The Good, The Bad, and The Ugly: ACC

Here is a story of a builder named John.

John hurt his shoulder 20 years ago but he recovered and continued working, with no symptoms or issues from that injury. Fast forward 20 years and John walked into a door frame and tore his rotator cuff, which put him out of work for about nine months. When John made a claim with ACC for the newer and recent shoulder injury, ACC denied his claim stating that the injury was due to his pre-existing condition, which means they blamed the new injury on the old accident. John’s surgeon stated that the torn rotator cuff was entirely independent of any previous injury and his condition was not due to the old injury, but alas, ACC said no.

New Zealanders are fortunate to have something like ACC in place because many countries do not. Yet, while ACC recognise its obligation to the people of New Zealand, they simply don’t have enough money to pay out every claim. The issue is that many Kiwis believe that ACC will always take care of them – which is simply unrealistic.

Some of the main conditions that ACC doesn’t cover include:

  • illness, sickness, or contagious diseases, e.g., measles.
  • conditions related to ageing, e.g., arthritis.
  • most hernias.
  • injuries that happen over time, unless an activity at work is causing it.
  • if you have appendicitis and need an emergency trip to the hospital.

You can view everything ACC doesn’t cover here: Injuries we don’t cover (acc.co.nz).

It’s important to recognise that ACC can deny a claim, despite a medical professional disagreeing with the decision (as in John’s case). A person can challenge ACC’s decision (and are encouraged to do so if they have a doctor’s opinion on your side); yet roughly 90% of claims denied by ACC won’t be challenged (due to the cost, time and stress involved). This means many people will miss out on payment they deserve.

In John’s case, his medical insurer challenged the case, taking ACC to court and winning the case so that John was paid out nine months’ worth of wages, in arrears. This was great news for John: it meant that he didn’t have to wait in the public system for his surgery or go through the mental and financial stress of having to fight the decision himself through the courts.

Medical insurance can be a valuable option for many. As with all insurances, it’s a balance of premiums with likelihood of claim and value, and a good financial adviser will ensure your plan includes a portion of, or even entire, self-insurance as cashflow allows. The thing to think about here is: if you get sick, will you be happy to wait? If you need medical attention, the public health system will help you sooner or later – although it’s the ‘later’ part that can cause a lot of distress for people.

While ACC is not a perfect system (and may not cover us under every circumstance) it’s a system that many other countries do not have. The solution is to equip yourself with knowledge: know what ACC does and does not cover and look into alternative protection (such as private insurance) if they suit you.

About Cameron Irvine

Cameron Irvine
Cameron Irvine is a Financial Adviser/Investment Coordinator at Lifetime.

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