Impairment Assessments for Lump Sum Compensation and ... · Accident Compensation Corporation Page 7 of 45 3. Roles and Responsibilities Impairment Assessments require all those involved

Impairment Assessments – Operational Guidelines

Accident Compensation Corporation Page 1 of 45

V2.0

Impairment Assessments for Lump Sum

Compensation and Independence Allowance

Operational Guidelines

October 2019

This is a living document and will be updated as required



Useful Contacts and Telephone Numbers

Service Name Contact Details

Contracts administrator and health procurement specialist

0800 400 503

[email protected]

Client/patient helpline 0800 101 996

Digital Operations eBusiness help 0800 222 994 (option 1)

[email protected]

Engagement and performance Managers

Engagement and Performance Managers can help the Supplier to provide the services outlined in your contract; contact Provider help services or go to the ACC website - contact our provider relationship team for details of the Engagement and Performance Manager in your region

Provider help 0800 222 070

[email protected]

Provider registration 04 560 5211

[email protected]

ACC Portfolio For contact details of the Impairment Assessments Advisor/Manager email Contact Provider Help Services at [email protected]

Entitlements Unit Ph: 0800 101 996 Email: [email protected]

For regions north of New Plymouth and Gisborne:

ACC Hamilton Service Centre PO Box 952, Waikato Mail Centre, Hamilton 3240 Fax: 07 848 7201

For New Plymouth, Gisborne and all areas south:

ACC Dunedin Service Centre PO Box 408, Dunedin 9054 Fax: 0800 844 850

The ACC website can provide you with a lot of information, especially our ‘Health and service providers’ section. Please visit www.acc.co.nz

Please report all health, safety and security risks or incidents in writing using the

procedure on our website www.acc.co.nz/for-providers/report-health-safety-incidents

mailto:[email protected]


https://www.acc.co.nz/for-providers/provide-services/provider-relationship-team/?smooth-scroll=content-after-navs





http://www.acc.co.nz/

http://www.acc.co.nz/for-providers/report-health-safety-incidents



Contents Useful Contacts and Telephone Numbers ............................................................................. 2

1. Introduction .................................................................................................................... 5

2. Impairment Assessments Overview ............................................................................... 5

3. Roles and Responsibilities ............................................................................................. 7

4. Approvided Service Providers ........................................................................................ 7

Qualifications Required ........................................................................................... 7

Assessment Tool .................................................................................................... 7

Training Requirments .............................................................................................. 8

Keeping up Training ................................................................................................ 8

Types of Assessment .............................................................................................. 9

Assessors who Travel ............................................................................................. 9

Completing Peer Reviews ....................................................................................... 9

Updating Provider Details: .................................................................................... 10

5. Client’s Eligibility and Referrals .................................................................................... 10

Impairment Assessment Eligibility ......................................................................... 10

Reassessment Eligibility ....................................................................................... 10

Impairment Assessment Referrals ........................................................................ 11

Multiple or Additional Impairment Assessments: ................................................... 11

Urgent Referrals ................................................................................................... 12

6. Impairment Assessment Service Requirements ........................................................... 12

Assessment Process ............................................................................................ 12

Impairment Assessments on Medical Records ...................................................... 13

Imapiarment Assessments for Overseas Clients ................................................... 13

Impairment Assessment Reports .......................................................................... 14

Service Timeframes .............................................................................................. 15

7. Quality/performance measures .................................................................................... 15

8. Peer Reviews ............................................................................................................... 15

Peer Reviewer’s Role ........................................................................................... 16

Amendments to the Impairment Assessment Report ............................................ 16

Peer Review Timeframes ...................................................................................... 18

9. Clinical Guidelines ....................................................................................................... 18

Apportionment Methods ........................................................................................ 18

The Respiratory System........................................................................................ 21

The Visual System ................................................................................................ 22

Mental Injury ......................................................................................................... 25

Pain ...................................................................................................................... 28



The Spine ............................................................................................................. 31

10. Payment and Invoicing ............................................................................................. 34

General Assessments ....................................................................................... 34

Chapter 14 Assessments .................................................................................. 35

Functional Sub-Units ......................................................................................... 35

Request for Additional Information..................................................................... 37

Peer Reviews .................................................................................................... 37

Non-attendance Fee .......................................................................................... 37

11. Travel ....................................................................................................................... 38

12. Culturally Competent Services ................................................................................. 38

Meeting the Cultural Needs of Māori Clients ...................................................... 38

Clients who Require an Interpreter .................................................................... 39

Multiple Support People .................................................................................... 39

13. Working with Clients who may pose a Health and Safety Risk ................................. 39

Communication Regarding Clients with a Care Indicator (Risky) ....................... 40

Reporting Health and Safety Risks and Incidents .............................................. 41

14. Privacy and Storage of Client Health Information ..................................................... 41

Practical Meaning of the Code ........................................................................... 41

15. Service Management ................................................................................................ 41

Engagement and Performance Manager Meetings ............................................ 42

16. Appendices .............................................................................................................. 43

Glossary ............................................................................................................ 43

Impairment Assessment Report Checklist ......................................................... 44



1. Introduction

Welcome to the Impairment Assessments for Lump Sum Compensation and Independence

Allowance Operational Guidelines. This document is intended as both a guideline for those

working to deliver Impairment Assessments and as a framework document for ACC Case

Owners.

These guidelines apply to all professions delivering services under the Impairment

Assessment Services contract across all geographic regions.

These Operational Guidelines should be read in conjunction with the:

• Standard Terms and Conditions document; and

• Service Schedule for Impairment Assessment Services.

Services must comply with the Impairment Assessment Service Schedule. Where there are

inconsistencies between the Operational Guidelines and the Impairment Assessment

Service Schedules, the Service Schedules will take precedence.

These guidelines are a living document and will be updated in response to Supplier, Provider

and client feedback, Provider service delivery issues, and as part of ACC’s continuous

improvement process. ACC will notify Suppliers when each new version of the Impairment

Assessments Operational Guidelines is issued, and that latest version will be available on

the ACC website at www.acc.co.nz.

These guidelines cover information about:

• Carrying out Impairment Assessments for ACC clients.

• Clinical guidelines for assessing whole person impairment.

2. Impairment Assessments Overview

Clients who suffer a permanent or long-term impairment resulting from an injury may be

entitled to lump sum compensation or an independence allowance (IA).

To determine the level of impairment, ACC purchases Impairment Assessment services from

appropriately contracted and qualified health professionals. Assessing a client’s impairment

provides a fair and equitable basis for determining the level of lump sum and IA.

https://www.acc.co.nz/resources/#/subcategory/130

https://www.acc.co.nz/assets/contracts/imp-schedule.pdf

http://www.acc.co.nz/



It is important to note that the concept of impairment differs from the concepts of disability

and work capacity. The testing of impairment determines the severity of the injury, not the

impact the client’s impairment has on them personally (their disability), or their ability to work

(work capacity). An Impairment Assessment does not determine diagnosis or causation. The

key output from an Assessment is an Impairment Report.

All Impairment Assessments must be carried out using an Assessment Tool. Assessors are

required to use the American Medical Association’s Guides to the Evaluation of Permanent

Impairment, Fourth Edition (AMA4) and the ACC User Handbook to AMA4 to assess

impairment related to the client’s covered injuries.

The Assessor is required to proportion the client’s impairment, identifying the impairment

which related to injuries covered by ACC and deducting any impairment that has not resulted

from the covered injury. This leaves the portion that is used to calculate a client’s entitlement

to an IA and/or lump sum.

Whole person impairment ratings are determined based on the client’s covered injuries:

• A physical injury is for a loss of physical function eg scaring, nerve damage, loss of

range of movement etc.

• A mental injury is based on the direct link to the covered diagnosis eg. PTSD and

how four areas of their life are being affected:

• activities daily living (shopping, sleeping, hygiene etc.);

• social functioning;

• adaptation & decompensation (stress);

• concentration, persistence and pace (organising and completing tasks).

• A traumatic brain injury is based on cognitive functioning eg comprehension, mental

status, emotional behaviours, consciousness, epilepsy/ seizures etc.

If a Client has a whole person impairment rating of 10% or greater and they meet eligibility

criteria, they will likely be eligible for either an IA or a lump sum. There are some cases

where clients must reach higher than the 10% threshold. An overview of the process is

illustrated below.

Eligible clients can request ACC arrange an

Impairment Assessment to determine lump sum and

IA eligbility

ACC helps the client to gather their medical

information and arrange the Impairment

Assessment

An Impairment Assessment is completed

by a contracted Impairment Assessor

The Assessor determines impairment for each

covered condition and the whole-person impairment

rating

ACC is provided with an Impairment Assessment report. ACC reviews the report (peer review may

be completed)

If the whole person impairment rating is 10% or greater, ACC will offer

either a lump sum or IA to the client

https://www.acc.co.nz/assets/provider/fe092baf01/acc716-ama4-handbook.pdf



3. Roles and Responsibilities

Impairment Assessments require all those involved to work in partnership, with a mutual

understanding of each other’s roles and responsibilities. The diagram below illustrates the

roles and responsibilities of those involved in the Impairment Assessment process.

4. Approvided Service Providers

Qualifications Required

To be an ACC approved Impairment Assessor the Assessor must be a Medical Practitioner

who has at least general registration with the New Zealand Medical Council (NZMC) and

three years’ post-registration clinical experience.

They must hold a current annual practising certificate, ie it is renewed annually. ACC relies

on the NZMC to assess the competence of a Medical Practitioner to hold a vocational annual

practising certificate.

Assessment Tool

To be an ACC approved Impairment Assessor the Assessor must have satisfactorily

completed ACC’s training course on the Assessment Tool and a post-course test in the use

and application of the Assessment Tool. The Assessment Tool refers to the:



• The American Medical Association’s Guides to the Evaluation of Permanent

Impairment 4th Edition (AMA4) (AMA Guides); and

• The ACC User Handbook to the AMA ‘Guides to the Evaluation of Permanent

Impairment’ 4th Edition (ACC Handbook).

The AMA Guides are explicit, but not intuitive, and are designed to require training in their

use and application, as well as clinical judgement and expertise. The AMA Guides provide a

framework for minimising interobserver variation in assessing impairment.

The interpretation and application of the AMA Guides are supported by the ACC Handbook,

which provides additional material so that the AMA Guides are relevant to the New Zealand.

Training Requirments

To complete Impairment Assessments for ACC, ACC requires an appropriately qualified

Medical Practitioner to have satisfactorily completed ACC’s training courses on using the

AMA Guides and the ACC Handbook.

Initial Training involves practice in using the AMA Guides, assessment methods, calculating

impairment, and report formatting. An Assessor must satisfactorily complete several sample

case studies before they undertake assessments.

Initial training is followed by a period of mentorship and collegial oversight from ACC’s

Clinical Advisor, who is independently trained in the use of the AMA Guides in Australia, and

has experience in conducting, peer reviewing, and instructing doctors in the formal

assessment of impairment and proportional attribution in New Zealand and Australia.

The Clinical Advisor provides support in the application of the AMA Guides and ACC

Handbook to individual cases and advice on report formatting until the Assessor’s reports

are consistently compliant with the Assessment Tool.

Subsequently, a proportion of all assessment reports are Peer Reviewed by an experienced

assessor to ensure compliance and quality, with direct feedback to assessors.

Keeping up Training

ACC requires impairment assessors to maintain their skills through the following:

• Ensuring they have current experience in preparing Impairment Reports.

• Attending annual refresher training for Impairment Assessors held by ACC. This

covers both general assessments for physical injury and Chapter 14 assessments for

behavioural and mental impairment. It also provides an opportunity for Impairment

Assessor to raise issues for clarification.

• Regular teleconferences for Impairment Assessors to discuss cases studies and

reports. This provides an opportunity for Assessor’s to obtain support and advice

from experienced Assessors and ACC’s Clinical Advisor.

• Interval guidance on consistency of approach is also provided via the publication of

Operational Guidelines.



Impairment rating reports are also subject to Peer Review by expert medical assessors as

part of ACC’s quality assurance program. Peer Reviewers provide direct feedback to the

assessor.

Types of Assessment

Assessors may only carry out the types of Impairment Assessment that they are listed as

being able to undertake. The types of assessment are:

• General assessments for physical injury; and

• Chapter 14 assessments for behavioural and mental impairment.

To complete Chapter 14 assessments for behavioural and mental impairment, the

Impairment Assessor must either be a psychiatrist, or be experienced in completing general

assessments for physical injury for ACC and have knowledge of psychology and the

diagnostic system in psychiatry/psychology (as per the Diagnostic Statistical Manual of

Mental Disorders (DSM)). Requirements for General Practice registration with the NZMC is

that the Medical Practitioner has knowledge of the DSM.

The Impairment Assessor must also have satisfactorily completed ACC’s training courses on

using Chapter 14 (assessments for behavioural and mental impairment) of the AMA Guides

and the ACC Handbook.

Assessors who Travel

Impairment Assessors can nominate to travel and hold clinics in different locations if there is

a shortage of local Assessors in that area.

ACC will contact the Impairment Assessors who have agreed to travel once there are

several clients needing Impairment Assessments in a given area. The Impairment Assessor

will be required to confirm their availability to complete the Impairment Assessments. ACC

will work with the Impairment Assessor to ensure all available appointments times are filled.

The Impairment Assessor is required to contact the Client with the Assessment date, time

and location, 10 days before their clinic.

Completing Peer Reviews

A small number of Impairment Assessors are approved by ACC to provide Peer Reviews.

The Impairment Assessors who provide Peer Reviews must:

• have the necessary qualifications to be an Impairment Assessor;

• have completed the necessary training to be an Impairment Assessor;

• have maintained their competency through attending refresher training as well as

providing Impairment Assessment services; or,

• has demonstrated their ability to produce Impairment Assessment reports of a

consistently high standard.




Updating Provider Details:

Assessors must keep their details up to date. Whenever contract details change, please

email [email protected] or phone 0800 101 996 and confirm their current:

• postal address

• courier delivery address

• e-mail address

• telephone contact details, including the number that:

• can be disclosed to the client

• is for ACC use only.

5. Client’s Eligibility and Referrals

Impairment Assessment Eligibility

A client can apply for an IA/Lump sum entitlement (or both) at any time. To determine

eligibility for an Impairment Assessment, the client and their doctor may have to complete an

ACC544 Medical Certificate and provided relevant medical records relating to the client’s

injury(s).

If the client meets the following criteria ACC will arrange an Impairment Assessment to

determine the level of impairment.

Independence Allowance (Date of Injury: 1 April 1974 – 31 March 2002):

• the Client’s condition is stable and there is a likely impairment from injury;

• the Client’s condition is not stable, but there is a likely impairment and it is more

than 52 weeks since the injury.

Lump Sum (Date of Injury: 1 April 2002 to present):

• the Client’s condition is stable and there is a likely impairment from injury;

• the Client’s condition is not stable, but there is a likely impairment and it is two

years or more since the injury.

Children under the age of 16 are not eligible to have the impairment effects of a mental injury

assessed, for lump sum only, unless there are compelling reasons. This is because long-

term mental impairment effects cannot be accurately established.

Reassessment Eligibility

A client is eligible for an Impairment Reassessment if the ACC554 Medical Certificate states

that:

• the impairment may have increased since the date of Assessment;

• the impairment may have decreased since the date of Assessment (where the client

is in receipt of an IA).

A Client is not entitled to have more than one Reassessment in any 12-month period. A

Client is not required to undergo more than one Reassessment in any 5-year period




It is not considered a Reassessment if the client was previously certified likely to have an

impairment, but unstable and a new ACC554 Medical Certificate now certifies the injury as

stable.

ACC may request for a Reassessment when:

• there are reasonable grounds to believe the impairment may have decreased since

the last Assessment;

• it has been five years or more since the last Reassessment.

Impairment Assessment Referrals

Once an application for an IA or lump sum is deemed complete, ACC determines whether

the Client is eligible for an Impairment Assessment. If they are eligible, ACC will ensure

there is enough information before completing the Impairment Assessment referral.

ACC will consult with the Client to choose a contracted Assessor who is qualified to assess

the Client’s injury type. The Client can elect which appropriate Assessor they would prefer to

complete their Impairment Assessment.

ACC will send the Client a letter confirming the referral and advising them that the

Impairment Assessor will contract them within 10 days to arrange the assessment. Clients

are instructed to advise the Impairment Assessor if they will be bringing with them a support

person. If the Client is unable to attend the assessment for some reason they are instructed

to phone ACC within five working days.

ACC will send the Impairment Assessor a referral letter containing the Client’s contact

details and requesting they contact the client within 10 working days. The referral letter will

clearly outline the covered injuries which need assessing. The following supporting

documentation will be enclosed:

• medical certificates;

• medical notes;

• consent form.

After reviewing the referral information, if the Impairment Assessor determines they need

additional specialist reports or travel to complete the Assessment they should contact ACC

prior to the Assessment. If the Assessor notices anything inconsistent regarding the covered

injuries, they should contract ACC. Assessors must only assess the covered conditions that

have been requested by ACC.

Multiple or Additional Impairment Assessments:

ACC may need to arrange two separate Assessments by two appropriately qualified

Impairment Assessors when both of the following apply:

• a Client suffers injuries that mean they need a physical Assessment and a mental

and behavioral Assessment;

• there is no Assessor available and qualified to conduct both Assessment types.



If ACC discovers that new information about a Client was available at the date of an

Assessment or Reassessment but wasn’t made available to the Assessor at the time they

conducted and rated the impairment of the Client, ACC can arrange an additional

Assessment to include the new information so that it can be considered.

A Client can arrange for an additional Assessment at any time at their own cost. If there are

any points of difference because of this Assessment, ACC will investigate further.

Urgent Referrals

To be eligible for a lump sum entitlement, a deceased Client must have been assessed prior

to their death and all the following must apply:

• the Client suffered a personal injury for which they have cover;

• the Client survived the injury for no fewer than 28 day;

• the Assessment established that the Client's injury resulted in a whole person

impairment (WPI) of 10% or above.

The rules for assessing the impairment for an IA differ from those for lump sums.

If a Client requests an Impairment Assessment and has a terminal or rapidly deteriorating

condition, such as mesothelioma, the Assessment process can be completed urgently.

ACC can prepare the claim(s) file records for the assessment process while the claim for

cover is still being considered. This will reduce any delay between cover acceptance and the

Assessment outcome. Where possible an Assessment based on the medical documents,

without the need to see the Client in person may be completed.

6. Impairment Assessment Service Requirements

Assessment Process

The Assessment Tool is used during an Impairment Assessment to provide an objective

measure of a Client’s impairment for ACC. The ACC Handbook sets out the procedures,

formatting and other requirements for the Assessment and Impairment Report in full detail.

The Impairment Assessor must, but is not limited to:

• Introduce themselves to the Client and provide an explanation of the Impairment

Assessment process and what the assessment involves.

• Obtaining and reviewing any additional information required for a comprehensive

Assessment of the client.

• Complete a medical examination of the Client, see image below.

• Completion an Impairment Report in accordance with the formatting and procedural

requirements of the ACC Handbook, including a whole-body impairment rating.

• Discuss with the Client on the findings of the assessment.

The medical examination of the Client follows the process below:





When required, the Impairment Assessor may be required to submit a revised Impairment

Report to ACC if feedback is received from ACC, or a reviewer engaged by ACC that the

initial Impairment Report is unsatisfactory.

Impairment Assessments on Medical Records

In certain circumstances a Client may not be able to attend an Assessment due to being

overseas or are physically unable to attend due to injury or illness. In these cases, ACC may

ask an Assessor to complete the Assessment based on medical records. The Assessor will

determine and advise ACC whether an accurate Assessment of their level of impairment can

be completed from the medical records.

Impiarment Assessments for Overseas Clients

In certain circumstances, ACC may request a client return to New Zealand for an Impairment

Assessment. ACC may require overseas Medical Practitioners to provide relevant medical

reports. The overseas Medical Practitioner must meet the following criteria:

• holds registration in the country in which they are practising;

• holds a medical degree from a medical school approved by the New Zealand Medical

Council. This includes universities listed in the WHO World Directory of Medical

Schools.

ACC is not required to meet either of the following costs:

•Review the medical records, investigations and laboratory findings for each condition you have been asked to assess

1 - Gather and evaluate relevant information

2 - Read relevant material in the ACC Handbook

•The ACC Handbook provides details on where to refer to in the AMA Guide

3 - Read relevant material in the AMA Guide

•Clients need reassurance that you have considered all of their injuries and taken time to listen to them

4 - Establish clinical history and examine Client

•Rate the impairment for each condition using the tables and charts in AMA Guide and using the relevant material in the ACC Handbook

5 - Determine impairment for each condition

•Use the tables in AMA Guide

6 - Determine whole-person rating



• any costs incurred by the Client overseas;

• any costs relating to the return of the Client to New Zealand for Assessment.

Clients who live overseas may be assessed over the phone by a New Zealand Impairment

Assessor based on an up-to-date Psychiatric report (for Chapter 14 assessments for

behavioural and mental impairment).

To be assessed over the phone the Client must be comfortable and give their consent. ACC

must also have an up-to-date Psychiatric report that meets our requirements. The report

must be from a psychiatrist who meets our requirements for an overseas Psychiatrist

The Impairment Assessor must also be satisfied that it is clinically appropriate to complete

the Assessment over the phone, ie the Client will not be left in an ‘unsafe’ psychological

state without existing local support.

Impairment Assessment Reports

Prior to ACC issuing a IA and lump sum decision or sending a report for Peer Review, ACC

will check the Impairment Report to ensure it meets the basic criteria required (refer to the

Impairment Assessment Report Checklist). If an error in the Impairment Assessment Report

is identified, ACC will contract the Assessor to discuss the error prior to issuing a decision or

sending a report for Peer Review.

The ACC Handbook contains the format required for the Impairment Reports. The report

format for general assessments for physical injury is found on page 11. The report format for

chapter 14 assessments for behavioural and mental impairment is found on page 41. The

report format for an ACC4152 Impairment Assessment Accredited Employer Report is found

at www.acc.co.nz.

The injuries assessed should be listed and consistent with those specified in the referral

documents. Only include additional injuries when they have been requested or approved by

ACC to be included. A list of the documents used in the assessment should also be listed.

This should include any notes from the client.

When apportioning non-covered conditions, it is important to including a clear description

and clinical reasoning. Impairment Reports should include a comment on apportionment,

even if it’s simply that it wasn’t required. When completing a Reassessment, it is also

important to provide a clear clinical opinion on changes since the previous Assessment. This

ensures the Client understands the reasoning for their entitlement decision.

Accredited Employer Reports needs to be comprehensive enough for the employer to

understand how the Assessor reached their conclusion. When writing the Accredited

Employer Report, it is important that only details about the Client that relates to the injury

covered by the employer is included.

It is also important to avoid making small errors. Any error, even in the spelling of a Client’s

name, can lead a Client to doubt the Impairment Report, raise concerns about possible

rating errors and request a review of ACC’s decision.


https://www.acc.co.nz/assets/provider/be5bc689a0/ACC-4152-Impairment-Assessment-Accredited-Employer-Report.doc



Service Timeframes

The Impairment Assessor

must…

within…

contact the Client and arrange

an assessment

10 working days of receiving the referral

assess the Client 30 working days of receiving the referral, or notify ACC if this is

not possible

see the Client at their

Assessment appointment

30 minutes, or else give the Client a full explanation of why they

were made to wait

supply an Impairment Report to

ACC

10 working days of assessing the Client

NOTE: Assessors who travel and complete Assessments offsite are required to contact the Client

with the Assessment date, time and location, 10 days before their clinic.

7. Quality/performance measures

The performance of Impairment Assessors is measured against the quality and performance

measures listed in the Service Schedule. The key measures are:

• To provide Impairment Reports assessed by ACC as complete, accurate and of

suitable quality.

• Complete the services within the timeframes set out.

The quality of the Impairment Assessment Reports is reviewed by the Treatment and Support

Assessor using the Impairment Assessment Report Checklist. Peer reviews are also

completed to check the quality of Impairment Reports and the impairment rating. ACC can use

data from invoices submitted to measure if services are being delivered within contractual

timeframes.

The Claims Assessment unit at ACC will communicate with Impairment Assessors on their

performance as the need arises. Engagement and Performance Managers (EPM) may meet

with Impairment Assessors where quality issues need addressing.

8. Peer Reviews

ACC checks the quality of Impairment Reports and the impairment rating through a process

of Peer Reviews. Peer Reviews ensure the consistent and equitable provision of IA and

lump sum entitlements to Clients.

Not all Impairment Reports are Peer Reviewed. The Treatment and Support Assessor will

determine if an Impairment Report requires a Peer Review. They may consider referring for

a Peer Review when:

• the quality of the Impairment Report is questioned, or the Assessor is new;

• the whole person impairment percent is less than 10% or more than 35%;




• an Impairment Report is required for the ACC review process;

• a complex injury type or a high degree of non-injury related factors; or

• a significant increase or decrease from a previous Assessment

When ACC refers for a Peer Review, ACC will send a referral letter, including the

Impairment Report and the relevant medical records to the appropriately qualified

Impairment Assessor to undertake the review.

A letter will also be sent to the Client informing them of the Peer Review taking place.

Peer Reviewer’s Role

The peer reviewer determines whether the Impairment Assessment Report:

• complies with the correct use of AMA Guides 4th Edition and the ACC User

Handbook to AMA4;

• reflects the available information;

• draws the correct conclusions from the findings;

• states the injury is stable and permanent;

• considers the correct Diagnosis Related Estimates and tables;

• has correct calculations;

• ensures Chapter 14 Impairment Reports appear entirely reasonable and justified;

• contains the impairment rating for all injuries for which a rating has been sought;

• contains no apparent conflict between the records provided and the clinical findings;

• and, ensures apportionment correctly measured and justified.

If the Peer Review service Provider considers that the Impairment Report complies with the

report requirements and the accepts the impairment percentage, they will provide ACC with

a Peer Review Report. This report should comment on the above, along with general

comments on the quality of the report. The Peer Review service Provider should provide the

Impairment Assessor with a copy of the Peer Review Report.

Amendments to the Impairment Assessment Report

If the Peer Review service Provider considers the Impairment Report requires amendment

they will return the Impairment Report to the Assessor with the Peer Review Report and their

suggested comments and amendments.

The Peer Review service Provider should call the Impairment Assessor to discuss the

aspects of the Impairment Report that require amendment. The Impairment Assessor is

required to make the amendments required to the Impairment Report and return it to the

Peer Review service Provider. Once the Peer Review service Provider receives the

amended Impairment Report and reviews it, if satisfactory, they will send it with the Peer

Review Report to ACC.



If the Impairment Assessor disputes the Peer Review service Provider’s findings, the

Impairment Assessor can contact the Treatment and Support Assessor or ACC’s Clinical

Advisor. The Clinical Advisor may discuss the suggested amendments with the Impairment

Assessor and provide advice. The Impairment Assessor will then make the amendments

required to the Impairment Assessment report and return it to the Peer Review service

Provider.

If the Impairment Assessor still disputes the Peer Review service Provider’s findings and the

advice of ACC’s Clinical Advisor, the Peer Review service Provider will note this on the Peer

Review Report and return it without signing it off. ACC will then make a final decision. This

may include sending the Impairment Report and Peer Review Report to another Peer

Review service Provider to conduct a Peer Review.

The Peer Review process is outlined below:

NOTE: The Peer Review Report should be provided to both the Impairment Assessor and ACC whether

amendments are required or not.



Peer Review Timeframes

The peer review service

Provider must…

within…

complete a standard Peer

Review (no amendments)

5 working days from the date the Peer Review referral was

received

complete a complex Peer

Review (amendments required)

10 Working Days from the date the Peer Review referral was

received

inform ACC if the Impairment

Assessor has taken longer than

5 Working Days to amend an Impairment Report

9. Clinical Guidelines

The following clinical guidelines section provides guidelines and examples for those working

to deliver Impairment Assessments. The topics covered are those which Assessors

commonly require further guidance with.

Apportionment Methods

Apportionment needs to be considered when:

• a medical condition not covered by ACC has contributed to the impairment

percentage. You’ll need to apportion your rating into covered and non-covered

impairments;

• a body part (eg a lower limb) has been injured in more than one accident;

• the impairment spans different entitlement periods (eg lump sum compensation,

combined independence allowance and separate independence allowance). For

example, a client may have two knee injuries, one suffered in a lump sum period and

the other in a combined independence allowance period. You need to rate the

current impairment and apportion the impairment to attribute the relevant

percentages to the two separate injuries. This enables us to consider possible

entitlements according to the claim type.

The question that apportionment needs to answer is: ‘once it stabilised, what contribution did

the particular injury make to the impairment of a body part?’ The ACC Handbook (page 10)

outlines two apportionment methods:

• Use medical records to estimate the impairment before the covered injury happened.

However, this method has its challenges. For example, you might not have enough

information to do this (especially if the injury happened many years ago), and a non-

covered condition or issue that also contributes to the overall impairment might have

developed after the covered condition.

• Use the available records and your assessment findings and exercise your clinical

judgement (as detailed in the ACC Handbook, page 10). Resources could include

your objective findings, old medical reports, previous impairment assessment reports,

relatives’ or close friends’ comments, and specialist opinions. Unfortunately, patient

histories are not necessarily reliable; in some cases, the patient is convinced that all



of a particular impairment is due to an accident despite other evidence not supporting

this.

Once you’ve decided on the percentage impairment of the body part for each time period,

the impairment due to each injury is simply a case of subtraction.

Explaining apportionment in your report

It’s important that you explain your reasons for apportionment clearly and simply in your

report, so that anyone reading it can understand them. Clients often want to discuss them

when we advise them of our decisions, and it helps to reduce the risk of clients requesting

reviews of our decisions.

For example, in apportioning mental and behavioural impairment, it can be useful to

comment on how the covered and non-covered conditions affect functions such as ‘activities

of daily living’, ‘social functioning’, ‘concentration, persistence and pace’ and ‘adaptation and

decompensation’. See Section 6 on page 17 of the ACC Handbook for more detail.

Examples of apportionment

The ACC Handbook includes examples of using pre-existing impairments based on medical

records. However, a non-covered impairment might have changed or be from a condition

that arose after the injury. In these situations, please use your clinical judgement.

Examples 1

In 1982 Mr X was involved in a motorbike accident. He suffered a right-lower-tibia fracture

that required internal fixation, which resulted in his right leg shortening by three centimetres

(a 10% lower-extremity impairment).

In October 2007 Mr X’s right total hip joint was replaced owing to medical osteoarthritis. He

said it healed very well and he was pain free. The available medical records confirmed this

good result (a 37% lower-extremity impairment).

In December 2007 Mr X fell, suffering a periprosthetic fracture of his right femur. ACC

covered the injury and his right total hip joint was properly replaced in late 2008.

A history and examination at the impairment assessment appointment showed a poor result,

but no additional lower limb shortening (a 75% lower-extremity impairment).

Mr X’s available medical records showed that he suffered osteoarthritis of both knees and

his left hip. He said he suffered constant back pain because of his right leg shortening, and

believed the osteoarthritis affecting his right side and his back pain were a result of his 1982

injury and right leg shortening. This opinion was not supported by specialist records.

Mr X had had previous diagnoses of depression, anxiety disorder and bipolar disorder. He

suffered migraine headaches, had a longstanding history of chronic pain, and had a past

history of head injuries and drug abuse.

The apportionment

Mr X’s two covered injuries and his medical osteoarthritis can be apportioned as follows:

• before 1982: 0% right-lower-extremity impairment.



• 1982 injury: 10% right-lower-extremity impairment due to the tibia fracture (10%

minus 0%).

• October 2007 medical event: 37% right-lower-extremity impairment due to the hip

replacement, combined with the pre-existing 10% right-lower-extremity impairment =

43%. The medical event thus increased the right-lower-extremity impairment by 33%

(43% - 10% = 33%).

• December 2007 accident: 75% right-lower-extremity impairment due to the now poor

hip replacement result, combined with the pre-existing 10% right-lower-extremity

impairment = 78%. The December 2007 covered injury increased Mr X’s right-lower-

extremity impairment by 78% - 43% = 35% lower-extremity impairment.

This means that Mr X has a 10% lower-extremity impairment, a 4% whole-person

impairment due to his 1982 accident (which was before 1 July 1999 so stands alone), a 35%

lower-extremity impairment and a 14% whole-person impairment due to his December 2007

accident (which was after 1 April 2002 so also stands alone).

In this example, the medical condition is rated and apportioned as it contributes to the lower-

extremity impairment. The unrelated medical conditions aren’t included in the rating or the

apportionment, as they’re not considered to influence the injury-related impairment

assessment.

Examples 2

Mr Y has a stroke causing left hemiparesis and reduced motor function in his left leg. This

makes it difficult for him to walk distances and he’s limited to walking on flat surfaces.

Mr Y then falls and fractures his neck of femur. A subsequent hip replacement has a poor

outcome when graded using AMA Guides (Table 65, page 87 and Table 64, page 85).

It’s clear that Mr Y suffered a lower-limb impairment from his medical condition before the

injury. The figure to apportion can be justified using the AMA Guides’ brain and cranial nerve

section or the Handbook’s lower-extremity section.

You could use Table 13 or Tables 38 and 39 in the AMA Guides (pages 148 and 77

respectively) to determine the percentage to apportion for the pre-existing impairment for the

reduced lower-limb function.

The assessment tool does not allow weakness to be combined with a diagnosis-related

estimate, so the highest current rating would be 30% whole-person impairment.

The apportionment

• The rating would be 30% for the poor hip replacement minus 15% for the pre-existing

weakness. This means a 15% whole-person impairment, reflecting the effect of the

hip replacement.

Examples 3

Mr Z fractures his ankle; it heals with 10 degrees of angulation. He later has an amputation

below the knee with a 7.6-centimetre stump, following an arterial occlusion (not a covered

injury).



The healed extra-articular fracture with angulation was a 15% Lower Extremity Impairment, a

6% whole-person impairment (AMA Guides. Table 64. page 86).

The current state is the amputation; a 28% whole-person impairment (AMA Guides, Table

63, page 83).

The fracture is no longer present, but did cause impairment, so the increase in impairment

from the amputation is therefore 28% - 6%, a 22% whole-person

The Respiratory System

Overview

The rating method for impairments of the respiratory system is detailed in the AMA Guides

(page 450). However, it has been modified in relation to mesothelioma.

Notes on some commonly encountered conditions

Mesothelioma

When we receive a claim from a client who has mesothelioma, our staff work closely with

them to establish whether the client is well enough to attend a face-to-face assessment, or

their medical condition means the assessment needs to be done via a file review. Either

way, it’s important that an assessor undertakes the assessment, to ensure an official and

independent interpretation of and report on the clinical information.

In 2005, ACC determined that clients with confirmed diagnoses of mesothelioma would

automatically be given a whole-person impairment rating of 80% irrespective of their clinical

condition. Currently this is the only cancer rated in this manner.

When you receive a referral for a client with mesothelioma, please arrange your assessment

quickly. If for any reason there’s a delay in seeing them, let us know as quickly as possible.

Lung cancer

Please use the method in the ACC Handbook (page 45) to assess clients with lung cancer

other than mesothelioma.

Clients with cancers at other body sites should be rated using the relevant chapters in the

AMA4 Guides.

Asbestosis/pleural plaques

When we receive a claim from a client who has asbestosis or pleural plaques, we’ll provide

you with lung function tests from the previous 12 months. If these aren’t available, we’ll

arrange a test before we send you the referral.

As asbestosis typically causes a restrictive defect on spirometry, this is the component that’s

usually rated. It can be difficult to apportion for co-existing lung disease, such as when there

is a mixed picture with an element of obstruction on spirometry, for example smoking.

If needed, we can arrange for a respiratory physician to comment on the proportions of the

client’s obstructive and restrictive breathing impairments. This will help you support your

rationale for apportioning breathing impairment from exposure to asbestos as opposed to

non-ACC-covered conditions.



The Visual System

Overview

The rating method for clients’ visual systems is detailed in the ACC Handbook (pages 54-

55).

If a client has a visual field defect, the referral documents you receive should include a

recent optometrist’s assessment indicating its full extent.

If the client needs visual field testing beyond 30 degrees, please contact one of our service

centres; they have the details of providers who undertake these tests.

Example

Mr A was cutting a tensioned wire when it sprang back, knocking off his safety glasses and

penetrating his right eye.

An urgent repair was attempted, but after the operation it was noted that the retina had

detached. An assessment also revealed a cataract in Mr A’s left eye, which was considered

unrelated to the trauma.

A visual acuity examination revealed:

• Right eye- light perception only

• Left eye – 6/12, n8

Despite further surgery to his right eye, Mr A’s vision in the right eye was completely lost.

Calculating the impairment

In calculating the impairment due to Mr A’s injury, the assessor needs to consider the

impairment before the injury, as Mr A’s visual system was already impaired owing to the

cataract in his left eye.

Assuming the right eye had normal vision before the injury, the impairment calculation using

the worksheet from the ACC Handbook (page 71) would be as follows:

Topic Comment Right Left

Monocular aphakia

is present

No No

acuity (VA)

distance (Snellen)

• See AMA Guides, Table 2, page 211 6/6

20/20

6/12

20/40 A

VA near • See AMA Guides, Table 2, page 211

• Also, see ‘Visual Acuity near’ on page 54 of the ACC

Handbook

NS

14/18

NB

14/24 B

Percent loss of VA • Combine A and B for each eye (see AMA Guides,

Table 3, page 24, including footnote)

• Note:

• Aphakia = loss of lens

• Pseudophakia = artificial lens

0 11 C



Loss of visual field

(VF)

• See ‘Visual Fields’ page 55 of the ACC Handbook 0 0 D

Loss of VA

combined with loss

of VF

• Combine C and D for each eye

• See AMA Guides, page 322

0 11 E

Loss of ocular

motility (OM)

(diplopia)

• Enter under worse eye

• See AMA Guides, section 803, Figure 3, page 217

0 0 F

Loss of VA, VF and

OM

• For worse eye, combine E and F. For the other eye,

transfer E to G. See AMA Guides, page 322 0 44 G

Other ocular

functions and

disturbances

• May combine 5%-10% impairment for an ocular

abnormality or dysfunction if you believe it isn’t adequately reflected in the VA, VF or diplopia testing (see AMA Guides, page 209, paragraph 3)

• Enter any rating you assess under the involved eye

• Justify in your report

0 0 H

Loss of VA, VF and

OM and ocular

dysfunction

• If an eye has additional impairment, combine G and H

• If not, transfer G to I


0 11 I

Convert both eyes

to the visual

system

• See AMA Guides, Table 7, page 219 3 J

Convert the visual

systems to whole

person

• Convert J to whole person

• See AMA Guides, Table 6, page 218

3 K

Cosmetic

deformities

• Can allow for permanent cosmetic deformities

causing up to 10% whole-person impairment

• See AMA Guides, page 222, section 8.5

0 L

Grand total • Combine K and L

• See AMAGuides, page 322

3 M

This is a 3% whole-person impairment.

Following the injury and failed salvage surgery. The rating is:

Topic Comment Right Left

Monocular aphakia

is present

No No

VA distance

(Snellen)

• See AMA Guides, Table 2, page 211 6/12

20/40 A

VA near • See AMA Guides, Table 2, page 211

• Also see Visual Acuity near’ on page 54 of the ACC

Handbook

NB

14/24 B



Percent loss of VA • Combine A and B for each eye (see AMA Guides,

Table 3, page 24, including footnote)

• Note:

• Aphakia = loss of lens

• Pseudophakia = artificial lens

100 11 C

Loss of VF • See ‘Visual Fields’ page 55 of the ACC Handbook to

AMA 100 0 D

Loss of VA

combined with loss

of VF

• Combine C and D for each eye


100 11 E

Loss of OM

(diplopia)

• Enter under worse eye

• See AMA Guides, section 803, Figure 3, page 217

0 0 F

Loss of VA, VF and

OM

• For worse eye, combine E and F. For the other eye,

transfer E to G. See AMA Guides, page 322 100 0 G

Other ocular

functions and

disturbances

• May combine 5%-10% impairment for an ocular

abnormality or dysfunction if you believe it isn’t adequately reflected in the VA, VF or diplopia testing (see AMA Guides, page 209, paragraph 3)

• Enter any rating you assess under the involved eye

• Justify in your report

0 0 H

Loss of VA, VF and

OM and ocular

dysfunction

• If an eye has additional impairment, combine G and H

• If not, transfer G to I


100 11 I

system • See AMA Guides, Table 7, page 219 33 J

Convert the visual

systems to whole

person

• Convert J to whole person

• See AMA Guides, Table 6, page 218

31 K

Cosmetic

deformities

• Can allow for permanent cosmetic deformities

causing up to 10% whole-person impairment

• See AMA Guides, page 222, section 8.5

0 L

Grand total • Combine K and L


31 M

The impairment relating attributed to the right eye injury is therefore 31% - 3% = 28% whole-

person impairment after apportionment.

Note that in this example an injury for a person with already compromised vision results in a

higher impairment rating than if they had had normal vision beforehand. It is important to use

the visual impairment worksheets in the ACC Handbook (page 71), to support your rating

and apportionment.

Using prostheses in assessment

A client’s visual system is tested with glasses or corrective lenses if they usually wear them.

However, the AMA Guides (page 9) also refer to the use of prostheses in assessments.

A client who’s lost an eye may wear a cosmetic prosthetic eye, which isn’t considered to be

a contact lens as it doesn’t correct vision. As it can be removed easily, the client’s



impairment can be assessed without it. This attracts a cosmetic rating; the AMA Guides

(page 222) allow up to 10% impairment in this case.

Mental Injury

Background and context

Historically two broad approaches have been used to apportion a client’s total claim-related

impairment in relation to mental injury:

1. Focus on the covered mental injury or condition (eg post-traumatic stress disorder

[PTSD]) and exclude from the current impairment any impairment not related to this

condition.

2. Focus on the factors that led to cover (eg sexual abuse, genetics, upbringing).

Deduct a proportion of the current impairment based on those factors’ contribution to

the current state, including the covered injury where it’s been caused by a number of

factors.

Both methods can be supported using the ACC Handbook. However, they can result in

inconsistent and inequitable outcomes for clients owing to the different levels of assessed

claim-related impairment that result, which can affect whether they qualify for entitlements,

and the levels of those entitlements. The issue is all the more important given that mental

and behavioural impairment assessments are by their nature relatively subjective.

Apportioning for conditions

Apportioning for conditions, which focuses on the covered mental Injury, is our confirmed

approach to mental injury apportionment in impairment assessments.

Under this approach:

• there’s no apportionment of the covered mental injury.

• any impairments due to non-covered conditions, non-covered symptoms or

behaviours (even when these don’t meet a diagnostic threshold) are deducted.

This approach can also be applied to rating behaviours and symptoms where the diagnostic

criteria for a formal mental health condition that ACC has covered are no longer met.

For example, if a client has previously received mental injury cover for a particular condition,

and a new assessment finds that they don’t have the condition, or the condition no longer

meets the full diagnostic criteria, symptoms related to the previously diagnosed condition

might still continue. The impairment due to these symptoms can be rated in an assessment.

Examples

A client has cover for PTSD caused in part by sexual abuse in New Zealand and in part by

earlier sexual abuse overseas. The client has another diagnosis (major depressive disorder),

which isn’t covered by ACC and pre-dated the sexual assault in New Zealand.

The client’s current presentation is thought to relate mainly to PTSD.

How should the client’s mental and behavioural impairment be rated and apportioned?



As the PTSD is the covered injury, it shouldn’t be apportioned even though the overseas

event may have contributed to the cause. Cover for this episode of PTSD has been

established.

The current impairment rating determined by using Chapter 14 of the AMA Guides and the

ACC Handbook, is thought to relate mainly to PTSD.

There’s no apportionment for PTSD, but some apportionment would be expected for the

impairment that doesn’t relate to PTSD (in this case the major depressive disorder). This can

be achieved, as detailed on the Handbook (page 10), by deducting the impairment that

existed before the PTSD from the current impairment rating, or alternatively by using your

clinical judgement. It might be helpful to use mental and behavioural functional

classifications (that is ‘activities of daily living’, ‘social functioning’, ‘concentration,

persistence and pace’ and ‘adaptation and decompensation’) to justify the extent of

apportionment for non-covered conditions.

In this case apportionment, would be for the major depressive disorder component: 36% -

8% = 28%.

In this example, what if the New Zealand sexual abuse was part of the overall

background to the major depressive disorder, but not a material cause?

The impairment rating is for the injury covered by ACC. If we don’t cover the major

depressive disorder, it should be apportioned. The impairment rating is not of the sexual

abuse (the event) but of the covered injury condition resulting from it (in this example PTSD).

When calculating a mental and behavioural impairment rating should I apportion only

for diagnosed mental health conditions that aren’t covered?



In all physical and mental impairment assessments, apportionment is necessary when the

impairment has been caused by multiple conditions. The current impairment is rated, then

apportioned into covered and non-covered impairments. The non-covered impairment is

deducted from the overall current impairment, leaving the injury-related component.

In the case of mental and behavioural impairment, the apportionment should be for all

impairment not arising from the covered condition. It may reflect non-covered conditions with

a formal psychiatric diagnosis but will also include factors that contribute to the overall

mental and behavioural impairment rating and that are separate from the covered mental

injury.

In this example, the total impairment using the mental and behavioural tables relates to

PTSD, major depressive disorder and poor education (considered to be separate from the

PTSD and not causing it). The apportionment would be for major depressive disorder and

poor education: 40% - 7% -7% = 26%.

A client has cover for borderline personality disorder and polysubstance abuse, and

while sexual abuse contributed to these conditions there were many other

contributors. How should these be apportioned?

If the impairment relates fully to borderline personality disorder and polysubstance abuse,

the causal factors for these conditions should not be apportioned. If you believe there was

impairment unrelated to the conditions, it should still be apportioned with an appropriate

explanation.

The referral letter doesn’t detail an injury, but simply refers to the read code “sexual

abuse head nos (not otherwise specified)”. What should I rate?



If you need help identifying the covered injury or extent of cover, contact the impairment

assessment unit before you undertake the assessment or write your report.

‘Not otherwise specified’ cases

There are some cases where there is no clear specified mental injury accepted historically

by ACC. This may relate to claims accepted under the 1972 or 1982 Accident Compensation

Act, where cover was extended to the physical and mental consequences of injuries and

accidents, or to historically accepted Sensitive claims under the 1992 Accident Rehabilitation

and Compensation Insurance Act for ‘mental or nervous shock’. There may not be enough

evidence for a psychiatrist who sees the client now to determine their diagnosis at the time

cover was accepted.

In these situations, the clients are covered by ACC and have a right to apply for

Independence Allowances for those covered injuries.

If a client meets ACC’s legislative requirements for an assessment or a re-assessment of

their impairment, we’re legally required to make that happen.

We’ll refer the client to you for an assessment based on the cover granted when we first

received their claim.

If the cover at that time is unclear, we’ll ask you to use your clinical experience to rate the

effects of sexual abuse using the historical medical notes and a recently provided

psychiatrist opinion.

Example

We have accepted a client’s sensitive claim for ‘sexual abuse’. Historical counselling reports

noted symptoms of PTSD, anxiety disorder and some borderline personality traits, but no

relevant clinical opinion or diagnosis was sought at that time.

A recent psychiatric assessment diagnosed major depressive disorder, with the psychiatrist

noting that the abuse was not a material cause but one of ‘several factors’ in the background

to the depressive disorder.

The recent assessment can’t confirm from the historical notes that there was a previous

diagnosis of PTSD, and if it was evident at that time, there are no longer any symptoms of

PTSD. There are some borderline personality traits, but not enough for diagnosis.

Given that there isn’t enough information to establish that ACC made an error in providing

cover when the claim was lodged and no evidence of a diagnosis by someone duly qualified,

the client is entitled to have their current impairment level rated.

The assessor would use the functional categories from the ACC Handbook, see pages 33-

41, to rate the current presentation. The assessor would need to justify how the rating

derived relates to persisting symptoms from the historic injury.

Pain

Overview

If your assessment finds evidence that a client is in continual pain, your impairment

assessment report must show that you’ve considered page 42 of the ACC Handbook and

Chapter 15 of the AMA Guides. The report should include:



• the source of a client’s pain (eg injury/non-injury)

• how you’ve considered page 42 of the ACC Handbook, including whether you consider the

pain psychogenic

• how you’ve considered Chapter 15 of the AMA Guides, including the frequency and

intensity of the client’s pain

• how the chapter on the relevant organ system has considered pain and how this is

reflected in your rating

• any other relevant information.

An additional clinical assessment won’t always be required. However, please contact the

referring claims officer if you need additional information for a rating.

Chapter 15 in the AMA Guides doesn’t provide a separate impairment rating for pain.

Instead, it refers you to the relevant body part or organ system section. As a result, a client’s

impairment rating is unlikely to change with your consideration of Chapter 15.

Assessment method

The first step in rating for pain should be to review its aetiology. You need to make a

distinction between pain arising from the covered physical or mental injury and chronic pain

from non-covered conditions.

Follow the ACC User Handbook to AMA4

The pain rating method is detailed on page 42 of the Handbook. Pain isn’t separately

rateable, unless it’s specifically noted in the AMA Guides. In general, the AMA Guides’

percentages for organ systems already allow for accompanying pain.

The following ACC Handbook references to the AMA Guides generally apply to pain:

1. AMA Guides page 9 details that, in general, the impairment percentages shown in

the organ system chapters allow for pain that may accompany the impairing

conditions. Chronic pain syndrome is evaluated as described in the chapter on pain

on page 303.

2. AMA Guides page 13, paragraph 2 indicates that in most cases the impairment

ratings provided in the organ system/body part chapters include a consideration of

pain.

3. AMA Guides page 152, section 4.5 details that impairment due primarily to

intractable pain may greatly influence an individual’s ability to function. Psychological

factors can influence the degree and perception of pain. Pain will sometimes affect

the proper functioning of a specific organ system. While impairment percentages

shown in the AMA4Guides’ chapters considering organ systems make allowance for

pain that may accompany the impairing conditions, chronic pain should be evaluated

according to criteria in the chapter on pain.

4. AMA Guides page 303, Chapter 15 considers the subjective nature of pain, noting

that it can’t be validated or measured objectively.

The ACC Handbook details exceptions where pain could be rated:

• Causalgia (now known as complex regional pain syndrome)



• Cervical spine

• Chronic pain syndrome – may be assessed for mental injury if a psychiatrist has

diagnosed a chronic pain syndrome arising from a physical injury

• Peripheral nerve pain syndrome

• Phantom limb pain

• Trigeminal neuralgia.

When rating chronic pain syndrome where it’s a covered mental injury, you should use the

mental and behavioural method. The AMA4 Guides (page 297) note:

“The assessment of impairment due to pain, especially in circumstances in which the

complaint exceeds what is expected on the basis of medical findings, is complex and

controversial. While pain is discussed in the chapter on pain at page 303 and elsewhere in

this book, it is germane also to the consideration of mental and behavioural disorders”.

“Mental illness may distort the perception of pain. Pain may become part of a somatic

delusion in a patient with major depression or a psychotic disorder. Pain may become the

object of an obsessive preoccupation, or it may be the chief complaint of a conversion

disorder”.

“Establishing whether pain is or is not a symptom of a mental impairment may be a difficult

and complex task”.

Guidelines for this process are detailed in this section in Chapter 14 AMA Guides.

Chronic pain can also be evaluated using Chapter 15 in the AMA Guides (pages 303-304),

which states that:

• pain is subjective in nature; it can’t be validated or measured objectively

• impairment due to pain has not been well defined

• in general, the impairment percentages given in the tables and figures applicable to

permanent impairment of the various organ systems include allowances for the pain

that may happen with those impairments.

• The clinical assessment process for chronic pain impairment is detailed in section

15.6 of the AMA Guides (page 308). It involves:

• reviewing the records

• obtaining the history from the patient – including the work, family and social history

and the activities of daily living

• documenting the pain complaint

• performing a physical examination

• arranging appropriate investigations

• undertaking psychological testing – assessment tools are detailed

• formulating a diagnosis including the cause/classification of the pain, with detail of

the biopsychosocial impacts

• estimating the extent of the pain and impairment using the procedures detailed in

section 15.9 and other parts of the AMA Guides as appropriate.

Section 15.9 of the AMA Guides provides examples of impairment rating for pain. All the

examples refer assessors to the appropriate chapters to derive the ratings.

Section 15.8 provides additional comment on estimating impairment from pain. It notes that

in testing it’s important to consider whether the client can perform daily activities rather than



whether activity causes pain. The section considers the use of functional capacity

assessment in the process and discusses validity testing issues.

Section 15.8 indicates that:

Acute pain is not permanent impairment

1. Psychogenic pain should be assessed according to the chapter on mental and

behavioural disorders (Chapter 14)

2. Recurrent acute pain is likely to be classified as primary and nociceptive or

neurogenic. It clearly relates to a well-defined disease or pathology

3. Chronic pain syndrome is likely to be classified as secondary pain. Chronic pain in

the absence of objectively validated diseases or impairments should be assessed by

a multidisciplinary group by doctors with an interest in pain medicine, particularly in

considering the effects of pain on the ability to perform activities of daily living.

The pain intensity grid, on page 310 of the AMA Guides, is used to record the pain intensity

and frequency. It doesn’t in itself provide an impairment percentage rating but describes the

degree of impairment.

Section 15.8 indicates that an impairment percentage can be determined for a person’s pain

if the condition causing the pain can be evaluated according to criteria applicable to a

particular organ system. Example 3, on page 313, looks at trigeminal neuralgia and refers

assessors to the appropriate section in the AMA Guides (in this case the brain and cranial

nerve section).

Overall, Chapter 15 provides a method for acknowledging and describing impairment from

pain and indicates the situations where it’s rateable. As it doesn’t actually determine the

rating, applying Chapter 15 isn’t expected to alter a rating; however, it does acknowledge the

reported severity of pain.

The Spine

Overview

The assessment method for spine impairments is detailed on pages 48-49 of the ACC

Handbook, and includes a referral to pages 94 -111 of the AMA4 Guides.

If there are multiple spinal claims, you may need to apportion the current impairment to

specific claims. It might be useful to consider the injury details on the referral and whether

the current impairment relates to them.

Back pain is a common complaint and frequently encountered in assessments. Where it’s

linked to the covered injury, it’s important that your report covers how you’ve considered pain

in your rating and includes an explanation of the ACC Handbook’s pain section.

Note that while radiculopathy requires the presence of significant signs to be confirmed, this

is not the same as radicular pain. Significant signs include loss of reflexes, atrophy greater

than two centimetres above or below the knee or electro diagnostic studies. Table 71 on

page 109 of the ACC Handbook provides more detail on this.

The ACC Handbook also indicates that loss of motion segment integrity and a history of

guarding are not used as differentiators.



Example

A patient currently has an L5 radiculopathy and a 50% compression fracture of L3.

How would you rate this spinal impairment? Would it be different if the impairment had been

sustained in one accident or different accidents?

The impairment rating method determines the current spinal whole-person impairment, then

deducts the impairment that relates to non-injury pathology.

However, if there are multiple injuries you also need to determine the injury (claim), if any, to

which the current impairment relates.

If there are multiple accidents, each causing injury, you might find that a timeline helps in

determining the impairments at different times, and in your apportioning attribution.

Applying the impairment rating method

In the above example:

• the lumbosacral region is primarily involved, and both injuries are in this area

• L5 radiculopathy (if confirmed by the presence of objective findings in the AMA

Guides, Table 71, page 109) would be a Diagnosis Related Estimate (DRE) category

III impairment

• a 50% compression fracture at L3 would also place the client in DRE category III.

The current impairment rating in the example is therefore clearly in the lumbosacral category

III range; a 10% whole-person impairment.

If the injuries had been sustained in the same accident, the rating would be straightforward.

This is a 10% impairment rating, and both injuries place the client in this range. If there were

no prior problems, there would be no apportionment.

If one injury pre-dated the other, apportionment would be used to determine the rating for

each injury.

For example, if the L5 radiculopathy happened in 1999, and in 2011 there was further injury

with an L3 50% compression fracture:

• the rating in 1999 would be lumbosacral category DRE III 10%

• after the fracture in 2011 the spinal rating would remain unchanged at lumbosacral

category DRE III 10%. This is because:

o the rating for the 1999 L5 radiculopathy is 10%

o the rating for the fracture is 10% - 10% = 0%

• the impairment would be rated as an Independence Allowance 1999 injury 10%

whole-person impairment and a lump sum 2011 injury 0% whole-person impairment.

Injuries in different spinal regions (cervicothoracic, thoracolumbar and lumbosacral) should

be combined as detailed in the AMA Guides, page 101, bullet point 8:



“If more than one spine region is impaired, determine the impairment of the other regions,

combine the regional impairments using the combined values chart to express the patient’s

total spinal impairment”.

While the current impairment in this example doesn’t change if the injuries were caused by

more than one accident, you’d need to comment on apportionment in your report.

Rating multi-level spinal impairments

Spinal DRE Category IV

Loss of motion segment integrity is not used for rating, but this category also includes

'Structural inclusions' - definition - (2) details 'multilevel motion segment structural

compromise without residual neurologic motor compromise, for example, multilevel fracture

or dislocation'.

At first glance the principle in this definition is quite clear. A person qualifies if there is

multilevel structural compromise with fractures or dislocations. A closer look at the AMA

Guides and The ACC Handbook texts can be confusing for some people. In the AMA Guides

page 102 and 106 the wording is “as with fractures or dislocations” – but on page 104 “for

example, multilevel fractures or dislocation”. The ACC Handbook states: “Injuries affecting

structural integrity (Vertebral fractures and dislocations, disc injuries etc)”.

The logical consequence of this is to ask the question: must a person have fractures and

dislocations in order to qualify – or do the words “as with” and “etc” suggest that other

findings may also qualify, like spinal fusions, which after all is a multilevel structural

compromise?

Here’s an example to help clarify.

Example

Mr S had had six lower back operations at the time of assessment. These had resulted in a

fusion of L3/L4/L5. He reported loss of sexual function and bladder urgency.

The assessor noted:

“He presents in considerable discomfort. He uses a stick and displays an antalgic gait.

Circumferential limb measurements are symmetrical. He has loss of the lumbar lordosis and

there is a mature surgical scar measuring 10 cm over the lumbar spine. Knee reflexes are

present. (The left ankle jerk which was reported to be absent at the last examination is now

demonstrated.)”

Mr S had no fractures or dislocations and didn’t demonstrate significant signs of

radiculopathy, so he could be DRE II 5% whole-person impaired. However, he is clearly

more impaired than that normally seen in Category II.

There was multilevel structural compromise within one spinal region (cervicothoracic,

thoracolumbar or lumbosacral) and he should have been rated as DRE IV. This would have

included two-level fusions (eg L4, 5 and S1), not single-level fusions (eg L5,S1).

This interpretation provides a more generous rating than would have occurred if ‘multilevel’

had been defined as only fractures or dislocations.



10. Payment and Invoicing

ACC requires all contracted Suppliers to invoice ACC electronically using one of ACC’s

approved digital channels. Invoicing electronically has many benefits for Suppliers, such as:

• Faster processing and payment of Invoices.

• Search functions for submitted invoices and tracking the progress of invoices

(including amounts paid and payment dates).

• Ability to proactively check if an invoice needs further information to be sent to ACC.

• Access to digital copies of remittance letters.

• Querying claim and injury status.

There are several ways electronic invoicing can be done. To learn more please visit the ACC

website ‘Getting Set Up online’. Suppliers can also check whether their computer(s) meets

the minimum specifications via the ACC website under ‘Check your computer meets the

minimum specs’.

Suppliers that are a large organisation are expected to adopt the ACC Invoicing API.

Information about our ACC API’s can be found at the ACC Developer Portal.

Suppliers can contact the ACC Digital Operations eBusiness team to discuss which method

is fit for purpose for their organisation if they are not already invoicing ACC electronically.

Their contact details are:

• Telephone: 0800 222 994 (option 1)

• Email: [email protected]

The Provider Contact Centre will answer queries relating to payment of invoices. If Suppliers

are unable to find the information online they can contact 0800 222 070.

ACC requires one account per Supplier for payment of invoices. This means there is one

supplier identification, one address for all correspondence (i.e. purchase orders and

remittance advices) and one bank account number per supplier. This requirement is to

enable transparency of transactions for monitoring purposes by ACC.

General Assessments

For all general Assessments, ACC will provide the Assessor with a Purchase order

containing the service item codes to be used when invoicing ACC for the service. All general

assessments have a base fee and at least one functional unit.

General Assessment Service Item Codes

IA01 Physical Injury Base Fee, or

IA02 TBI Base Fee

IA05 Functional Unit

(Standard)

IA05 Functional Unit (Complex)

https://www.acc.co.nz/for-providers/set-up-online/?smooth-scroll=content-after-navs

https://www.acc.co.nz/for-providers/set-up-online/#if-you-dont-use-a-practice-management-system

https://www.acc.co.nz/for-providers/set-up-online/#if-you-dont-use-a-practice-management-system

https://developer.acc.co.nz/




Chapter 14 Assessments

For all Ch 14 Assessments, ACC will provide the Assessor with a Purchase order containing

the service item codes to be used when invoicing ACC for the service. All Ch 14

Assessments completed by General Practitioners (GP) have a base fee. All Ch 14

Assessments completed by Psychiatrists are paid based on an hourly rate, set at 4 hours

per assessment. No functional units are available for Ch 14 Assessments.

Ch 14 Assessment Service Item Codes

When an Assessor is required to complete both a general and Ch 14 Assessment, the

Purchase order will contain the service item components of each Assessment.

General Assessment and Ch 14 Assessment Service Item Codes

Functional Sub-Units

The whole-person is divided into functional sub-units which are detailed on page 12 of the

ACC Handbook. For the purposes of payment and invoicing, the Assessor will be provided a

service item code for each functional sub-unit needing to be rated. The functional subunits

are split into:

Functional Sub-Unit (Standard) – IA05A Functional Sub-Unit (Complex) – IA05B

Hearing and other ENT related injuries

Respiratory

Right upper extremity

Right lower extremity

Cardiovascular

Skin (see exceptions)

Urinary and reproductive

Nervous system

Speech

Visual

Digestive

Right/Left upper extremity where the ‘Hand’ is

involved.

Assessed by GP

IA04 Base FeeNo Functional Unit

Assessed by Psychiatrist

IA07 (4 Hours)

No Base Fee

No Functional Unit

IA01 Physical Injury Base Fee, or

IA02 TBI Base Fee

Assessed by GP

IA04 Base Fee

Assessed by Psychiatrist IOA7

(4 Hours)


(Standard)


(Complex)




Endocrine

Spine

Pelvis (see exceptions)

Hematopoietic

Left lower extremity

Left upper extremity

Exceptions

• Skin: 1 unit but cannot be counted as a second functional unit in any one claim.

Scarring cannot be counted as a separate functional unit

• Pelvis: 1 unit but is not counted as a second functional unit in any one claim. A pelvic

injury is considered as a second functional unit when the injury fits into the urinary

and reproductive or endocrine system. The ‘Pelvic’ functional unit refers to the bony

pelvis.

For example:

• You’re asked to rate two lumbar spine claims. As this involves considering the spine,

skin and pain, your service should be invoiced as one functional unit: the spine.

• You’re asked to rate injuries to both lower limbs. As this involves considering both

lower extremities, skin and pain, your service should be invoiced as two functional

units – left and right lower extremities.

If your purchase order doesn’t match the functional units you’re assessing, please contact

the Treatment and Support Assessor.

Exceptional Circumstances

An Impairment Assessment can be considered exceptionally complex and the Assessor will

be entitled to utilise the IA06 code. A standard Impairment Assessment is expected to take

an experienced Assessor no more than 3.5 hours for a General Assessment and 4.5 hours

for a Ch 14 Assessment. The exceptional circumstances code is available when the

complexity results in an Assessment taking longer than the expected timeframe and either:

• the covered injuries being assessed cover two legislative periods,

• the Client has five or more separate injuries being assessed,

• the Client has a Treatment Injury,

• the Client has a communication impairment which limits their ability to communicate,

• the Client has complex apportionment requirements eg progression of cancer, or

another condition where the client had pre-existing non-injury impairment prior to the

injury occurring.

Assessments that take longer than the expected timeframe, but do not meet any of the

above criteria are not entitled to the exceptional circumstances code. Any use of the

exceptional code outside of these circumstances require Portfolio approval.



Request for Additional Information

The IA14 and IA15 service item codes are used when ACC requires additional information

from the Assessor. The Treatment and Support Assessor will contact the Assessor and

advice what additional information ACC requires. They will add to the Purchase order either

the IA14 or IA15 code depending on type of information requested.

Where an Assessor requires additional information from ACC not provided in the referral,

they should contact the Treatment and Support Assessor. The Treatment and Support

Assessor will arrange for the additional information to be sent to the Assessor. Where

circumstances require the Assessor to contact the Client’s treating medical practitioner

directly, ACC will add to the purchase order either the IA14 or IA15 service item codes. The

Assessor should always seek prior approval for the use of the IA14 or IA15 service item

codes.

When the Assessor identifies a need to follow up with the Client’s treating medical

practitioner or case owner due to issues unrelated to preparing the Impairment Report, the

IA14 or IA15 service item codes cannot be used. The Assessor should contact the case

owner and request a new purchase order be created using non-contracted service item

codes. The case owner will determine whether ACC will reimburse the Assessor for the

additional work.

Peer Reviews

For all Peer Reviews, ACC will provide the Peer Review Service Provider with a purchase

order containing the service item codes to be used when invoicing ACC for the service.

Peer Review Service Item Codes

Non-attendance Fee

Clients have a responsibility to participate and co-operate in the Impairment Assessment

process. Clients should notify their Treatment and Support Assessor and the Impairment

Assessor if they are unable to keep their appointment, or where there are unexpected

changes in their circumstances.

Peer Review Report:

(a) takes approx. 15 to 30 minutes to complete and/or

(b) requires no communication with the Impairment Assessor

IA20 Standard Peer Review

Peer Review Report

(a) takes longer than 30 minutes to complete,

(b) involves communication with the Impairment Assessor,

(c) requires review of the amended Impairment Assessment report, and

(d) may require communication with the Prinicpal Clinical Advisor

IA20 Standard Peer Review

IA21 Complex Peer Review



ACC expects that Impairment Assessors will make all reasonable efforts to remind the client

of the appointment such as an appointment card, a reminder letter, a phone call the day

before, or a text message on the day to the client.

Impairment Assessors can invoice ACC for a client non-attendance fee if the Client does not

attend their appointment and fails to give 48 hours’ notice. They can only charge this fee

once for any referral. Where the Assessor is holding a travelling clinic, the Assessor may

receive more than one non-attendance fee where the Treatment and Support Assessor

arranges a subsequent Assessment and the Client failures to attend again.

If the appointment is an onsite appointment, the Assessor can claim 40% of the base fee. If it

was an offsite appointment, the Assessor can claim 60% of the base fee. The base fee may

vary depending on which type of Assessment has been referred. If there was more than one

Assessment referred, the Assessor can invoice for the Assessment with the higher amount.

To claim the non-attendance fee the Assessor must submit copies of relevant

correspondence with the Client, or copies of file notes recording communication with the

Client, dated at least seven days before the scheduled appointment date.

11. Travel

In scheduling assessments, we always consider whether there are qualified Assessors close

to where our Clients live. However, if a Client wishes to see someone else and has a valid

reason for doing so, ACC will arrange for an Assessor to travel to them and try to make at

least two Assessment appointments in the area on the same day.

Any travel required outside the areas Assessors are usually contracted to go to will need to

get prior approval from ACC. Assessors may need to travel outside their usual areas when:

• there is a shortage of Impairment Assessors in the area

• a Psychiatrist is required

• an Assessor is required for a specific reason.

ACC will not normally pay Assessors for travelling beyond their usual contracted locations

for one Client. However, one-off situations can be discussed with the Team Manager at your

local unit (see pages 3 & 4 for our phone numbers).

Guidelines for provider travel can be found on ACC’s website, see Providers/Invoicing and

Payment/Supplier travel service: Travel guideline and calculator tool

12. Culturally Competent Services

Impairment Assessments should be conducted in a Client-centred manner and tailored to

meet the cultural needs of Clients. Services delivered will recognise and respect individual

cultural and spiritual values and beliefs. Impairment Assessors should check with Clients that

information is communicated in a way Clients and their family understand.

Meeting the Cultural Needs of Māori Clients

Impairment Assessors will ensure services are delivered to Māori clients in a way that

recognises and respects Māori values and beliefs, and information is communicated in a way

that they and their family/whānau understand.

http://www.acc.co.nz/for-providers/invoicing-and-payment/WPC115885

http://www.acc.co.nz/for-providers/invoicing-and-payment/WPC115885



For further information see: Guidelines on Māori Cultural Competencies for Providers -

ACC1625 can be downloaded from the ACC website. Adhering to the requirements of these

guidelines will assist Suppliers in meeting their responsibilities for cultural competence and

deliver positive health outcomes for Māori clients.

Clients who Require an Interpreter

If there are any interpreting or cultural needs identified, the Impairment Assessors should

discuss these with the Treatment and Support Assessor. If the Client needs an interpreter, a

professional interpreter will be provided by ACC to ensure the Impairment Assessment is

conducted in a way that is confidential, effective, and ensures the Client is fully aware of what’s

being asked of them.

The cost of the interpreter service is met by ACC. Payment is conditional on ACC’s prior

approval that an interpreter is needed, cost effective and appropriate.

Multiple Support People

To complete a good Assessment the Client should feel comfortable and relaxed. This may

be helped with the support of a friend or relative.

The Client has the right to bring a support person/s (friends, family members / whānau, or

other representatives) with them for support, provided that the safety of all involved can be

assured and the effectiveness of the Assessment is preserved. Clients do not have to

explain or justify why they want a support person and it may involve more than one person.

However, if the Impairment Assessors is not comfortable with the situation and consider that

they cannot undertake the Assessment (eg a support person/s becomes disruptive and/or

obstructs the Assessment process) this should be discussed with the Client. If the

Impairment Assessor cannot resolve the issues they may need to terminate the Assessment

and contact the Client’s Treatment and Support Assessor.

13. Working with Clients who may pose a Health and Safety Risk

ACC may not always have access to detailed information concerning a Client’s history, but if

a Client has been identified as posing a risk, the Treatment and Support Assessor will be able

to provide information relevant to the Impairment Assessors to help mitigate health and safety

risks.

ACC Clients who meet two or more of the following criteria are considered to pose a potential

risk to safety, and will have a Care Indicator activated by ACC:

• Have continued to demonstrate intimidating and/or offensive behaviour (e.g. body

language and verbal dialogue has made employees feel unsafe).

• Been abusive, verbally or in writing.

• Made racist or sexist comments.

• The current actions being undertaken on their claim by ACC are known to have

caused or are expected to cause a significantly negative response from the client.

For example, Prosecution, Fraud Investigation, cessation of Weekly Compensation,

etc.

https://www.acc.co.nz/assets/provider/acc1625-maori-cultural-competency.pdf

https://www.acc.co.nz/assets/provider/acc1625-maori-cultural-competency.pdf



Clients who meet any one of the following criteria are also considered a hazard and will also

have a Care Indicator activated:

• Have been or are physically violent (this unacceptable behaviour may not have

occurred directly towards ACC employees).

• Have a history of violence or aggressive behaviour, have known convictions for

violence.

• Made threats previously against ACC, ACC employees or agents acting on ACC’s

behalf.

• Intimidated an employee through written abuse or verbal abuse (face-to-face or over

the telephone) to the extent they felt unsafe.

• Exhibited homicidal ideation.

If, for some reason, such as a safety risk or an inability to obtain a history or undertake a

physical assessment, the Impairment Assessor considers that the Assessment may not be

able to continue, they should discuss the situation with the Client and try and resolve the

situation. Another reason for stopping the Assessment is when a Client withdraws their

consent to continue with the Assessment.

If despite discussion the Impairment Assessor are unable to reach a resolution and feel that

the Assessment should not or cannot continue, they should explain this to the Client and

terminate the Assessment. In this situation, the Impairment Assessor will notify the Client’s

Treatment and Support Assessor as soon as possible and fully document the reasons for the

termination of the Assessment in their Impairment Report.

Communication Regarding Clients with a Care Indicator (Risky)

The Treatment and Support Assessor of a Client with a Care Indicator will advise the

Supplier in writing, either:

• Prior to the Suppliers initial contact with the client, or

• If the Supplier is already providing services to the client, as soon as possible when

ACC receives new information about client risk.

Please report any threatening behaviour to the police immediately if you feel that it is

warranted in the circumstances and advise ACC and any other parties that are at risk as

soon as possible. All threats by Clients or their representatives must be reported to ACC in

writing using the online form on our website. ACC ask that Suppliers report threats for the

protection and safety of ACC staff and other providers that are working with the Client.

Supplier safety is a priority and any Assessment should be terminated if the client, their

advocate or support persons make the Impairment Assessor feel threatened or unsafe in

any way. If the Impairment Assessor’s safety is at risk, please notify:

• The Client’s Treatment and Support Assessor as soon as possible and fully document the reasons for the termination of the Assessment in the Impairment Report.

• The police warranted in the circumstance.

If the Impairment Assessor choose to continue with Assessment of a care indicated Client

and wish to employ a security guard then please contact the Treatment and Support

Assessor.



Reporting Health and Safety Risks and Incidents

Health and safety risks and incidents (including notifiable events (as defined by WorkSafe)),

threats, and other health and safety risks, must be reported to ACC using the procedure and

online form on the ACC website.

14. Privacy and Storage of Client Health Information

Assessors are bound by the Health Information Privacy Code 1994 regarding collection and

storage of health information. This means that:

• Health information may only be gathered for the purpose for which it is required and

must be as accurate as possible.

• The Client must be informed about why the information is being asked for and give

their consent for this information to be gathered.

• The Client has the right to see their information and correct any information which is

factually incorrect.

• Care must be taken with the storage of Client health information and there are limits

on the disclosure of this information.

• ACC requires Clients to complete an Application for Lump Sum/Independence

Allowance which gives ACC consent to obtain medical information.

Practical Meaning of the Code

• The Assessor must check they’ve been sent the right information.

• Use a secure email address for correspondence which includes personal Client

health information. Secure email is an email account with password and security

features that only you and authorised people can access.

• Check every email address to ensure that the email is going to the intended recipient.

• Documents which are password protected may be blocked by ACC’s fire wall.

• Store information responsibly. For example, personal Client information shouldn’t be

left unattended in your car or unsecured at your personal residence.

• Further information and advice on ACC’s requirements for supplier storage of

personal and health information can be found on our website.

15. Service Management

Impairment Assessors should contact the Treatment and Support Assessor in the first

instance if there are any matters requiring clarification. Examples could include:

• Poor or inadequate information in the referral.

• There is a requirement for verbal instructions to be put into writing.

• Issues regarding timeliness of the assessment.

• A change to a purchase order.

• Prior approval is required.

When an Impairment Assessor or Supplier raises an issue with ACC and the issue is not

able to be resolved directly with the Treatment and Support Assessor, it may need to be

https://www.acc.co.nz/for-providers/report-health-safety-incidents

https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=12&cad=rja&uact=8&ved=2ahUKEwjy3Iisp-7gAhUZbysKHU9dCoUQFjALegQIBRAC&url=https%3A%2F%2Fwww.privacy.org.nz%2Fassets%2FFiles%2FCodes-of-Practice-materials%2FHIPC-1994-2008-revised-edition.pdf&usg=AOvVaw1UIgnhBYrgep6kvkU88xkI

http://www.acc.co.nz/about-acc/procurement/WPC133871



escalated to a senior staff member, eg a Team Manager or EPM. If required, they will seek

advice and guidance from the Portfolio Advisor.

If the issue cannot be resolved by a Team Manager or EPM the Impairment must follow line

management escalation processes for that issue, eg escalate the issue to an Area Leader,

EPM, Portfolio or Health Procurement. This is especially important for any issue with the

potential to be high risk, involves risk to a client, or risk to ACC’s reputation. For contact

details please see list of contacts at beginning of this document.

If there has been a high risk or adverse event, such as a:

• Privacy breach.

• Personal or client harm or safety issue.

• Contract breach.

• Media risk.

The Impairment Assessor or Supplier must tell ACC immediately by either:

• Contacting the EPM.

• Contacting the Provider Helpline on 0800 222 070.

It is important to make contact and not just leave a message. For issues not able to be

resolved using the process outlined above please refer to ACC’s website and/or your

Standard Terms and Conditions.

Engagement and Performance Manager Meetings

EPMs may meet with Assessors as arranged between the parties to discuss any issues

which have been escalated to the EPMs from ACC, clients, other health providers, or other

stakeholders. Assessors are encouraged to raise any issues in relation to meeting their

performance requirements with the EPM in the first instance.

http://thesauce/team-spaces/chips/employers/experience-rating/policy/adverse-events-and-their-impacts/index.htm

http://www.acc.co.nz/for-Providers/resolving-issues/index.htm



16. Appendices

Glossary

ACC Claims

Assessment Unit

The unit within ACC which is responsible for determining complex cover,

treatment and support decisions.

ACC Handbook The ACC User Handbook to the AMA “Guides to the Evaluation of

Permanent Impairment” 4th edition” as published by ACC from time to time.

AMA Guides The American Medical Association’s Guides to the Evaluation of

Permanent Impairment (4th edition).

Assessor or

Impairment Assessor

The approved assessors listed in Part A, clause 3 of the service schedule

approved by ACC to provide Impairment Assessments/Reassessments.

Assessment or

Reassessment

The services described in the Service Schedule for Impairment

Assessment Services, particularly the assessment of the Client.

Assessment Tool The American Medical Association’s Guides to the Evaluation of

Permanent Impairment (4th edition) and the ACC User Handbook to AMA4.

Client The injured person receiving cover and support from ACC.

Impairment Report The report prepared by an Assessor based on the results and

recommendations arising from an Assessment.

Medical Practitioner A person registered or deemed to be registered under the Medical

Practitioners Act 1995 (see that Act, ss12, 144);

Clinical Advisor The ACC Clinical Advisor who provides clinical oversight and ensures

quality of the Impairment Reports and whole-person impairment rating.

Peer Review The services described in the Service Schedule for Impairment

Assessment Services, particularly the Peer Review assessment.

Peer Review Report The report prepared by a Peer Review service Provider based on the

results and recommendations arising from the Peer Review.

Supplier The Supplier is the legal holder of the contract and has the full and final

responsibility for the delivery of the service. The Supplier can also be a

service provider and/or the employer of service providers.

Treatment and

Support Assessor

The ACC staff member responsible for the independent allowance and

lump sum entitlement decision.








Impairment Assessment Report Checklist

General

Client Name/address/DOB correct: Yes No

Date/time of appointment and duration of assessment noted: Yes No

History of Accident/s correct: Yes No

Injuries correctly described: Yes No

Treatment history discussed (where appropriate): Yes No

Details of medical records received: Yes No

Pre-existing medical conditions/non-accident related injuries noted:

:

Yes No

Adequate Analysis

Permanence stated: Yes No

Stability stated: Yes No

Adequacy of medical records referenced and noted in report: Yes No

Scaring considered and rated (even if 0%): Yes No

Discussion with client noted: Yes No

Impairment Rating

Have all injury related impairments been considered? Yes No

Are calculations of impairment referenced to the AMA guides? Yes No

Have the appropriate worksheets been used and enclosed?

• Upper extremity

• Visual impairment

• Brain and cranial nerves

• Lower extremity

Yes No

Has apportionment been considered and justified where appropriate? Yes No

Have all the relevant injuries been combined for the correct date ranges (pre 01/07/99;

01/07/99-31/03/02; post 31/03/02)?

Yes No

Have enough details been obtained (for head injuries or mental injuries only)

Current personal circumstances: Yes No

Personal history: Yes No

Medical history: Yes No

Psychiatric history: Yes No

Drug, alcohol, forensic history: Yes No

Mental status examination: Yes No

Activities of daily living: Yes No



Social functioning: Yes No

Concentration persistence and pace: Yes No

Fatigue/sleep disorder: Yes No

Apportionment discussed and justified where appropriate: Yes No

Comments: