Recovery at Work

Published: 24^th October 2024

Injury assessments are a routine aspect of practice for primary care clinicians. Depending on the nature of the injury and other factors, there may be minimal disruption on a patient’s daily life, including their ability to engage in work. However, in some cases, injuries can have a more significant impact on functional capacity, and consideration must be given towards work capacity and associated decisions around medical certification.

Reintegrating into the workplace is an essential component of the recovery trajectory. Recent evidence suggests many injured patients are being signed off for too long, potentially compromising long-term outcomes. In the same way that medicines must be prescribed at the right dose and for the right duration, so too must time off work.

ACC definitions for medical certification have evolved over time; of the three categories, the criteria for “Fully unfit” has undergone the most significant change. Understanding the distinctions between these categories is essential to facilitate delivery of the recovery at work model, and to guide provision of additional ACC-mediated supports such as financial/social assistance, treatment and vocational rehabilitation services.

A prompt return to, and recovery at, work should be prioritised for most patients with non-complex injuries to improve physical rehabilitation, mental health and to maintain social/vocational connections. A key point for clinicians is to focus on the physical and cognitive capacity of the patient after an injury, and identify what functions they can perform; deciding whether there are suitable work tasks to meet these functional parameters is the responsibility of the patient and their employer, with assistance from ACC if required.

For a full overview of the Recovery at Work programme, read the main article here

A convenient summary is available here

Or browse other available resources (see sidebar); further activities will be added to support this resource over the coming months.

Certificate of Accreditation

A Certificate of Accreditation is available to clinicians authorised to issue ACC45 or ACC18 medical certificates for time off work, following review and completion of resources in the Recovery at Work education module. This certificate is awarded to clinicians who have demonstrated the required level of understanding of the ACC medical certification process.

To check your eligibility and apply for a Recovery at Work Certificate of Accreditation, click below.

Recovery at Work Certificate of Accreditation

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Nicholas Cooper 19 Dec 2024 18:36

Sharyn Willis, Medical Advisor, bpacnz 9 Jan 2025 09:53

Hi Nick, Thank you for your comment regarding medical certification. We approached ACC for their thoughts, and they provided the following response:

“The ACC legislation describes incapacity broadly.

As you correctly note in your comment, the key issue is whether the injury has impacted the person’s ability to do their preinjury role. Good medical certification practices, however, relate to the wider wellbeing of the patient and are not described in the legislation.

Being ‘fit for selected work’ still identifies that there is an incapacity, allowing a patient to access weekly compensation, and vocational rehabilitation. It also provides an opportunity for the patient to stay engaged with the workplace where possible, to enable the best recovery.

The ‘fit for selected work’ designation also provides useful guidance for ACC when considering the patients vocational rehabilitation needs.”

As noted in the full article, short-term absences from work (i.e. “Fully unfit”) immediately post-injury can be important for recovery in many cases. However, extended absences from the workplace can compromise longer-term outcomes without providing substantial ongoing recovery benefits. Being “Fit for selected work” does not mean patients must immediately return to previous levels of work engagement, and clinicians are not expected to decide whether there are actually suitable work tasks available for the patient within their specific workplace. This certification is instead about building a clinical picture of the patient’s physical and cognitive capabilities and restrictions; sometimes there will be no suitable alternative duties or arrangements available that fall within these parameters; ACC support will still be available for these patients even if they are unable to work. A key theme of the Recovery at Work resource is about striking the right balance for the right patient depending on their injury, medical history and vocational/social context.

Nicholas Cooper 9 Jan 2025 12:02

Viv Roberts 21 Feb 2025 17:39

I agree with Nick here. I understand and applaud ACC's drive to have people stay at work, however there are a multitude of factors to understand here. 
I have been engaging with ACC in various forms for over 40 years, and sadly the current version of ACC is completely out of touch with the initial intent, and VASTLY inferior for that. 
The 3 biggest barriers that I see to people getting back to work early / staying engaged with work are 
1) Difficulty accessing primary care - mainly because of the disasterously poor funding for primary care (GPs and physios). The people most likely to have a prolonged time off work are usually younger men in physical low pain work, who truely can't afford the $20 or so fee to come in. Also the poor funding means that there are simply less GPs and physio's willing to engage in working in NZ.  The very small investment in fully funding the first visit to the GP and physio would save significant amounts later. 
2)  There is difficulty for some accessing OT assessment with them and the employer. This delays the return to work process
3) Many employers now find ACC SOOOOO difficult to work with that they actively discourage their workers from making an ACC claim. 
All 3 of these very much emanate from ACC. 
Viv Roberts FRNZCGP

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