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Accident Compensation Act 2001

Miscellaneous provisions - Situations where previous insurer involved

296: Failure to reach agreement

You could also call this:

“What happens when ACC and the insurer can't agree on your claim”

If the insurer and the Corporation can’t agree on how to handle your claim within 3 months after you get hurt again, they need to get a mediator to help them try to agree. This is about figuring out how to manage and pay for what you need.

If they still can’t agree after talking with the mediator, either the insurer or the Corporation can ask the District Court to decide. They have to ask the right District Court in the way the rules say.

When the District Court makes its decision, it needs to think about why these rules exist. It will decide who should provide or manage what you need for both your old injury and your new injury. The court will include any things the insurer and Corporation have already agreed on.

The court can say the insurer, the Corporation, or both should be responsible. This can be for things you’ve already received and things you’ll get in the future.

If the court thinks that either your old injury or your new injury is the main reason you can’t work or need help, it can say that either the insurer or the Corporation should take care of everything from a certain time.

The court will make its decision based on what’s really important, not small details. It will look at the main facts of your situation.

If things change for you later, and the insurer and Corporation can’t agree on what to do, either of them can ask the court for more instructions.

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View the original legislation for this page at https://legislation.govt.nz/act/public/1986/0120/latest/link.aspx?id=DLM103430.

Topics:
Health and wellbeing > Healthcare services
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"ACC and insurers must work together to help you if you get hurt again"

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Part 9 Miscellaneous provisions
Situations where previous insurer involved

296Failure to reach agreement

  1. If the insurer and the Corporation are unable to reach an agreement under section 295(1)(e) within 3 months of the subsequent injury being suffered, they must jointly engage a mediator in an endeavour to reach an agreement.

  2. If the insurer and the Corporation are still unable to reach an agreement under section 295(1)(e) at the conclusion of the mediation, either party may apply to the District Court for a determination as to how the claimant's entitlements should be managed and paid for.

  3. Any application to the District Court under this section must be made to the District Court specified in regulations for that purpose and must be made in the prescribed manner.

  4. In determining an application under this section, the District Court must have regard to the purpose set out in section 294(2) and must make a determination about which party or parties is or are liable to provide or manage the claimant's entitlements in respect of both the previous injury and the subsequent injury, and in doing so must incorporate any matters that have already been agreed between the parties.

  5. A determination of the District Court may allocate responsibility on a specified basis to either the insurer and the Corporation or to both, including in relation to entitlements that have already been provided and in relation to entitlements that are to be provided.

  6. If satisfied that either the previous injury or the subsequent injury is, or was for a particular period, wholly or substantially causing the claimant's ongoing incapacity or the claimant's need for ongoing entitlements, the District Court may in its determination direct accordingly that the insurer or the Corporation must bear all of the responsibilities for entitlements from a specified time or for a specified period.

  7. In making a determination under this section, the District Court must determine the matter according to the substantial merits of the situation, without regard to minor matters.

  8. If the circumstances of the claimant change and the parties are unable to reach agreement about any changes to their responsibilities, either party may apply to the District Court by originating application for further directions in accordance with this section.