A coalition of claimant advocates and professionals is challenging how New Zealand’s Accident Compensation Corporation (ACC) is managing its long-term claims portfolio, as new figures show thousands of exits where the primary reason is not clearly recorded.
The ACC Futures Coalition, which promotes the Woodhouse principles underpinning the country’s no-fault accident compensation scheme, said recent changes in long-term claims management and ministerial directives to reduce the size of the long-term pool raise legal, operational, and policy questions for the scheme. The group notes that ACC’s core function is to provide income support, treatment, and rehabilitation for injured people in exchange for the removal of the right to sue. It is concerned that current practices around exiting long-term claimants may not align with the scheme’s statutory obligations or its intended role as a social insurance mechanism. The coalition’s position follows a series of RNZ reports and interviews, including statements from ACC chief executive Megan Main and senior leaders, setting out changes to long-term claims management and the scale of recent exits from the long-term pool.
According to figures released under the Official Information Act, more than 8,000 long-term claimants were exited from ACC in the year to June, as the corporation seeks to reduce a long-term claims pool of about 25,000 people. ACC recorded 8,741 people as having left the long-term pool over that period. When re-entries are included, total exits reached 10,682, with 1,941 people exited and later reclassified as long-term claimants. Outcome data shows that only a minority of those who left the pool were recorded as returning to their previous roles or entering new jobs after retraining. Thirteen percent were recorded as going back to their pre-injury employment, while 3.6% were retrained for other work. For 5,333 of the 10,682 exits, ACC stated it could not “accurately determine” the primary reason for leaving the long-term pool.
ACC said some of these exits are likely to relate to vocational independence decisions or returns to pre-injury work, and that a full breakdown would require a manual review of individual claim files. Over the past five years, 42,733 people have left the long-term claim pool as ACC has managed higher claim volumes, longer recovery times, and pressure on levy and liability settings. ACC Minister Scott Simpson has directed the organisation to reduce the number of people receiving weekly compensation for more than 12 months. ACC said decisions on ongoing support are made on a case-by-case basis, using clinical and vocational assessments. Claimant representatives said many exits are being justified on causation grounds, where ACC concludes that ongoing incapacity is no longer linked to the original covered injury but to other physical or mental health conditions.
The ACC Futures Coalition has drawn attention to how clinical information is being applied in decisions about long-term claims. It points to a case reported by RNZ involving claimant Jonathan Simcock, who has permanent paralysis of his dominant arm, along with chronic pain, anxiety, and depression. Clinical information on his file reportedly indicated that he could work about three hours a day, up to 10 hours a week. ACC later assessed him as able to work more than 30 hours a week and ended his weekly compensation with four weeks’ notice. After the case was raised publicly, ACC reinstated his support and said it would reassess the claim.
Responding to questions about recent changes in long-term claims management, Matthew Goodger, ACC’s acting head of client recovery, outlined adjustments made in mid-2024. “In mid-2024, we changed the way we managed some long-term claims to ensure these clients were getting the dedicated, interdisciplinary support they needed to get back to independence, including the establishment of new teams of one-to-one case managers. This focus is reflected in an increased number of long-term claims being closed as clients were successfully supported to recover from their injuries so they could return to their pre-injury role or other work types, or in some cases identifying that covered injuries had resolved,” Goodger said, as reported by RNZ.
The coalition notes that this represents a move back toward dedicated case management after earlier structural changes in which files were handled by multiple staff. It said being able to “identify that covered injuries had resolved” for long-term claimants depends on up-to-date and comprehensive clinical evidence, particularly for complex or evolving conditions. Law firms and community legal services associated with the coalition report cases involving tetraplegia, traumatic brain injury, and complex surgery where, in their view, decisions have been taken with limited medical documentation or by providers whose expertise does not match the complexity of the injuries.
Claimant advocates said the exit data and case narratives reflect broader incentives within the scheme. Wellington lawyer and advocate Warren Forster, who obtained the exit data from ACC, said the volume and pattern of exits indicate system-wide pressure. “There is absolutely a pattern of systemic exit. There’s no doubt whatsoever that ACC is exiting long-term claimants at a scale that’s unprecedented,” he said, as reported by RNZ.
Forster said many of his clients have been exited after ACC determined that their current condition is no longer caused by the covered injury. He argues that this approach can miss the complexity of multi-factor or progressive diagnoses. “People aren’t off work for four years because of a sprain. Something else is going on – a tendon tear, a disc prolapse, and mental distress – and none of that analysis is being done,” he said.
Advocate Daniel Wood, who represents claimants at review, said that while the legislation defining entitlements is clear, application and timeframes can vary. He estimates that about 30 of his clients have been exited from the long-term pool in the past four months, with many choosing to challenge those decisions. “They have no option but to challenge the decision through an independent review, which can take at least six to eight months – and that’s optimistic,” he said. During that period, he added, households can face “significant financial hardship,” with some relationship breakdowns and self-harm incidents reported.
ACC chief executive Megan Main has responded by outlining the decision-making process and avenues for dispute. In a written statement, she said ACC “considered each client’s entitlements on a case-by-case basis using clinical notes and evidence. If a client feels that we have made the wrong decision on their claim or entitlement, we have a robust independent review process in place.” Main has also pointed to ACC’s responsibilities to levy payers as well as to injured clients. “In addition to our responsibility to support people to be rehabilitated, to recover, we also have a responsibility to all New Zealanders who pay their levies to make sure that ACC is only funding injury related treatment,” she said in a recent radio interview.
