum compensation for treatment injuries in the circumstances described in that provision).

In sections 40 and 45, Corporation includes—

• (a) an accredited employer (within the meaning of section 181); and

• (b) a person acting as an agent of the Corporation; and

• (c) a person who provides services (excluding treatment) to claimants on behalf of or authorised by the Corporation.

(1) The purpose of the Code of ACC Claimants' Rights is to meet the reasonable expectations of claimants (including the highest practicable standard of service and fairness) about how the Corporation should deal with them, by—

• (a) conferring rights on claimants and imposing obligations on the Corporation in relation to how the Corporation should deal with claimants; and

• (b) providing for the procedure for lodging and dealing with complaints about breaches of the Code by the Corporation; and

• (c) providing—

  • (i) for the consequences of, and remedies for, a breach of the Code by the Corporation; and

  • (ii) without limiting subparagraph (i), how and to what extent the Corporation must address situations where its conduct is not consistent with or does not uphold the rights of claimants under the Code; and

• (d) explaining a claimant's right to a review, under Part 5, of a decision made under the Code about a claimant's complaint.

(2) The rights and obligations in the Code—

• (a) are in addition to any other rights claimants have and obligations the Corporation has under this Act, any other enactment, or the general law; and

• (b) do not affect the entitlements and responsibilities of claimants under this Act, any other enactment, or the general law.

(1) The Code applies not only for the purposes of this Part but also for the purposes of this Act generally.

(2) This section applies to avoid doubt.

(1) The Corporation must, as soon as practicable after this section comes into force, prepare a draft Code of ACC Claimants' Rights.

(2) In preparing a draft Code the Corporation must consult such persons, bodies, organisations, and agencies as the Minister considers necessary to ensure that a wide range of views is available to the Corporation to assist it in preparing a draft Code.

(3) In subsection (2), organisations includes groups representing claimants.

(4) For the purposes of subsection (2), the Minister may take into account any relevant consultation undertaken by the Corporation before this section comes into force.

(5) After preparing the draft code, the Corporation must forward it to the Minister.

(1) If the Minister agrees with the draft Code forwarded to him or her under section 42(5), the Corporation must, as soon as practicable, arrange for the draft Code to be notified—

• (a) in the Gazette; and

• (b) in daily newspapers published in Auckland, Hamilton, Wellington, Christchurch, and Dunedin.

(2) Notification of the draft Code must state—

• (a) that written submissions on the draft Code are invited from members of the public and interested organisations; and

• (b) where copies of the draft Code may be obtained; and

• (c) the closing date for submissions; and

• (d) the address submissions are to be forwarded to.

(3) The Corporation must—

• (a) prepare a report on the submissions, including any proposed amendments to the draft Code; and

• (b) forward the report to the Minister.

(1) After considering the report and making any amendments (whether recommended or not) to the draft Code, the Minister must,—

• (a) by notice in the Gazette, approve the Code; and

• (b) present the Code to the House of Representatives within 12 sitting days after approving the Code; and

• (c) arrange for the approval of the Code to be notified in daily newspapers published in Auckland, Hamilton, Wellington, Christchurch and Dunedin.

(2) A notice given under subsection (1)(c) must state where copies of the Code may be obtained.

(3) The Code comes into force—

• (a) on the date specified for that purpose in the Code, being a date after the date on which the Code is approved; or

• (b) if no such date is specified, the day after the date on which the Code is approved.

(1) The Corporation must, in all its dealings with claimants, ensure that its actions are consistent with and uphold the rights of claimants in the Code.

(2) The Corporation must—

• (a) make the Code accessible to claimants and members of the public generally; and

• (b) promote awareness of the Code among claimants and members of the public generally.

(3) For the purposes of subsection (2), the Corporation must make the Code accessible, and promote awareness of the Code, in a variety of communications media and languages.

The Code is a regulation for the purposes of the Regulations (Disallowance) Act 1989.

(1) The Code may be amended by the Minister approving, by notice in the Gazette, 1 or more amendments to the Code proposed by the Minister or the Corporation.

(2) Sections 42(2) to (5), 43, and 44 apply, with all necessary modifications, in relation to an amendment to the Code as if the amendment were the preparation of a draft Code.

(3) However, those provisions do not apply to an amendment if—

• (a) the amendment is a minor or technical amendment; and

• (b) the Minister considers that compliance with those provisions is unnecessary.

A person who wishes to claim under this Act must lodge a claim with the Corporation for—

• (a) cover for his or her personal injury; or

• (b) cover, and a specified entitlement, for his or her personal injury; or

• (c) a specified entitlement for his or her personal injury, once the Corporation has accepted the person has cover for the personal injury.

A treatment provider lodging a claim under section 48 on behalf of a person must lodge the claim promptly with the Corporation after the person has authorised its being lodged.

(1) On receiving a claim for cover under section 48 from a person, the Corporation must—

• (a) decide whether or not it accepts that the person has cover; and

• (b) if it accepts that the person has cover,—

  • (i) provide information about the entitlements to which it considers the claimant may be entitled; and

  • (ii) facilitate the claimant's access to those entitlements.

(2) If the claim is for cover for a treatment injury, the Corporation must provide the claimant with information on the role of the Health and Disability Commissioner under the Code of Health and Disability Services Consumers' Rights.

For all the purposes of this Act, a claim under section 48 is lodged and received on the date on which the Corporation receives a claim lodged in accordance with this Part.

(1) A person must lodge a claim with the Corporation in a manner specified by the Corporation.

(2) The Corporation must specify a manner that it is reasonable to expect the person to comply with.

(3) The Corporation may impose reasonable requirements on the person, such as, for example, requiring the person to lodge a written claim.

(1) A person must lodge a claim with the Corporation within the time limit specified in this section.

(2) The Corporation must not decline a claim lodged after the time limit specified in this section on the ground that the claim was lodged late, unless the claim's lateness prejudices the Corporation in its ability to make decisions.

(3) A person must lodge a claim under section 48,—

• (a) in the case of a claim for cover, within 12 months after the date on which he or she suffers the personal injury; or

• (b) in the case of a claim for an entitlement, within 12 months after the date on which the need for the entitlement arose.

(4) Despite subsection (3), if a claim is for a treatment injury, a person must lodge the claim under section 48,—

• (a) in the case of a claim for cover, within 12 months after the later of—

  • (i) the date that the personal injury was first considered by a registered health professional to be a treatment injury; or

  • (ii) the date that the person suffered the treatment injury (as determined under section 38):

• (b) in the case of a claim for an entitlement, within 12 months after the later of—

  • (i) the date on which the need for the entitlement arose; or

  • (ii) if the need for entitlement arose before the injury was diagnosed as being a treatment injury, and a claim for cover for that injury has been lodged with the Corporation, the date on which the Corporation accepted the claim for cover.

The Corporation must make every decision on a claim on reasonable grounds, and in a timely manner, having regard to the requirements of this Act, the nature of the decision, and all the circumstances.

(1) A person who lodges a claim under section 48 must, when reasonably required to do so by the Corporation,—

• (a) give the Corporation a certificate by a registered health professional that deals with the matters, and contains the information, that the Corporation requires:

• (b) give the Corporation any other relevant information that the Corporation requires:

• (c) authorise the Corporation to obtain medical and other records that are or may be relevant to the claim:

• (d) undergo a medical assessment by a registered health professional specified by the Corporation, at the Corporation's expense:

• (e) undergo any other assessment at the Corporation's expense.

(2) Whenever reasonably requested to do so by the Corporation, a person who lodges a claim under section 48 must give the Corporation a statement in writing about any specified matters relating to the person's eligibility, or continuing eligibility, for cover or an entitlement.

(3) If the Corporation requires the person to do so, the person must make the statement referred to in subsection (2) as a statutory declaration or in a form supplied by the Corporation.

(1) This section applies to a claim for cover that is not a claim described in section 57 (complicated claims).

(2) The Corporation must take the following steps as soon as practicable, and no later than 21 days, after the claim is lodged:

• (a) investigate the claim—

  • (i) at its own expense; and

  • (ii) to the extent reasonably necessary to enable it to take the following steps in this subsection; and

• (b) either—

  • (i) make its decision on the claim and give notice of it under section 64; or

  • (ii) decide that it cannot make its decision on the claim, or any other decision, without additional information, extend the time for making its decision, and tell the person making the claim about the extension.

(3) Except where it decides under subsection (2)(b)(ii) that it needs additional information, section 58 applies if the Corporation does not make its decision within 21 days after the claim was lodged.

(4) If subsection (2)(b)(ii) applies, the Corporation must take the following steps as soon as practicable:

• (a) make a reasonable request to the person, or decide to make a request to another person, for the additional information; and

• (b) if the Corporation makes a request to another person for the additional information, tell the person making the claim about the making of the request and its nature; and

• (c) make its decision on the claim and give notice of it under section 64.

(5) In any case dealt with under subsection (4), the Corporation's decision on the claim must be made within 4 months of the claim being lodged.

(1) This section applies to a claim for cover—

• (a) for mental injury in the circumstances described in section 21 or 21B:

• (b) for personal injury caused by a work-related gradual process, disease, or infection:

• (c) for personal injury caused by treatment:

• (d) lodged outside the period stated in section 53.

(2) The Corporation must take the following steps as soon as practicable, and no later than 2 months, after the claim is lodged:

• (a) investigate the claim—

  • (i) at its own expense; and

  • (ii) to the extent reasonably necessary to enable it to take the following steps in this subsection; and

• (b) either—

  • (i) make its decision on the claim and give notice of it under section 64; or

  • (ii) decide that it cannot make its decision on the claim, or any other decision, without additional information, and tell the person of the extension, which must not exceed 2 months, that will be required.

(3) The Corporation must take the following steps as soon as practicable, and no later than the expiry of the extension:

• (a) make a reasonable request to the person, or decide to make a request to another person, for the additional information; and

• (b) if the Corporation proposes to make a request to another person for the additional information, tell the person making the claim about the making of the request and its nature; and

• (c) make its decision on the claim and give notice of it under section 64.

(4) The Corporation and the person making the claim may agree to further extensions after the extension referred to in subsection (3), and that subsection applies to any further extension, but the Corporation's decision on the claim must be made within 9 months of the claim being lodged.

(5) If the Corporation finds that the claim is an uncomplicated claim under section 56, that section applies as if the claim were lodged on the date the Corporation made that finding.

(1) When the Corporation fails to comply with a time limit under section 56 or section 57, whichever applies, the claimant is to be regarded as having a decision by the Corporation that he or she has cover for the personal injury in respect of which the claim was made.

(2) When subsection (1) applies, the Corporation must tell the person that—

• (a) the time limit has expired without the Corporation having made a decision; and

• (b) the effect is that the claimant has a decision that the claimant has cover; and

• (c) the date of the decision is the date of the expiry of the time limit.

(1) The fact that the Corporation accepts a levy does not of itself decide the question of whether or not a person has cover.

(2) The question of whether or not a person has cover is determined by the provisions of this Act.

The Corporation may decline a claim that a personal injury is a work-related personal injury of a kind described in section 30(3) only if the Corporation establishes that—

• (a) the person is not suffering from a personal injury of a kind described in Schedule 2; or

• (b) the person's personal injury has a cause other than his or her employment.

(1) When the Corporation determines cover for hearing loss caused by noise exposure within a person's employment, the Corporation must assess the percentage of binaural hearing loss caused in these circumstances by applying the pure tone audiometry test and any other test that the Corporation considers to be appropriate for this purpose.

(2) All tests under subsection (1) must be performed—

• (a) by a treatment provider who holds qualifications satisfactory to the Corporation; and

• (b) in accordance with any regulations made under this Act for this purpose.

(1) When investigating a claim for cover for a treatment injury, the Corporation may seek clinical advice if the Corporation considers the advice will assist it in determining the claim.

(2) Subsection (1) does not prevent the Corporation from seeking advice in other situations.

(3) Subsection (2) is for the avoidance of doubt.

The Corporation must tell the claimant that he or she has the right to apply for a review of any of the Corporation's decisions on the claim, including a decision under section 58, and must do so at a time appropriate to enable the claimant to exercise the right.

(1) The Corporation must give notice of its decision on a claim to the claimant.

(2) In the case of a claim for cover for a work-related personal injury to an employee, the Corporation must give notice of its decision on the claim for cover to every employer entitled to apply for a review of that decision.

(3) [Repealed]

(4) Every notice given under this section must—

• (a) be written; and

• (b) contain the reasons for the decision; and

• (c) give the claimant or other person information about his or her rights to apply for review, including details of the time available to do so and an explanation of when applications can be made outside that time.

(1) If the Corporation considers it made a decision in error, it may revise the decision at any time, whatever the reason for the error.

(2) The Corporation may revise a decision deemed by section 58 to have been made in respect of any claim for cover, but may not recover from the claimant any payments made by it, in respect of the claim, before the date of the revision unless the claimant has made statements or provided information to the Corporation that are, in the opinion of the Corporation, intentionally misleading.

(3) A revision may—

• (a) amend the original decision; or

• (b) revoke the original decision and substitute a new decision.

(4) Every amendment to a decision, and every substituted decision, is a fresh decision.

(5) Sections 19 to 23 of the Crown Entities Act 2004 do not limit this section.

The Corporation must keep every claim file for at least 10 years after the date of the latest action the Corporation has recorded on the claim.

A claimant who has suffered a personal injury is entitled to 1 or more entitlements if he or she—

• (a) has cover for the personal injury; and

• (b) is eligible under this Act for the entitlement or entitlements in respect of the personal injury.

(1) The Corporation provides entitlements to claimants in accordance with this Act.

(2) If any provision of this Act requires the Corporation to provide an entitlement (regardless of how that requirement is expressed), the Corporation is required to provide the entitlement only to the extent required by this Act.

(3) However, the Corporation may, at its own discretion, provide an entitlement or a payment to a claimant if it is satisfied that—

• (a) the entitlement or payment could be provided but for a requirement in section 127(4) or section 129 or section 379(2), or in any of clauses 4, 13, 15, 17, 19(3)(e), 19(3)(i), 19(3)(j), 22(1), 22(2)(b), 22(2)(c), 22(2)(e), or 22(2)(f) of Schedule 1; and

• (b) the provision of the entitlement or payment would be consistent with the purpose of this Act.

(4) The exercise of a discretion under subsection (3) is subject to section 134(1A).

(1) The entitlements provided under this Act are—

• (a) rehabilitation, comprising treatment, social rehabilitation, and vocational rehabilitation:

• (b) first week compensation:

• (c) weekly compensation:

• (d) lump sum compensation for permanent impairment:

• (e) funeral grants, survivors' grants, weekly compensation for the spouse or partner, children and other dependants of a deceased claimant, and child care payments.

(2) The entitlements provided under this Act also include the entitlements referred to in Parts 10 and 11.

A claimant who has suffered personal injury for which he or she has cover—

• (a) is entitled to be provided by the Corporation with rehabilitation, to the extent provided by this Act, to assist in restoring the claimant's health, independence, and participation to the maximum extent practicable; but

• (b) is responsible for his or her own rehabilitation to the extent practicable having regard to the consequences of his or her personal injury.

(1) This section applies to an employer if—

• (a) the Corporation decides, under section 86(2)(a), that it is reasonably practicable to return the claimant to the same employment in which the claimant was engaged, and with the employer who was employing the claimant, when the claimant's incapacity commenced; and

• (b) the Corporation gives the employer notice, in writing, of the decision.

(2) The employer must take all practicable steps to assist the claimant with the claimant's vocational rehabilitation under his or her individual rehabilitation plan.

(1) A claimant who receives any entitlement must, when reasonably required to do so by the Corporation,—

• (a) give the Corporation a certificate by a registered health professional or treatment provider that deals with the matters and contains the information that the Corporation requires:

• (b) give the Corporation any other relevant information that the Corporation requires:

• (c) authorise the Corporation to obtain medical and other records that are or may be relevant to the claim:

• (d) undergo assessment by a registered health professional specified by the Corporation, at the Corporation's expense:

• (e) undergo assessment, at the Corporation's expense:

• (f) co-operate with the Corporation in the development and implementation of an individual rehabilitation plan:

• (g) undergo assessment of present and likely capabilities for the purposes of rehabilitation, at the Corporation's expense:

• (h) participate in rehabilitation.

(2) Every such claimant must give the Corporation a statement in writing about any matters relating to the claimant's entitlement, or continuing entitlement, to an entitlement that the Corporation specifies, and must do so whenever the Corporation requires such a statement.

(3) If the Corporation requires the claimant to do so, the claimant must make the statement referred to in subsection (2) as a statutory declaration or in a form supplied by the Corporation.

(1) In this section, treatment means treatment that—

• (a) is treatment of a type that the Corporation is liable to provide under this Act; and

• (b) is acute treatment; and

• (c) is not a public health acute service.

(2) A claimant is not liable to pay that part of the treatment provider's fee that is an entitlement.

(3) A treatment provider who wishes to seek payment of the part of the fee that is an entitlement must seek it—

• (a) from the person specified in arrangements the treatment provider has made for being paid for treating people suffering personal injury covered by this Act; or

• (b) if the treatment provider has not made any such arrangements, from the Corporation.

(1) A treatment provider to whom a claimant presents for treatment may exercise the clinical judgment described in section 7(b) as to the urgency of the need for the treatment only if he or she is a treatment provider of a type appropriately qualified to make a clinical judgment of that kind.

(2) A treatment provider qualified as required by subsection (1) who makes a clinical judgment that treatment requires an acute admission must ensure that the treatment is provided by—

• (a) a publicly funded provider; or

• (b) if the Corporation gives its prior agreement, a provider that is not a publicly funded provider; or

• (c) if, for reasons of clinical safety, treatment by a publicly funded provider is not practicable, a provider that is not a publicly funded provider.

(3) A treatment provider who is not qualified as required by subsection (1) must refer the claimant to a treatment provider who is so qualified, and the visit to that treatment provider, on referral, is also regarded as acute treatment.

(4) For the purposes of subsection (2),—

Within 13 weeks after the Corporation accepts the claimant's claim for cover, the Corporation—

• (a) must—

  • (i) determine whether the claimant is likely to need social or vocational rehabilitation after the 13 weeks have ended; and

  • (ii) if so, prepare an individual rehabilitation plan in consultation with the claimant; and

• (b) may include in the plan provision for treatment.

(1) Before an individual rehabilitation plan for the claimant is agreed, the Corporation is liable to provide the claimant with—

• (a) social rehabilitation that the Corporation considers suitable for the claimant and necessary in the circumstances, having regard to the purpose in section 79; and

• (b) vocational rehabilitation that the Corporation considers suitable for the claimant and appropriate in the circumstances, having regard to the purpose in section 80.

(2) The Corporation may provide rehabilitation under subsection (1) before—

• (a) any assessment of the claimant is undertaken or completed for the purposes of this Part; or

• (b) starting or concluding its consideration of the matters specified in section 87(1).

(3) To avoid doubt, subsections (1) and (2) do not prevent the provision of treatment before an individual rehabilitation plan is agreed.

(4) After an individual rehabilitation plan for the claimant is agreed, the Corporation is liable to provide the claimant with rehabilitation in accordance with the plan and Schedule 1, but only to the extent that the Corporation has specified which services it will provide under the plan.

(1) In preparing an individual rehabilitation plan, the Corporation must assess the claimant's needs for rehabilitation having regard to the purposes in sections 79 and 80.

(2) An individual rehabilitation plan must—

• (a) identify the claimant's needs for rehabilitation; and

• (b) identify the assessments to be done; and

• (c) identify services appropriate to those needs, whether or not the Corporation is liable to provide any or all of those services; and

• (d) specify which of the services identified under paragraph (c) that the Corporation will provide, pay for, or contribute to.

(3) For the purposes of subsection (2)(a), the Corporation must assess a claimant's needs for—

• (a) social rehabilitation under section 84 and clauses 13 to 23 of Schedule 1; and

• (b) for vocational rehabilitation under sections 89 to 96.

(4) However, the Corporation is not required to assess a claimant's needs under subclause (3)(b) if the claimant's needs are solely related to maintaining employment.

An individual rehabilitation plan must be updated from time to time to reflect the outcome of assessments done and progress made under the plan.

The purpose of social rehabilitation is to assist in restoring a claimant's independence to the maximum extent practicable.

(1) The purpose of vocational rehabilitation is to help a claimant to, as appropriate,—

• (a) maintain employment; or

• (b) obtain employment; or

• (c) regain or acquire vocational independence.

(2) Without limiting subsection (1), the provision of vocational rehabilitation includes the provision of activities for the purpose of maintaining or obtaining employment that is—

• (a) suitable for the claimant; and

• (b) appropriate for the claimant's levels of training and experience.

(1) In this section, key aspect of social rehabilitation means any of the following:

• (a) aids and appliances:

• (b) attendant care:

• (c) child care:

• (d) education support:

• (e) home help:

• (f) modifications to the home:

• (g) training for independence:

• (h) transport for independence.

(2) Terms in subsection (1)(a), (b), and (d) to (h) have the same meaning as in clause 12 of Schedule 1.

(3) The Corporation is liable to provide a key aspect of social rehabilitation to a claimant—

• (a) if the conditions in subsection (4) are met; but

• (b) not earlier than a date determined in accordance with section 83.

(4) The conditions are—

• (a) a claimant is assessed or reassessed under section 84 as needing the key aspect; and

• (b) the provision of the key aspect is in accordance with the Corporation's assessment of it under whichever of clauses 13 to 22 of Schedule 1 are relevant; and

• (c) the Corporation considers that the key aspect—

  • (i) is required as a direct consequence of the personal injury for which the claimant has cover; and

  • (ii) is for the purpose set out in section 79; and

  • (iii) is necessary and appropriate, and of the quality required, for that purpose; and

  • (iv) is of a type normally provided by a rehabilitation provider; and

• (d) the provision of the key aspect has been agreed in the claimant's individual rehabilitation plan, if a plan has been agreed.

(5) This clause is subject to any regulations made under section 324.

(1) The Corporation may provide any other social rehabilitation if—

• (a) it is required as a direct consequence of the personal injury for which the claimant has cover; and

• (b) a claimant is assessed or reassessed under section 84 as needing it; and

• (c) the Corporation considers that it—

  • (i) is for the purpose set out in section 79; and

  • (ii) is necessary and appropriate, and of the quality required, for that purpose; and

  • (iii) is of a type normally provided by a rehabilitation provider; and

• (d) its provision has been agreed in the claimant's individual rehabilitation plan, if a plan has been agreed.

(2) This clause is subject to any regulations made under sections 324 and 325.

(1) This section applies to the provision of social rehabilitation that the Corporation—

• (a) is liable to provide under section 81; or

• (b) has decided to provide under section 82.

(2) The Corporation must provide social rehabilitation on the later of the following:

• (a) the date on which the application for the social rehabilitation is made:

• (b) if the need for the social rehabilitation is assessed to arise after the date of the application, the date when it is assessed to arise.

(3) However, if the Corporation considers that, in the claimant's circumstances, it would be unreasonable for the claimant to have made an earlier application, it may begin providing social rehabilitation on and from another date it considers reasonable to the claimant.

(4) Subsection (3) does not entitle a claimant to entitlements that the claimant would not have been entitled to had the application been made earlier.

(1) An assessment under this section assesses a claimant's need for social rehabilitation and identifies the specific social rehabilitation that the claimant needs.

(2) The Corporation may—

• (a) do assessments and reassessments, itself, by using appropriately qualified assessors employed by the Corporation; or

• (b) appoint and pay as many appropriately qualified assessors as it considers necessary to do assessments and reassessments; or

• (c) both.

(3) A claimant's need for social rehabilitation—

• (a) may be reassessed from time to time; and

• (b) must be reassessed if the Corporation considers that the claimant's condition or circumstances have changed.

(4) The matters to be taken into account in an assessment or reassessment include—

• (a) the level of independence a claimant had before suffering the personal injury:

• (b) the level of independence a claimant has after suffering the personal injury:

• (c) the limitations suffered by a claimant as a result of the personal injury:

• (d) the kinds of social rehabilitation that are appropriate for a claimant to minimise those limitations:

• (e) the rehabilitation outcome that would be achieved by providing particular social rehabilitation:

• (f) the alternatives and options available for providing particular social rehabilitation so as to achieve the relevant rehabilitation outcome in the most cost effective way:

• (g) any social rehabilitation (not provided as vocational rehabilitation) that may reasonably be provided to enable a claimant who is entitled to vocational rehabilitation to participate in employment:

• (h) the geographical location in which a claimant lives:

• (i) in the case of a reassessment,—

  • (i) whether any item that the Corporation provided for the purposes of social rehabilitation is in such a condition as to need replacing:

  • (ii) changes in the claimant's condition or circumstances since the last assessment was undertaken.

(5) The Corporation must provide to an assessor (whether employed or appointed by the Corporation) all information the Corporation has that is relevant to the assessment.

(1) The Corporation is liable to provide vocational rehabilitation to a claimant who—

• (a) has suffered personal injury for which he or she has cover; and

• (b) is—

  • (i) entitled to weekly compensation; or

  • (ii) likely, unless he or she has vocational rehabilitation, to be entitled to weekly compensation; or

  • (iii) on parental leave.

(2) Despite subsection (1)(b)(i), the Corporation is liable to provide vocational rehabilitation to a person who was entitled to weekly compensation and who would, but for clause 52 of Schedule 1 (relationship between weekly compensation and New Zealand superannuation), continue to be entitled to weekly compensation.

(1) In deciding whether to provide vocational rehabilitation, the Corporation must have regard to the matters in section 87.

(2) In deciding what vocational rehabilitation is appropriate for the claimant to achieve the purpose of vocational rehabilitation under section 80,—

• (a) the Corporation must consider whether it is reasonably practicable to return the claimant to the same employment in which the claimant was engaged, and with the employer who was employing the claimant, when the claimant's incapacity commenced; and

• (b) if it is not, the Corporation must consider the following matters:

  • (i) whether it is reasonably practicable to return the claimant to an employment of a different kind with that employer:

  • (ii) whether it is reasonably practicable to return the claimant to the employment in which the claimant was engaged when the claimant's incapacity commenced, but with a different employer:

  • (iii) whether it is reasonably practicable to return the claimant to a different employment with a different employer, in which the claimant is able to use his or her experience, education, or training:

  • (iv) whether it is reasonably practicable to help the claimant use as many of his or her pre-injury skills as possible to obtain employment.