B-QuiCK: Recovery at Work - a guide to ACC work certifications
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.
Practice point: In keeping with the principles of rational medicine use, if time off work is required following injury, “prescribe” it at an appropriate dose, frequency and duration. Just as prescribing too much medicine can lead to harm, prescribing too much time off work can detrimentally affect a patient’s vocational outcomes, without providing any added benefit to their physical recovery.
The three ACC medical certification categories
| Definition
| What this means for the patient
|
Fully fit |
The patient can functionally perform their full pre-injury work duties and hours |
- Can receive appropriate ACC-funded rehabilitation support
|
Fit for selected work |
The patient is able to engage in active rehabilitation and some level of work with support. This can be facilitated through:
- Amended duties
- Workplace adaptations
- Altered hours
- A phased return to work
N.B. Clinicians are not expected to decide if there are suitable work tasks available within the patient's workplace; that is for the employer and employee to decide with the help of ACC and vocational rehabilitation service providers (if required).
|
- After the first week post-injury, can receive up to 100% of pre-injury income through a combination of ACC compensation and work-related income (depending on hours worked); if no alternative duties or arrangements can be made, patients still receive 80% of pre-injury income via ACC
- Maintain professional/social connections, retain current skills or develop new ones
- Make the most of their recovery and access the full range of ACC-mediated rehabilitation supports available. Being certified as “Fully unfit” (see below) can limit engagement with certain aspects of rehabilitation support, potentially delaying the overall recovery process.
|
Fully unfit |
The patient should meet one of the following limited criteria:
- Total inability to work due to being admitted to hospital or confined to bed. This is not the same as general “bed rest”.
- Contagion risk or quarantine need due to their injury or work environment
- Health and safety risk. The patient being in the workplace, even with assistance or modifications, poses a specific health and safety hazard to themselves or others (e.g. due to the impact of the injury or the effects of medicines being taken). N.B. This criterion does not apply if there are potential alternative tasks that could be done safely.
|
- Eligible for ACC compensation after the first week post-injury, but income capped at 80% of pre-injury earnings
- Can receive ACC-funding for general treatment to assist in their recovery but there may be some aspects of rehabilitation support that the patient cannot engage with
|
Practice point: Framing medical certification as a “fit note” rather than a “sick note” can shift patient perception and help establish positive recovery expectations, i.e. changing the “default setting” from considering what the patient cannot do to what they can do.
An overview of information relating to (A) the medical certification process in primary care and (B) employee payments if ACC compensation is applicable
* Further information on the types of injuries covered by ACC is available at: www.acc.co.nz/im-injured/what-we-cover/injuries-we-cover. ACC usually only covers injuries caused by a specific identifiable event, not long-term gradual processes. However, ACC can cover injuries and conditions caused by long-term work-related harmful exposures or processes.
† Clinicians are not expected to know whether there are alternative duties or arrangements available in the patient’s workplace; this assessment involves determining whether there are any types of physical or cognitive tasks the patient could potentially undertake without compromising recovery.
** ACC can provide injured employees compensation up to 80% of pre-injury weekly income. If the employee can complete some work, they can top up their weekly income to a maximum of 100% of pre-injury earnings (depending on the hours completed); ACC does not reduce (abate) the first 20% of earnings paid by the employer. ACC will abate weekly compensation payments based on additional income received from the employer beyond the first 20%, i.e. if the employer pays 40% pre-injury income, ACC will pay the remaining 60%.
‡ In rare cases, longer durations between reviews may be appropriate (e.g. 6- or 12-monthly intervals) for patients with stable serious injuries. However, this is subject to strict criteria and usually only applicable much later in the recovery timeline. For further information, see: www.acc.co.nz/for-providers/treatment-recovery/issuing-medical-certificates
Tips for completing and submitting ACC injury forms
- Cause – Ensure there is sufficient information to establish a causal link between an accident event and the injury when completing the ACC45 form
- Read Codes – Use a Read Code that represents the physical injury (not the symptoms or cause) and avoid using non-specific Read Codes. If there is uncertainty regarding a Read Code for a diagnosis, select the closest match or use the code “Z”, and clarify the injury further in the comments field or by using the dropdown boxes available.
- Certificate duration – Regular follow up is needed for patients who are certified as being “Fully unfit” and “Fit for selected work” to support recovery; avoid excessive periods of “Fully unfit” wherever possible. Consider predictors of a prolonged return to work when tailoring the duration of medical certification and follow up, e.g. severe injuries, unclear diagnosis, negative recovery expectations, multiple pre-existing co-morbidities, adverse pre-injury work conditions.
- Additional ACC support – Support provided in primary care, along with physiotherapy referral (if needed), will often be sufficient to enable successful recovery and return to work. However, ACC can provide a range of additional support(s) for patients following injury if they do not have straightforward vocational or physical circumstances, e.g. return to work/vocational support, financial compensation, travel costs, childcare, personal care, equipment provision and home modifications and additional treatments, e.g. surgery. In some cases, additional support can also be provided for people who meet the criteria of a mental injury related to their claim.
Patients can request support independently at any stage following ACC45 approval by using MyACC, by completing an ACC1 form or by contacting a Recovery Team member.
Clinicians can specify the type of treatment or support that would meet the patient’s needs on the ACC18 form, or request that ACC contacts the clinician directly. Clinicians can also receive direct ACC assistance by calling the Provider Helpline at 0800 222 070 or by emailing providerhelp@acc.co.nz.
Tips for interacting with injured patients
- Maintain a positive, optimistic and non-judgemental attitude towards the patient, regardless of the expected diagnosis or claim outcome
- Reinforce positive recovery expectations and address fears around re-injury
- Use clear, direct language and simple explanations
- Correct misinformation or misunderstandings that impede recovery
For example: explain to patients they do not need to be “Fully unfit” to receive ACC financial compensation; prioritising an early return to work is often best to limit the impact of physical inactivity/deconditioning, to improve mental health and maintain social/vocational connections
- Involve the patient in finding solutions to perceived barriers
- Be conscious of differences between patients (e.g. needs, priorities, what work means within the context of their culture); address any biases that may potentially impact patient outcomes
Additional resources:
