WHAT is ACC? What is a mental injurY? PTSD

The most frequent question I get when I talk about my experiences with Accident Compensation Corporation (ACC) for my mental injury is 'What is ACC?' ACC has information about their history and what they do on their website. However, I want to provide a persective from someone who has been through the assessment and compensation process for mental injury. This blog post is a combination of my research plus my experiences.

People from overseas get ACC confused with a disability scheme they may have in their country. ACC is a Crown entity scheme in New Zealand to compensate for no-fault accidents and injuries that take place in New Zealand. So it does NOT cover pre-existing disablities or medical conditions that are not directly linked to an event resulting in injury.

My understanding of a Crown entity is that it is set up by the government but operates independently from other government functions. All earners in New Zealand are charged a compulsory levy, similar to a tax.

Mental injuries such as post-traumatic stress disorder (PTSD) resulting from sexual abuse or sexual assault may be compensated for under the Accident Compensation Act 2001. 
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Physical injuries vs Mental Injuries

 Most physical injuries I have had (numerous sprains and strains from a specified accidents, including doing exercise) have been covered by ACC. Even an injury ACC has on their records from my accidently slicing my thumb open (it was over 20 years ago and I vaguely recall that from opening a pet food tin).

The cover minor to moderate physical injuries are usually approved quickly after being seen by a doctor or a physiotherapist who assesses the injury and contacts ACC directly. The key is to get assessed as soon as possible, to be covered. Here in New Zealand, it's quicker for me to self-refer to a physiotherapist, if I am injured, than to see a doctor. Treatment can be started quicker and I pay a fee but not as much as if ACC didn't cover some of the bill.

ACC can be resistant to cover any injuries that are more complex, may cost them more, or result from occupational overuse syndrome (previously called repetitive strain injuries). As far as I am aware, disabilities at birth are not covered, unless it can be proven that there was an accident causing injury.

ACC can also be reluctant to cover mental injuries, which don't necessarily result from physical injuries. Here in New Zealand, ACC deals with PTSD, whereas Mental Health Services deal with mental health conditions. I experience bipolar disorder and PTSD tangled together but they are dealt with by two completely different systems. Bipolar disorder is not covered by ACC, even though there is growing research showing that bipolar disorder is linked to childhood trauma.
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What is 'sensitive Claims'?

'Sensitive Claims' is the name ACC gives to injuries that have been caused by criminal acts, such as sexual and/or physical violence, whether or not these have been prosecuted criminally. One can still be covered, even if many years have passed since the event(s) resulting in mental injury. This includes historical sexual abuse.

Sensitive Claims are handled by a special division within ACC as the information is considered to be 'sensitive'.

What is a mental injury?

The Accident Compensation Act 2001, Section 27 Mental Injury states:
'A mental injury means a clinically significant behavioural, cognitive or physiological dysfunction.'

My injury of PTSD from childhood sexual abuse was counted as a mental injury. My mental health conditions are NOT covered. Also note that autism isn't covered. 

Note that ACC will only cover injuries for events that took part in New Zealand, not overseas. The sexual assault in Australia is determined to be linked to the childhood sexual abuse trauma but is not covered.

Post-traumatic stress disorder (PTSD), which I am diagnosed with, may take years to fully develop. An assessment takes place to determine whether cover can be provided. For sensitive claims, this is typically in the form of counselling.
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How is Mental Injury Assessed

I was assessed by a clinical psychologist who contracts to ACC. She assessed me for around 8 hours (spread out over several weeks). The process is very stressful and triggering, as ACC require details of the trauma. Many claimants pull out during this process, as it's so triggering and can be retraumatising. 

ACC requires this in their reports before they decide whether to approve cover. It took several months, with the psychologist advocating strongly for me, before ACC finally approved cover. This meant paid therapy with the psychologist who assessed my PTSD to be 'severe'. I had the avoidance and shutdown presentation which ACC did not seem to be familiar with, plus ACC wanted to try blame bipolar disorder for my issues.

The psychologist said that most people take 1 to 1.5 years for treatment but because my case is complex (two main sexual assault traumas plus bipolar complicating things), I would need a slower approach. I am nearly at the end of treatment, 4 years later. I am still left with a mental injury but it is more manageable than previously.

Compensation

There are two forms of potential compensation I could potentially access with my mental injury of PTSD. The treatment stage which was pretty straight forward after the stress of the initial assessment and the update reports.

I have been receiving weekly therapy from a clinical psychologist, reducing recently to fortnightly.

Since I am left with permanent impairment despite treatment, I was eligible to be assessed for compensation in the form of weekly payments or a lump sum payment. I choose to pursue this, even though the potential payout is very little. 

This is a completely different process, involving an assessment of of a Whole Person Impairment (WPI). It's a legal process and ACC spent millions each year in court fighting claimants. It's in media how unfair, unjust and corrupt this system is.

I discovered for myself, this is a very biased as well as very stressful and long process over the past 2 years, involving 2 separate assessments by psychiatrists, one in my favour, one against me. The one who went against me assesssed me at threshold for compensation then apportioned half to bipolar disorder to bring me below threshold for a payout. It went all the way to court appeal. I lost the court appeal and the Court ordered name suppression of me. I will outline this process in another blog post, while I am still processing it, before I archive everything. I am eligible to be reassessed.