ACC declined my claim. What do I do now? Your rights when ACC says no in New Zealand

Last updated 18 May 2026. This is general information, not legal advice.

ACC is meant to be one of the simplest things about living in New Zealand. You get hurt, ACC pays for the treatment, you get back on your feet. For most people most of the time, that is how it works. But every year, ACC declines tens of thousands of claims, suspends weekly compensation, refuses surgery, and stops cover that was previously granted. When that happens, the system gets very complicated very fast, and the agencies running it know far more about how to navigate it than you do.

This guide explains, in plain English, what to do when ACC declines your claim or stops your cover. It covers the most common reasons for a decline, the formal review process, the appeal pathway, and the practical steps that have actually got people their cover back. It is general information, not legal advice. Every claim ties back to the Accident Compensation Act 2001 and recent decisions of the Accident Compensation District Court.

The basic deal, and why ACC matters more than people realise

The starting point. In 1972, New Zealand traded away the right to sue for personal injury in exchange for a universal no-fault accident compensation scheme. That trade-off is the foundation of ACC. If you are injured in New Zealand by an accident, ACC pays. You cannot generally sue the person or business that caused the injury. The system is meant to be simpler, faster, and more reliable than the courts.

That trade-off is still in place. The current statute is the Accident Compensation Act 2001, and it still reflects the original “social contract”. But the scheme has narrowed significantly since 1972. ACC declines far more claims than people expect, particularly for back injuries, shoulder injuries, knee injuries, and any condition that has elements of both injury and degeneration. The Wellington orthopaedic surgeon Robert Kusel told Stuff some years back that he and his colleagues had noticed a sharp increase in the number of patients being denied ACC cover for surgery on the basis of “degeneration”. ACC’s response is that it is simply looking at claims more carefully. From the patient’s perspective, the result is the same. The claim that should have been simple becomes a fight.

What matters about all of this is that ACC is the only route. You cannot just give up on ACC and sue. The no-fault scheme bars personal injury lawsuits. If ACC says no, the only way to challenge that is through ACC’s own internal process, then the formal review process, then the District Court. The system is designed to keep injury compensation out of the courts, and the legal pathway is correspondingly narrow.

The most common reasons ACC declines a claim

Before you do anything else, look at the reason on the decline letter. The decline letter must give a reason, and the reason determines your strategy.

The injury was not caused by an accident

This is the most common reason for declining cover, particularly for back, knee, shoulder and neck conditions in people over 40. ACC’s position is that the symptoms are caused by a pre-existing degenerative condition or a gradual process, not by a discrete accident. It cites the diagnostic imaging (often an MRI) showing degeneration in the joint, disc, or tendon.

The problem with this reason is that nearly everyone has some degree of degeneration once they are past about 35. ACC cannot lawfully decline a claim solely because degeneration exists. The legal test under section 26 of the Accident Compensation Act is whether the personal injury was caused by the accident, or whether the condition is substantially caused by a gradual process or disease.

The Accident Compensation District Court has been very clear that the presence of degeneration on a scan does not, on its own, dispose of a claim. In Aylward v Accident Compensation Corporation [2026] NZACC 035, the Court found that the weight of evidence established on the balance of probabilities that the appellant sustained spigelian hernias because of the accident, and quashed ACC’s review decision declining cover.

The defence in these cases turns on getting clear, dated medical evidence about what changed at the time of the accident. If the symptoms began at a specific moment, with a specific event, after a specific incident, you have an injury-caused condition regardless of any background degeneration. ACC’s degeneration argument is strongest where the onset of symptoms was gradual and the accident is being attached retrospectively. It is weakest where there is a discrete event, an immediate change in function, and contemporaneous medical records.

Not a personal injury covered by the Act

This is the catch-all for things ACC says do not fit the definition of personal injury. The Act covers physical injury, mental injury caused by specific traumatic events, and treatment injury caused by medical treatment. It does not cover general illness, age-related conditions, or most mental health issues that arise without a specific traumatic precipitating event.

If your decline letter says your condition is not a covered personal injury, you need to read carefully which limb of the definition ACC says you fall outside. Each limb has its own legal test and its own pathway for challenge.

Treatment injury not caused by treatment

For treatment injury claims (injuries caused by medical treatment), ACC often declines on the basis that the injury is not actually a consequence of the treatment but a natural progression of the underlying condition. The test under section 32 of the Act is whether the injury is an “ordinary consequence” of the treatment. If it is something that happens to a normal proportion of patients undergoing the same treatment, ACC will likely decline.

The 2026 case of Watts v Accident Compensation Corporation is a striking example. The Court found that ACC’s failure to provide treatment in a timely manner was causative of the appellant’s amputations, and that amputation was not an ordinary consequence of treatment for an ingrown toenail. The appellant’s underlying health conditions did not exclude him from cover. Appeal allowed.

The lesson is that treatment injury claims often come down to medical evidence about what should have happened versus what did, and whether the outcome falls outside the expected range. Specialist medical evidence is essential.

Work-related gradual process not established

For conditions like hearing loss, back conditions, repetitive strain, and certain occupational diseases, ACC requires you to establish a work-related gradual process under sections 30 to 31 of the Act. The Act sets out a three-step test that you must meet, or alternatively, your condition must be listed in Schedule 2 of the Act (the schedule of occupational diseases).

These claims are technically hard. You need evidence about your work tasks, the nature and duration of the exposure, and the causal link to the condition. Many of these claims are initially declined and then succeed at review with proper occupational health evidence.

Vocational independence achieved

This is the most painful decline for people who have been on weekly compensation. ACC concludes that you can now return to work, and stops your weekly compensation. The decision is based on a Vocational Independence Assessment that looks at your medical capacity and the kinds of jobs you are suited for.

The challenge for many claimants is that the assessment can find you “vocationally independent” for a hypothetical job that exists somewhere in New Zealand, even if you have no realistic prospect of getting that job. If ACC declares you vocationally independent, you get another three months of weekly compensation, then it stops. If you cannot find a job, you have to apply to Work and Income for a benefit.

If your condition gets worse later, you can reapply to ACC for weekly compensation. But you have to make that application and meet the legal threshold.

Vocational independence decisions are reviewable. They are won when the assessment was flawed, when it relied on jobs you genuinely cannot perform, or when the medical evidence was wrong.

Surgery not approved

ACC must give prior approval before paying for elective surgery related to a covered injury. If you have cover for the injury but ACC declines the surgery, the reason is usually one of these:

• ACC says the surgery is for a different condition not caused by the accident
• ACC says the surgery is not “the most appropriate” treatment
• ACC says the cost of the surgery is not justified by the expected benefit
• ACC says there is no causal link between the original injury and the current need for surgery

Surgery declines are commonly challenged successfully when the treating specialist’s evidence is strong and the link to the original injury is clear in the contemporaneous medical record.

Step one, the informal step before review

Before lodging a formal review, the law expects you to try to resolve the issue with ACC directly. The decline letter will name a person at ACC you have been dealing with. The first step is to contact them.

This is not a waste of time. ACC does sometimes reverse decisions at this stage if new information is provided. The threshold for raising new medical evidence is lower than at review. And the conversation tells you what ACC’s real concern is, which helps you target your review.

What to ask:

• What specific information did the decision rely on?
• What additional information would change the decision?
• Can the decision be reconsidered if I provide a fresh medical opinion or specialist report?
• What is the timeframe for that reconsideration?

If the conversation produces an offer to reconsider on the basis of new information, get it in writing. The clock on the formal review is still running while you do this. Keep an eye on the dates.

Step two, the independent review, the most important stage

If the informal step does not resolve the issue, the next step is to apply for a formal independent review. This is the single most important stage in the ACC dispute process. Most cases are won or lost at review.

Under sections 134 and 135 of the Act, you have three months from the date of the decision to apply for a review. That deadline is strict. Apply late and ACC will only accept the application in narrow “special circumstances”, for example where the injury or trauma prevented you thinking about a review, where you arranged for a representative who failed to apply, or where ACC failed to tell you what you needed to do.

The application is made on ACC’s Application for Review form (ACC33), available on ACC’s website. It can also be done by letter, but the form makes things simpler. Submit it to ACC, not directly to the reviewer.

ACC then sends the file to an independent reviewer organisation. ACC uses FairWay Resolution, which is technically an independent subsidiary that was carved out of ACC’s old internal review section. The reviewer is meant to be neutral.

A resolution coordinator will be assigned to your case. The hearing must be scheduled within three months of your application. You will be given at least seven days notice of the hearing date and location.

What happens at the review hearing

The hearing is informal. It can be held in person, by phone, or by video. You can attend, ACC can attend, and (if the decision was about a work injury) your employer can attend. You can bring a support person, witnesses, and a representative.

Both sides present their case. The reviewer can look at any relevant evidence. The rules of evidence are relaxed. You will be invited to speak about what happened and why you think the decision was wrong.

The reviewer’s decision must be issued within 28 days of the hearing. The decision is binding. ACC must implement it unless they appeal.

Cost reforms from 27 November 2025

A significant change came into force on 27 November 2025. The Accident Compensation (Review Costs and Appeals) Amendment Regulations 2025 changed the way review costs are calculated. ACC continues to pay the actual cost of running the review itself. ACC may also pay other costs related to the review, such as reimbursing your travel costs to the hearing. The detailed new costs schedule is in the regulations.

Importantly, if you use a representative (a lawyer or an ACC advocate), ACC is generally required to pay your representation costs up to a capped amount, currently around $2,100 for standard review matters. This is the single most important reason why most claimants who challenge an ACC decision should consider using a professional advocate or lawyer. The legal fees are usually recoverable, and the win rate with a representative is dramatically higher than self-represented.

Common reasons reviews succeed

Looking at the published Accident Compensation District Court decisions and FairWay review decisions, the patterns are clear. Reviews most commonly succeed when:

• New medical evidence has been produced that ACC did not have when it made the original decision
• A treating specialist (not just an ACC-appointed assessor) supports the link between the accident and the condition
• The decision was based on a flawed or incomplete medical assessment
• ACC’s decision relied on a misapplication of the legal test (for example, treating “presence of degeneration” as conclusive when the legal test is whether the accident materially caused the injury)
• ACC failed to follow its own procedural requirements
• The decision letter is internally inconsistent or relies on facts that are wrong

Reviews most commonly fail when the medical evidence genuinely supports ACC’s position, when the gap between the accident and the symptoms is too large to bridge, or when the appellant has not put forward new evidence.

Step three, appeal to the District Court

If the review goes against you, you have the right to appeal to the Accident Compensation District Court under section 149 of the Act. The District Court is the only specialist court in New Zealand for ACC matters.

You have 28 days from receiving the reviewer’s decision to file the appeal. This deadline is strict. Late filing requires leave of the Court, granted only where there were exceptional circumstances. In Read v Accident Compensation Corporation [2026] NZACC 034, the Court granted leave to file out of time where the appellant’s explanation was a misunderstanding about her right to appeal, ACC did not oppose the application, and there was no material prejudice. But these grants are not guaranteed.

The District Court conducts a fresh hearing of the case. It is not a review of the reviewer’s decision, it is a new hearing on the merits. New evidence is admissible. The Court can hear from medical experts, including specialists you have engaged separately from ACC’s panel.

The Court can:

• Allow the appeal and quash ACC’s decision (your cover is reinstated)
• Allow the appeal in part and refer the matter back to ACC for reconsideration
• Dismiss the appeal (ACC’s decision stands)

Hearing fees apply only if the hearing runs longer than half a day. There is no general filing fee for ACC appeals.

The 2026 decisions show that around 30 to 40 per cent of ACC appeals succeed in some form. The success rate is higher where the appellant has legal representation and where the medical evidence has materially changed since the original ACC decision.

Further appeals

From the District Court, you can appeal to the High Court under section 162 of the Act, but only on a question of law and only with leave of the Court. This is a high bar. The 2025 decision in Dooley v Accident Compensation Corporation [2025] NZACC 144 shows the Court applying a strict test. Leave was refused on the basis that no arguable question of law was established.

From the High Court, you can appeal to the Court of Appeal in narrow circumstances. Almost all ACC disputes that go to appeal end at the District Court stage. The High Court route is for points of law that affect the broader interpretation of the Act.

The practical playbook when ACC says no

If you have received a decline letter, suspension notice, or surgery refusal from ACC, the practical sequence is:

One. Read the letter carefully. Note the specific reason given, the date of the decision, and the timeframe for review. The three-month review deadline starts from the date of the decision.

Two. Get a copy of your full ACC file. Under the Privacy Act 2020, you have the right to all the information ACC holds about you. Request it in writing. ACC must respond within 20 working days. The file usually includes the medical assessments, internal notes, and the decision rationale. This is essential reading before you do anything else.

Three. Get an independent medical opinion. This is the single most important step you can take. ACC’s decisions rely heavily on medical opinions from its assessors. If you have an independent specialist opinion supporting your position, your review prospects improve dramatically. Your GP can refer you to a specialist, or you can request the referral directly from ACC.

Four. Make the informal contact first. Call the ACC person named on the decision letter. Note the conversation. If they offer to reconsider, get it in writing and confirm the timeline.

Five. Lodge the ACC33 review application before the deadline. Even if the informal step is still in progress, lodge the review form. You can always withdraw it later if ACC reconsiders. Missing the three-month deadline is the most common way claimants lose cases they could have won.

Six. Get a representative. This is where the maths is in your favour. ACC is required to pay representation costs up to the capped amount under the cost regulations. The win rate with a representative is dramatically higher. There are several free or low-cost advocacy services (see below), and many specialist ACC lawyers work on contingency or capped fees.

Seven. Prepare for the review hearing. Your representative will guide this. The key elements are a clear timeline of the injury and the symptoms, the medical evidence, the legal test as applied to your facts, and your testimony.

Eight. Keep good records. Keep every letter from ACC, every medical report, every communication. Keep a written timeline of when symptoms started, what they were, what changed and when. The Authority and the Court make decisions on documents.

Your rights under the Code of ACC Claimants’ Rights

Separate from the legal entitlement to cover, you have specific rights as an ACC claimant under the Code of ACC Claimants’ Rights. The Code is a set of legally enforceable rights that govern how ACC treats you.

Your rights under the Code include:

• The right to be treated with respect and have your dignity respected
• The right to be treated fairly, and to have your culture, values and beliefs respected
• The right to a support person at any meeting with ACC
• The right to information about your claim, in a form you can understand
• The right to make decisions about your treatment, rehabilitation, and the people involved in your claim
• The right to have your privacy respected
• The right to complain if you are not satisfied with the service

If ACC breaches the Code, you have a separate complaints pathway through ACC’s customer support team, and ultimately to the Office of the Health and Disability Commissioner for code complaints related to treatment. Code complaints do not affect cover decisions, but they can be useful where the issue is how ACC has handled you rather than whether they should pay.

Sensitive claims, a different pathway

If your claim relates to sexual abuse, sexual assault, or other sensitive matters, ACC has a separate pathway with dedicated case managers. The threshold for cover and the supports available are different. Contact ACC Sensitive Claims on 0800 735 566 for confidential advice. Free counselling and therapy are available regardless of whether you have made or are making a claim.

Free help when you need it

You are not on your own. The ACC system is genuinely complex, and free or low-cost help is available.

• Way Finders on 0800 273 030 is a free nationwide independent service providing advice and support for ACC claimants
• Talk Meet Resolve is a free independent service that helps resolve disputes with ACC
• Community Law Centres provide free initial legal advice nationwide
• Citizens Advice Bureau provides general guidance
• Legal Aid may be available for legal representation at ACC review hearings if you meet the income threshold
• ACC’s own Customer Support on 0800 101 996 for general queries about your claim
• The Office of the Health and Disability Commissioner for complaints about the conduct of medical treatment that led to an ACC claim

For paid representation, specialist ACC lawyers and advocates exist in most major centres. Many work on capped or contingency fees. Because most representation costs are recoverable from ACC under the review cost regulations, the net cost to a claimant is often much lower than people expect.

What about complaining to the Ombudsman

People often ask whether they can complain to the Ombudsman about an ACC decision. Generally, no. The Ombudsman’s office has said that the existence of the review and appeal rights effectively precludes them from investigating decisions about ACC entitlements. The Ombudsman cannot generally hear a complaint where there is a right of appeal to a court or tribunal on the merits.

The Ombudsman can sometimes look at administrative conduct issues where the formal review process is not the right venue. But for a decline of cover, a stopped weekly compensation payment, or a refused surgery, the only effective pathway is the review process and then the District Court.

The takeaway

ACC is a powerful safety net when it works. When it does not work, the system is opaque, the process is technical, and the agency on the other side is far better resourced than you are. The single biggest mistake people make is missing the three-month review deadline. The second biggest is trying to do it alone when free or recoverable representation is available.

Some takeaway truths:

• Most successful challenges to ACC decisions happen at the formal review stage, not in court
• The deadline for review is three months from the date of the decision, and missing it is usually fatal
• The deadline for appeal to the District Court is 28 days from the reviewer’s decision
• ACC pays the cost of running reviews and is required to contribute to representation costs up to a capped amount
• Independent medical evidence is the single most important factor in the success of an appeal
• The “degeneration” argument is the most common reason ACC declines, and it is also one of the most commonly overturned at review and appeal
• You cannot sue your way out of ACC. The review and appeal process is the only legal route
• Free representation exists. Use it

If you take only one thing from this guide, take this. Get the review application in within the three-month deadline, even if you are still gathering evidence. You can supplement the application later. You cannot extend the deadline.

ACC has the systems, the lawyers, and the experience. You have the right to push back, and you have a real chance of winning if you do it properly. The system is meant to support injured New Zealanders. When it does not, the law gives you a way to make it.

Frequently asked questions

How long do I have to challenge an ACC decision in New Zealand

Three months from the date of the decision to lodge a formal review under section 134 of the Accident Compensation Act 2001. After the review, you have 28 days from the reviewer’s decision to appeal to the Accident Compensation District Court. Both deadlines are strict and very hard to extend.

Can I sue someone if ACC will not pay

Generally no. New Zealand’s no-fault accident compensation scheme bars personal injury lawsuits in exchange for ACC cover. If ACC declines a claim, the only legal pathway is the internal challenge, the formal review, and the District Court appeal, not a separate civil claim against whoever caused the injury.

How much does it cost to challenge an ACC decision

The review process itself costs nothing. ACC pays the reviewer. From 27 November 2025, ACC is also required to contribute to your representation costs up to a capped amount (currently around $2,100 for standard review matters) if you use a lawyer or advocate. For most claimants the net cost of professional representation at review is much lower than people expect.

What does degeneration mean in an ACC decline

ACC uses “degeneration” to describe age-related or gradual wear-and-tear changes seen on imaging, such as a worn disc, a torn rotator cuff, or a degenerative meniscus. ACC often declines cover on the basis that the symptoms are caused by degeneration rather than the accident. The courts have repeatedly held that the presence of degeneration on a scan does not, on its own, dispose of a claim. The legal test is whether the accident materially caused the injury.

Can I get free help to challenge an ACC decision in New Zealand

Yes. Way Finders on 0800 273 030 is a free nationwide advocacy service for ACC claimants. Talk Meet Resolve is a free independent dispute resolution service. Community Law Centres provide free initial legal advice. Legal Aid may cover representation at review hearings if you meet the income threshold. ACC is also generally required to contribute to your representation costs up to a capped amount.

What is FairWay Resolution and is it independent

FairWay Resolution is the organisation that runs the formal review process for ACC. It is technically independent of ACC, having been carved out of ACC’s old internal review section. Reviewers are meant to be neutral. Most reviews are decided on the medical and legal evidence rather than on advocacy alone, and the patterns of outcomes are reasonably predictable from the strength of the underlying case.

What happens at an ACC review hearing

The hearing is informal. It can be held in person, by phone, or by video. You and ACC each present your case to the reviewer. You can bring a support person, witnesses and a representative. The rules of evidence are relaxed. The reviewer must issue a written decision within 28 days of the hearing, and that decision is binding on ACC.

Can I appeal an ACC decision to court in New Zealand

Yes. After the review you have 28 days to appeal the reviewer’s decision to the Accident Compensation District Court under section 149 of the Act. The Court conducts a fresh hearing on the merits. New medical evidence is admissible. Around 30 to 40 per cent of appeals succeed in some form, higher with representation.

How long does an ACC appeal take

The formal review hearing must be scheduled within three months of your application, with the reviewer’s decision issued within 28 days of the hearing. An appeal to the District Court typically takes a further six to twelve months from filing to decision. Total elapsed time from decline to final decision is commonly 12 to 18 months.

Can I get my weekly compensation back if it has stopped

Possibly. Vocational independence and other compensation-stopping decisions are reviewable. They are most often overturned when the medical assessment was flawed, when the jobs identified are not realistically available to you, or when your condition has worsened since the decision. If your circumstances change after the decision, you can also reapply to ACC for weekly compensation.

Can I get medical treatment while my ACC claim is in dispute

Yes, but you may have to pay for it yourself in the short term and claim reimbursement later if you win. Some specialists will treat under a private arrangement pending the dispute. Your GP and the public hospital system can continue to treat you regardless of ACC. If you win the review or appeal, ACC will normally reimburse reasonable treatment costs incurred during the dispute.

What is the success rate of ACC appeals in New Zealand

Roughly 30 to 40 per cent of ACC District Court appeals succeed in some form, including partial successes and remits back to ACC. The success rate is materially higher where the appellant has professional representation, where independent medical evidence supports the claim, and where the original ACC decision relied on a flawed or incomplete assessment.

Have you successfully overturned an ACC decline in New Zealand? Tell us how in the comments below.