What ACC does not cover and how to fill the gap

At a glance: ACC vs personal insurance 

The table below summarises key comparisons between the covers and benefits offered by ACC and personal insurance plans:

What does ACC cover in NZ?

ACC-covered conditions  

ACC provides cover for the following situations, regardless of whether you’re a resident, work visa holder, visitor, or international student:

• Physical injuries due to accidents, for example,
  • sprains or strains
  • wounds
  • burns
  • fractures
  • dislocations
  • dental injuries
  • hearing loss
  • concussion and loss of consciousness.
• Treatment-induced injuries if:
  • the treatment or procedure directly resulted in your harm
  • a licensed healthcare provider was providing the treatment
  • it's not a normal side-effect of your treatment.
• Work-related injuries or conditions that develop gradually, such as:
  • tendonitis from overusing muscles
  • deafness caused by excessive work noise
  • infections or diseases from harmful working environments.
• Serious injuries and disabilities with long-term effects, such as spinal and traumatic brain injuries.
• Mental injuries if these are a result of the following:
  • an ACC-covered physical injury, such as post-traumatic stress disorder (PTSD) after a physical assault
  • physical injury due to medical treatment
  • a traumatic event at work, even if you did not sustain physical injuries.
• Sexual maltreatment: ACC assists anyone, even visitors and Kiwis travelling overseas, who have experienced sexual abuse, regardless of the incident's timeline
• Dental injury from an accident, sports mishap, medical, or dental treatment-related issue
• Injuries leading to death: ACC provides financial aid for death due to accidents, work-related diseases, ACC-covered treatment injuries, or self-inflicted injuries in certain circumstances
• Specific maternal birth injuries: ACC can assist with recovery from an injury incurred during labour or delivery that occurred on or after October 1, 2022, including the following situations:
  • anterior wall prolapse, posterior wall prolapse, or uterine prolapse
  • coccyx fracture or dislocation
  • levator avulsion
  • obstetric anal sphincter injury tears or tears to the perineum, labia, vagina, vulva, clitoris, cervix, rectum, anus, or urethra
  • obstetric fistula (including vesicovaginal, colovaginal, and ureterovaginal)
  • obstetric haematoma of the pelvis
  • post-partum uterine inversion
  • pubic ramus fracture
  • pudendal neuropathy
  • ruptured uterus during labour
  • symphysis pubis capsule or ligament tear
  • physical or mental injuries due to a covered birth injury
  • injury from medical treatment during birth.

Support from ACC

ACC provides support for situations including:

• Assistance to different medical services, such as:
  • dental treatment services
  • medical specialist, general practitioner, and nurse services
  • hospital treatment and surgery
  • occupational and speech therapy
  • prescriptions
  • radiology services
  • counselling and therapy services
  • support at home.

• Other types of support include but are not limited to the following:
  
  • weekly compensation of up to 80% of your earnings if you are unable to work due to a covered condition. The minimum and maximum weekly rates as of April 1, 2024, are $740.80 and $2,350.62, respectively.  Compensation starts after the first week of your injury and continues until you can resume your pre-injury work or get another suitable job
  • financial support if you suffer a covered life-long or permanent injury
  • a funeral grant as well as other types of financial support if a person dies of a covered injury  
  • assistance like wheelchairs, specialised aids and equipment, and prosthetic limbs
  • the costs of some childcare, home help, attendant care, and educational support (for children with injuries).

What ACC does not cover and how insurance fills the gap

Despite many Kiwis believing that ACC offers support for most illnesses or injuries, the following situations are not covered unless they are related to an accident or covered condition: 

• Illnesses like cancer and heart disease - the most prevalent causes of death in New Zealand. In 2021, nearly 30% of deaths were due to cancer and 25% were due to ischaemic and other forms of heart disease as well as cerebrovascular diseases.
• Ailments associated with ageing, including arthritis. In 2023, about 746,000 adults in New Zealand were diagnosed with some form of arthritis.   
• Non-work-related gradual injuries
• Pre-existing or underlying issues not caused by a covered condition
• Pregnancy-related conditions, including:
  • injuries that happened before October 1, 2022
  • illnesses associated with pregnancy
  • injuries related to maternal birth not mentioned previously
  • injuries to the baby (may, however, qualify for treatment injury cover).
• Most hernias
• Treatments received outside New Zealand
• Emotional problems not caused by a covered condition
• Communicable diseases
• Medical services performed by an unregistered or unlicensed provider.

Why get insurance when you think you’ll be covered by ACC?

Protection for conditions not covered by ACC

Having personal insurance ensures that you have financial resources to draw on in cases not covered by ACC, such as income loss, disability, or death due to cancer, heart disease, and other serious conditions.

Consider these facts:

• According to a 2013 New Zealand Disability Survey, a large number (41%) of impairments associated with disabled people were caused by diseases or illnesses, and only 31% were due to ACC-covered accidents or injuries.
• In 2021, cancers and heart diseases - mostly not covered by ACC - caused more than half of the deaths in New Zealand.
• Serious illnesses such as cancer can hit anyone, regardless of age. Statistics compiled by Health New Zealand Te Whatu Ora in 2021 highlighted more than 200 children and adults aged 19 or younger, plus over 1,100 individuals in their 20s and 30s diagnosed with cancer.

Having the right comprehensive medical insurance means you can opt for private healthcare, avoiding long wait times in the public health system and the cost of expensive treatments. It also gives you access to non-Pharmac medications without the stress of big healthcare bills, having to sell your home, or going into debt to cover medical costs to save or prolong your loved one’s life.

And if you need to stop working, plans like mortgage repayment or income insurance can replace a portion of your monthly income - particularly helpful if you’re a primary or sole income earner.

Trauma insurance or total permanent disablement insurance can provide lump sum benefits to soften the financial impact of serious illnesses, like cancer, or permanent disabilities, helping keep your family afloat during trying times.

In case of your death due to a non-ACC covered condition, your loved ones can use your lump sum life cover benefit to pay for funeral costs, debts, and living expenses.

Declined or delayed ACC claims

It is possible to have a declined or delayed ACC claim due to technical or processing errors, legal issues, misdiagnoses, or miscommunication at the outset of an injury or covered illness.

Supplement ACC benefits

The right insurance plan can work alongside ACC. Here are some scenarios:

• Mortgage insurance does not usually cancel ACC benefits. You can receive it alongside your ACC, giving you and your family additional funds to utilise during recovery.
• ACC may offer financial assistance in the event of death due to an accident, treatment injury, or work-related condition. However, this benefit may be limited, whereas the significant lump sum paid from your life insurance policy guarantees that your family will have sufficient funds after your ACC cover ends.

Comparing insurance plans with the help of a licensed broker

Comparing different insurance policies can be complex, confusing, and time-consuming. Utilising the expertise of a trained insurance broker simplifies this process.

Policywise helps you identify your specific needs, evaluate your options, compare insurance plans and costs, get to grips with the nuances of each policy, and avoid common pitfalls. By leveraging their knowledge and resources, you can ensure that you select the most suitable insurance cover for your requirements.

Does ACC cover surgery? 

ACC can help pay for your surgery if it is related to a covered condition, such as an accident or treatment injury. Surgery must be the best option for your issue, and a recognised treatment in New Zealand, performed by a registered and licensed provider.

Unless it’s a covered condition, ACC will not pay for procedures related to cancer nor those related to aging, such as joint replacement surgeries.

Does ACC cover tourists and visitors in New Zealand?

ACC's no-fault scheme covers tourists and visitors injured in an accident while in New Zealand.

However, ACC does not cover the following:

• Illness
• Adjustments to your itinerary or an urgent need to return home
• Injuries received while travelling to or from New Zealand (e.g., boarding or getting off a boat or plane)
• Therapy and recovery once you get home.

Having personal insurance during your visit to New Zealand is recommended by the NZ government. Policywise can help visitors obtain health insurance if they:

• are staying in New Zealand for 3 days to 12 months and are not eligible for publicly funded healthcare
• have a New Zealand work visa that is valid for at least 12 months and has at least three months left
• have a New Zealand visitor visa valid for more than 12 months with at least 12 months left on it.

Policywise: Helping Kiwis get comprehensive protection

The ACC offers New Zealanders and visitors significant financial protection but has its limits. Depending solely on ACC may put you or your loved ones in a financially vulnerable position in the event of a critical illness, serious disability, or untimely death.

Let Policywise help you find insurance plans for conditions that aren’t covered by ACC. Policywise is a 100% free service which tells you which health, life, and disability insurance provider best fits your needs. We offer fast, comprehensive, and easy-to-understand comparisons of all leading providers, and a simple summary clearly recommending which insurer is best for your situation.

Not all insurance policies are the same. Policywise can help you sort out the duds, avoid the lemons, understand the fine print and exclusions, and get the right insurance for you and your family.

We make the important decision of where to buy your insurance super easy. We’ll answer your questions, provide experienced advice, quotes, and comparisons, and manage all the back and forth throughout the application process. Taking out your cover through us means you'll have our lifetime support and claims advocacy, and we'll help you negotiate a positive outcome at claim time. We can also take care of lodging any claims on your behalf and back you up if the going gets tough.

Check out the reviews on our homepage for how other New Zealanders have found our service, because now is the time to get your personal insurance sorted. Give your family or someone you love the most outstanding financial support possible. Book a 5-minute callback with Policywise today; our service is fast and free.

^{Disclaimer: This article is for general information only. Nothing in this blog or on this website is intended as medical, dietary, or financial advice. Although we aim to update our content regularly, you are advised to consult a Policywise adviser, health professional, or an appropriate specialist before acting on any information herein. They can factor in your personal circumstances or preferences and help guide your decision-making process.}