Accident Services - Who Pays? Edition One

Accident Services – Who Pays?
The Impact of the Accident Insurance Act 1998 on Hospital and Health Services

Date of publication: July 1999

Edition One

This guide is intended to indicate whose responsibility it is to pay for services provided to injured persons who have cover under the Accident Insurance Act 1998 (AI Act). It is aimed principally at Hospital and Health Services (HHSs), which provide a range of services, some of which are purchased through their arrangements with the Health Funding Authority (HFA) and some through arrangements with Accident Compensation Corporation (ACC) or registered insurers. It supplements the recent publication, 'A Health Provider’s Guide to the Impact of the Accident Insurance Act 1998', produced by the Department of Labour, Insurance Council of New Zealand (ICNZ) and the ACC.

This guide is not intended to replace more detailed information on the specific purchasing arrangements of the HFA, ACC or registered insurers.

Purchasers will communicate their own detailed information to providers.

Section 1 outlines the key changes arising from the AI Act and covers the background to purchasing and provision of services.

Section 2 defines services the HFA, ACC and registered insurers have a responsibility to purchase on behalf of injured persons.

Section 3 covers examples of specific services that often require clarification.

Section 4 describes key administrative processes to be used by HHSs in relation to the services purchased by HFA on behalf of ACC/registered insurers, or by ACC/registered insurers directly.

Section 5 outlines the disputes process.

Throughout this document the following terminology is used: An ‘injured person’ or ‘patient’ is a person who has cover under the AI Act. ‘Hospital and Health Service’ (HHS) has the meaning assigned in s.2 of the Health and Disability Services Act 1993. ‘ACC/registered insurer’ means the insurer that covers the injured person in terms of the AI Act. ACC is defined as an insurer in the Act. Registered insurers are insurance companies that are legislatively able to provide work accident insurance cover, having met certain criteria. In some parts of this document, where no distinction needs to be made between ACC or registered insurers, the term ‘insurer’ is used.

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