Auditor-General's overview

Accident Compensation Corporation: Using a case management approach to rehabilitation.

At some time in their lives, many New Zealanders will seek help from the Accident Compensation Corporation (ACC) to restore their health, independence, and participation in the community after an injury.

ACC uses a case management approach to help it to assess a person's treatment and rehabilitation needs after an injury and to help it plan and provide for those needs.

The theme for my Office's 2013/14 work programme is Service delivery. As part of that theme, my staff audited cases that were managed in ACC's local offices. We looked at those claims (which add up to about 4% of ACC's 1.7 million claims each year) because they can involve the most expensive injuries and injuries that have a substantial permanent effect on people's lives (for example, traumatic brain or spinal injuries). More than 40,000 New Zealanders have one of these claims at any point in time.

As part of rehabilitating people, ACC is expected to work with them to ensure that they "receive the highest practicable standard of service and fairness". The Code of ACC Claimants' Rights sets out what is expected of ACC.

As well as being fair to people with injuries, ACC has to be fair to the people who pay levies and tax that support ACC. It can be a difficult balance, and ACC has to carry out its functions in a way that is cost-effective and efficient. ACC continues to face the challenge of being fair to levy payers, taxpayers, and people who have been injured.

ACC needs to make changes to its case management systems and processes. It is committed to making these changes.

A person's rehabilitation depends on the knowledge a case manager has and the decisions that they make supported by ACC's systems and information. ACC needs to set out the standard possible treatment and rehabilitation steps for a given injury, based on scientific evidence, in its information systems – to ensure that all people in similar circumstances receive consistent and effective treatment and rehabilitation. To perform well, staff need to have good systems, knowledge, information, advice, and guidance.

ACC has an internal quality review and coaching tool. It needs to use this tool better – or an equivalent – to understand whether it provides the highest practicable standard of service and fairness.

In particular, ACC needs to review how adequate and appropriate its case management services are for relatively long-term clients with complex needs who do not meet the serious injury criteria.

ACC could more actively manage the transfer of clients between it and other public entities to reduce the potential for people to miss out on services they are entitled to and to ensure that people are appropriately prepared for transfer to another public entity.

ACC needs to learn better from the complaints that it receives. We looked at this matter in our recent report Accident Compensation Corporation: How it deals with complaints.

Although ACC needs to make more changes to its case management systems and processes, it has already started improving how it deals with people.

ACC has appointed a Chief Customer Officer (responsible for continuously improving ACC customers' experiences of ACC) to its Executive Team and has partnered with the Auckland University of Technology to offer specialist training in case management.

ACC is improving its extensive collection of forms, letters, and information sheets. These are its main means of communicating with people. ACC has a range of projects that are meant to support services that focus more on customers.

ACC accepts our audit findings and intends to address our recommendations as part of its Shaping Our Future initiative. I thank ACC for this commitment.

I thank those members of the public who shared their stories and views about ACC with my Office. I acknowledge that, for some of the people we spoke with, sharing those stories was not easy because of their complexity, sensitivity, and history.

In some instances, people had negative experiences of ACC. It is not my Office's role to resolve individual people's problems with ACC. However, we can look at how effectively and efficiently ACC's case management approach works for people collectively, with a view to highlighting where improvements can be made.

I appreciate and acknowledge the help of Colmar Brunton with the interview work that contributed to this report, the Ministry of Social Development for seconding a senior staff member to our audit team, and the ACC staff who gave generously of their time and views.

Signature - LP

Lyn Provost
Controller and Auditor-General

28 October 2014

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