Part 4: Consistency and fairness for claimants with complex needs

4.1
In our 2014 report, we observed that claimants had different service experiences depending on the case management team they were working with and where they were located. There were differences in the extent to which different teams focused on the needs of claimants. This observation was reinforced through interviews with some claimants.

4.2
This inconsistency was most apparent for relatively long-term claimants with complex needs who did not meet the serious injury criteria. We were concerned that these claimants might not always receive the highest practical standard of service or be treated fairly.

4.3
In our 2014 report, we recommended that ACC:

… review the adequacy and appropriateness of its case management services for relatively long-term clients with complex needs who do not meet the serious injury criteria, and improve those services where necessary so that people receive the highest practical standard of service and fairness.

4.4
In this Part, we discuss ACC's response to this recommendation.

Summary of findings

4.5
Claimants with complex needs can now expect a fairer and more consistent service. The new Partnered Recovery team has dedicated resourcing for claimants with complex needs. The NGCM approach promotes more informed engagement and meaningful conversations to better understand and respond to specific needs.

4.6
ACC acknowledges that traditional feedback channels might not always be enough to collect feedback from claimants with complex needs and their whānau. It has taken steps to improve how it understands their perspectives by instituting regular representative forums.

4.7
Listening to claimants with complex needs, and acting on what they say, will do a lot to support perceptions of fairness. We encourage ACC to build on these initiatives and continue to look for new ways for these claimants to provide their views.

Partnered Recovery

4.8
ACC has introduced a new approach and team within NGCM called Partnered Recovery. Partnered Recovery is intended for claimants with complex needs and their whānau to work more closely with an assigned case manager for a higher level of support. These claimants include people who have experienced a life-changing injury or event who need to rebuild their lives, have complex injuries or life circumstances, or are highly vulnerable.

4.9
The scope of Partnered Recovery has been broadened from covering serious injury and sensitive claims to now also include mental injury claims. ACC considers that Partnered Recovery now takes psychological factors into account more deliberately when making decisions about a claimant's management. The design and fit of Partnered Recovery have been informed, in part, by ACC's previous approach to claimants with complex needs (the Complex Claims Initiative).¹⁶

4.10
Partnered Recovery staff receive specialist training to enable them to perform the responsibilities of their role. They can access a broad suite of professional development training and specialist advice, as well as the guidance available under the overall NGCM approach.

4.11
Staff can access guidance to help them identify which new claimants are suitable for Partnered Recovery and to refer existing claimants to Partnered Recovery when their circumstances and needs have changed or have become better understood.

4.12
Partnered Recovery also supports claimants to access other public services or support they might need. Partnered Recovery staff are expected to work closely with other public organisations to ensure that more holistic support is provided. In our view, co-ordination between public organisations is critically important to meeting the needs of these claimants and to delivering public services seamlessly and effectively.

Seeking feedback from claimants with complex needs

4.13
ACC has created Customer Advisory Panels made up of people with expert and practical knowledge of the challenges that claimants with complex needs can face. Participants include relevant advocacy representatives and professional sector specialists (including clinicians). Different types of panels cater to specific demographics or situations. Types of panels include the Sexual Violence Panel, the Serious Injury Panel, and the Older Persons Panel.

4.14
Some claimants with complex needs might not feel comfortable voicing their views openly. ACC understands this concern and has developed the Customer Advisory Panels to complement its other feedback channels.

4.15
The panels can provide feedback to ACC proactively about issues claimants are experiencing. ACC uses that feedback to make improvements to processes.

4.17
ACC also consults with these panels to get insight into how any changes it is considering could affect claimants.

4.18
We encourage ACC to make the feedback and information these panels provide publicly available so that there is transparency on what claimants are experiencing and the issues being raised.

4.19
Seeking feedback from claimants with complex needs will continue to be challenging. We encourage ACC to regularly assess the effectiveness of these panels and continue to look for improved solutions to assist claimants to provide feedback and share their experiences. New solutions will need to be agile and adaptable as peoples' lives and needs change.

Developing staff capability for working with claimants with complex needs

4.20
Developing staff capability to work effectively with claimants with complex needs is critical. Staff might be in highly intense situations with anxious claimants and whānau who feel considerable pressure.

4.21
ACC told us that it recognises the need to support staff who deal with these difficult situations and maintain their well-being. For example, ACC told us about how it has worked closely with the Ministry of Social Development so both organisations could learn from each other in developing best-practice case management.

4.24
ACC told us that this included developing a better understanding of behavioural science, and sharing resources and approaches for supporting staff who work with people with mental health issues.

4.25
It is important that ACC incorporates these lessons into NGCM training programmes and makes them widely available to case managers. This will help build the capability of case managers to deal with potentially challenging situations effectively.

16: The Complex Claims initiative (CCI) was developed and implemented for claimants with complex needs after our 2014 audit. ACC replaced it with Partnered Recovery in 2019. ACC's internal review of CCI found that it had helped ensure that a higher proportion of claimants were getting the right and/or enhanced support, their needs were being better met, and they were getting a better experience than in 2014. However, we did not see that ACC specifically sought the views and perspectives of claimants with experience under CCI to inform that review.