• The majority of this information has been extracted from the Fire Service Intranet

Shortcut direct to: Accident compensation / Leave Entitlements

The New Zealand Fire Service is an Accredited Employer under the ACC Partnership Programme, since 1 October 2000.

Since this time the Fire Service has taken direct responsibility for the management of all work-related injuries, including the rehabilitation of and costs relating to those injuries.

In all accepted cases the Fire Service has the responsibility of providing services and paying entitlements that are, at a minimum, equal to those that would have been provided by ACC in similar circumstances. To do this the Fire Service has developed an in-house team to deliver claim and case management.

Please contact any member of this team if you have any questions or concerns about the claims process. You can also contact the claims management unit via the 0800 - Fire Injury (0800 347 346) number.

What to do if you are injured at work

1. Seek prompt medical attention/advice as soon as is practical, and ensure that an ACC injury Claim Form (ACC 45) is completed by the appropriate registered health professional ( eg doctor, physiotherapist, osteopath, chiropractor). Please note: Only a doctor can certify you unfit for work

2. Complete an FSC432 work injury form as soon as practicable after the incident. This is then forwarded to the claims management unit at the time of completion. This may be done by another employee if you are unable to do this due to your injury. Please note: The 432 is evidence that your injury occurred during the course of your work. A claim can only be accepted for cover as work related if there is evidence supporting this.

3. Advise your manager / CFO immediately (by phone if necessary) if time off work is required and then provide them with the employer's copy of the ACC Injury Claim Form (ACC45).

4. If further time off work is required due to injury beyond the time frame initially indicated on the ACC 45, ongoing medical certificates (ARC 18's) must be provided for the remainder of the period of incapacity. The originals must be sent to the claims management team. These will only be accepted from registered medical practitioners, and must clearly state injury diagnosis, period of incapacity and fitness for work.

5. Show your treatment provider your wallet card, which advises them that NZFS is an Accredited Employer and gives details of where to send invoices. Please note: NZFS will allow you up to 8 treatments with the ACC registered treatment provider of your choice, without prior approval. If you need treatment beyond this the treatment provider must contact the claims management unit to request further approval.

6. Complete a claim form and send to the claims management unit for claiming any additional entitlement.

What happens next?

On receipt of a claim the claims management unit will

1. Register the claim on the day it is received

2. Request the FSC 432, if this has not already been received

3. Make a claims decisions in accordance with the legislation

4. Advise you of the claim decision in writing within 21 days of receiving it, and provide an entitlement fact sheet, which outlines assistance you may be entitled to, to assist recovery from your injury.

5. If your claim is declined by the claims management unit, the reason for this will be discussed with and you will be advised of review rights.

6. If you have longer than 2 working days off as a result of your injury, you will be contacted by the rehabilitation coordinator who will explain the entitlements that you may be eligible for if your injury is accepted as work related, and to carry out an initial needs assessment at that time to ensure early and appropriate assistance is provided.

If you have longer than 7 days off as a result of your injury you may be then required to participate in a rehabilitation programme, which may include return to work on alternate duties where appropriate.

The following is a list and brief description of entitlements that you may qualify for as a result of your injury, to assist your recovery. If you wish to apply for any of these entitlements you will need to apply in writing by completing a claim form which can be obtained by contacting the Claims Management Unit, PO Box 2133, Wellington. Additional information and a copy of the claim form are also available on K-Net, under Health & Safety - ACC Information.

Medical Treatment

If your claim has been accepted as work related, the Fire Service Claims Management Unit will pay for 100% of the qualifying medical bills. These can be paid either by your medical provider claiming directly off NZFS, or you can pay the account yourself and claim reimbursement for your expenses using a Medical Expenses Claim Form.

Some types of treatment will require prior approval before the treatment is sought.

This includes:

• Extension of physiotherapy/chiropractor/ acupuncture/osteopath treatments beyond the first 8 visits
• Non-acute dental treatment
• Private hospital treatment - note in all circumstances, prior approval is required before surgery is performed.
• Counseling costs

Return to work

The NZ Fire Service will help you to remain at work or return to work as soon as possible. An early return to work, even in a limited way, can help you recover faster and more fully. If you are off work for longer than 7 days due to your work related injury the NZFS National Rehabilitation Coordinator will contact you to discuss your needs and to facilitate your return to work, where possible. Your doctor / treatment provider and manager will be included in this process, you are also welcome to involve a support person.

Weekly Compensation

Weekly compensation is payable where you have had time off work as a result of your injury lasting for longer than seven days. The weekly compensation rate is calculated based on 80% of your gross weekly earnings (including overtime) prior to your first day off work, calculated as follows:

• For the first four weeks you are off (not including the first seven days), your income for the four weeks prior to incapacity is divided by four and 80% of that figure is paid. The minimum payment made is 100% of your base rate.
• For any time after those four weeks, your earnings for the 52 weeks prior is divided by 52 and 80% of that figure is paid.
• You are able to earn 100% of your pre-accident earnings if you are back at work doing alternative duties.

Assessment of weekly compensation entitlement will not be made for any periods not covered by a medical certificate. Medical certificates need to be consecutive by date - not just cover 'actual' watch days.

Weekly Compensation / Leave Entitlements for Non-Work Accidents

• During the first week (either 5 or 7 day) sick leave at 100% of base rate is granted.
• From the 2nd to 5th weeks, payment (Earnings Related Compensation) is the greater of: 100% of base pay, or 80% of average earnings during the 4 weeks prior to incapacity.
• For absences of more than 5 weeks, ERC is the greater of : 100% of base pay, or 80% of average earnings during the 52 weeks prior to incapacity.
• Entitlement increases to 100% of average pre-accident earnings for periods where alternative or light duties are performed.
• From the 2nd week of absence, sick leave shall be debited if base pay exceeds the average earnings rate prior to incapacity. Sick Leave entitlement will be debited by the proportion by which base pay exceeds the average earnings rate

Lump Sum Payment

For injuries occurring after April 1 2002, you may be entitled to a lump sum payment if you have suffered a permanent impairment resulting from your injury/ies. To be assessed, you will need to ask your General Practitioner to provide certification confirming that your injury has stabilised, and that it is likely that permanent impairment has resulted.

Once an application has been received in writing for a Lump Sum Payment, you will be contacted and assessed by an independent and trained assessor. To qualify for payment your total body disability must be assessed at 10% or more.

If your injury occurred before 1 April 2002 an Independence Allowance may be paid instead of Lump Sum. Similar rules to lump sum applications apply.

Social Rehabilitation

Social rehabilitation aids to restore your independence after you sustain an injury. Social rehabilitation in most cases is looked at as short-term assistance to yourself and your family while you are recovering from your injuries.

Types of Social rehabilitation include:

• Home Help
• Childcare
• Attendant Care
• Aids and appliances
• Housing modifications
• Motor vehicle purchase or modification
• Educational training for independent living

Vocational Rehabilitation

Vocational rehabilitation support will be provided to you to enable you to return to work to the extent that your injury allows. If you are in receipt of weekly compensation entitlements, you are required to participate in an agreed rehabilitation programme.

Pharmaceuticals

100% of the cost of pharmaceuticals may be reimbursed for those prescribed by a treatment provider who has the authority to do so and where the pharmaceuticals prescribed are clearly required as a result of your injury. An original receipt will be required to claim reimbursement (eftpos receipts alone will not be accepted). The pharmacist cannot bill us directly.

Transport to Medical Attention / Accommodation

You will be entitled to receive some reimbursement for the above entitlements where it can be demonstrated that the costs are reasonably required as an ancillary service to treatment.

We can contribute to your travel costs (by reimbursing travel costs at public transport rates or at a rate of 28 cents per km) if:

• You travel more than 20km (one way trip) to your nearest place of rehabilitation within 2 weeks of your injury, or
• You travel more than 80kms in 1 calendar month, and/or
• The amount we can reimburse is $45 or more in any calendar month.
• Claim for transport to treatment must be made on the appropriate form which is available from the Claims Management team.
• Actual and reasonable costs of accommodation may be considered where it can clearly be demonstrated to be required for treatment of your injury.

Complaints

The claims management unit may receive complaint from a number of sources with regard to the way we may have handled claims or provided services.

These may include for example

• The manner in which a claim has been handled,
• Complaints from a provider,
• Complaints over non-payment of entitlements

Complaints may be received verbally or in writing. When this occurs.

1. All complaints will be responded to with respect and in a timely manner
2. All complaints will be forwarded to National Manager Injury and Rehabilitation for attention
3. Telephone contact will be established within 24 hours , where possible, to discuss concerns
4. All complaints will be investigated taking all relevant information in to account.
5. Further evidence/ information may be requested when investigating a complaint
6. All complaints will be responded to in writing outlining the outcome of any investigation.
7. Where it has been identified that the claims management unit has been at fault measures will be put in place to address the issue.
8. If the issue cannot be resolved by the claims management unit the injured employee has the right to take the complaint to the ACC complaints investigator.
9. Making a complaint does not affect the complainant's right to review any decision affecting entitlement.

Review

An employee has a right to dispute any decision on a claim that effects cover or entitlement for which they have received a formal decision in writing. These can include disputes over:

• Whether an accident is work related or not
• Whether a claim has cover in terms of the legislation
• The amount of weekly compensation or other entitlements being paid

1. In the first instance, where an employee disagrees with a decision made, they will be invited to "lodge" a review of a decision by way of advice in writing with reasons as to why they feel the incorrect decision has been made.
2. When a request for a review has been received, the National Manager, Injury and Rehabilitation will conduct an administrative review of the basis of the decision, or recheck the calculations where it involves entitlements, and advise the employee of the outcome.
3. If at this point the decision has not been overturned, the National Manager will contact the employee and explain the basis for the decision once more, including how the decision relates to the requirements of the Injury Prevention Rehabilitation and Compensation Act 2001. The employee will also be advised of their right to seek a review of the decision if they still do not agree with it.
4. If the employee still disagrees with a decision, the employee will have the right to ask that an independent internal reviewer conduct a review of the decision.
5. The Internal reviewer or "disputes officer" will in most circumstances be the Internal Audit Manager. The employee will also be invited to have an employee representative involved in the process. The review team will be required to look at the decision in line with the legislative requirements.
6. The employee will be notified in writing of the outcome of the review. If the decision is still unfavourable, the employee at that point will have the right to ask that an independent external review be made of the decision. An application can be made to the Claims Management Unit for a review hearing.

Note: Only decisions based on the application of ACC legislation can be taken to an Review. If the dispute relates to contractual interpretation, the disputes procedure of the contract which currently apply will be utilised.

If an employee is unhappy with a decision the Fire Service has made in respect to their claim and it has not been resolved internally, then they have the right to apply for an independent review There is a three month time limit for lodging a review.

How to lodge a review.

The employee must apply within three months of the date of the decision they do not agree with. Late applications will only be considered under exceptional circumstances!

Applications for a review must be received in writing on a form provided by the claims management unit... You need to send your completed application to:

National Manager, Injury and Rehabilitation
NZ Fire Service
P.O. Box 2133
WELLINGTON

Once the application has been received, the national manager will send the application to Dispute Resolution Services, an independent reviewer who they have formally appointed. The reviewer's role is to review all of the information. The employee will be asked to attend a review hearing at which point they will have an opportunity to further express their concerns.

If the employee is still unhappy with the outcome of the review hearing, they will be able to appeal against the decision in the District Court.

For further information on the Review process, employees should contact the Claims management Unit on 0800 347 346.

During the 12 months June 2001 and July 2002, career firefighters of the New Zealand Fire Service injured themselves 562 times. Based on international trends, the majority of these injuries should have occurred while attending some of the 60,000 odd emergency incidents that occurred during this period. What was not known is where the injuries actually took place, what type of injuries they were and did they in fact follow international trends of firefighter injuries.

Despite the compounding reasons why research into this field should be undertaken, research internationally has been undertaken, but within the New Zealand Fire Service, it has been non-existent.

To effectively and actively want to reduce injuries to firefighters, significant research had to be undertaken into firefighter injuries. Evidence of research into the injuries does not exist on a significant level to make the reductions currently required achievable or sustainable...

• Read More...
  New Zealand Firefighters Injured on the job or at the station
  by Dan Coward

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