Business Insurance Guide

ACC Cover Gaps – What NZ Businesses Need to Know

ACC provides essential workplace injury cover, but it doesn't protect everything. Learn about the gaps and how to safeguard your business.

Understanding ACC in New Zealand

The Accident Compensation Corporation (ACC) is a unique no-fault accident compensation scheme that covers everyone in New Zealand, including employees and self-employed persons. Established under the Accident Insurance Act 1998, it provides cover for injuries resulting from accidents.

For employers, paying ACC levies is mandatory if you have employees. These levies are based on your industry risk level and are typically paid quarterly. This system means you can't sue employees for compensatory damages if they're injured at work – ACC covers their treatment and rehabilitation instead.

Key Point

ACC is designed to cover immediate injury-related costs, but it has significant limitations that could leave your business exposed to substantial financial risk.

ACC at a Glance

  • No-fault cover – claims don't require proving negligence
  • Employer levies – mandatory based on industry risk
  • Covers work injuries – and some non-work injuries
  • Self-employed can opt in – voluntary coverage available

What ACC Actually Covers

Understanding what's included helps you identify where coverage gaps might exist.

Medical Costs

ACC covers reasonable medical costs related to your injury, including:

  • • Doctor visits and consultations
  • • Hospital treatment and surgery
  • • Physiotherapy and rehabilitation
  • • Prescribed medications
  • • Mental health treatment (work-related)

Income Support

If you're unable to work due to a covered injury, ACC provides:

  • • Weekly compensation (up to 80% of earnings)
  • • Independence rehabilitation payments
  • • Help returning to work
  • • Training and vocational support
  • • Lump sum payments for permanent disability

Other Covered Benefits

Additional support ACC provides includes:

  • • Travel costs to appointments
  • • Childcare assistance
  • • Home and vehicle modifications
  • • Funeral costs (if fatal injury)
  • • Survivor benefits for dependents

ACC Coverage Amounts

Weekly Compensation

Up to 80% of your pre-injury weekly earnings, subject to ACC's assessment and maximum rates.

Lump Sum Payments

For permanent impairments, lump sums range from $1,140 to a maximum of $138,938 (as of 2024), depending on severity.

ACC Limitations & Gaps

ACC provides essential cover, but significant gaps exist that could leave your business exposed.

What's NOT Covered by ACC

Mental Stress & Psychological Injuries

ACC generally does not cover mental stress, burnout, anxiety, or depression unless directly resulting from a specific work-related traumatic event. Employment-related stress claims are typically excluded.

Disease & Illness

Occupational diseases (like asbestosis or industrial deafness) have limited cover. Most ordinary illnesses like cancer, heart disease, or repetitive strain injuries are not covered unless directly caused by a specific accident.

Pain & Suffering

Unlike many overseas systems, ACC does not provide compensation for pain and suffering, emotional distress, or loss of enjoyment of life – regardless of how serious the injury.

Gradual Process Injuries

Injuries that develop over time (like tennis elbow or carpal tunnel) have limited coverage. ACC must be satisfied the injury was caused by a specific accident, not gradual wear and tear.

Business Owner Vulnerabilities

Self-Employed Not Automatically Covered

If you're self-employed, ACC cover is not automatic. You must actively opt into the scheme, and many sole traders don't realise they're not covered.

Limited Earnings Replacement

ACC only covers up to 80% of pre-injury earnings, and there are maximum weekly limits. High-earning employees and business owners may find the gap significant.

No Legal Defence Costs

If an employee disputes an ACC decision or brings a claim against your business, ACC doesn't cover your legal defence costs.

No Cover for Contractors in Some Cases

Independent contractors may not be covered under your ACC levy. They need their own ACC cover or may fall into a grey area of coverage.

The Real Cost of ACC Gaps

When ACC doesn't cover a claim, your business can be held directly liable. These claims can result in:

  • • Significant out-of-pocket expenses
  • • Legal defence costs
  • • Compensation payments
  • • Damaged employee relations
  • • Potential business closure in extreme cases

Additional Covers to Consider

Protect your business from the gaps in ACC coverage with these essential insurance products.

Employer's Liability

Covers claims not covered by ACC, including mental stress, employment disputes, and pain & suffering.

Essential for: All employers

Workers' Compensation Top-Up

Provides additional income replacement for employees when ACC payments don't cover their full wages.

Recommended for: Businesses with well-paid staff

Income Protection

Provides long-term income replacement for business owners and key personnel if they cannot work due to illness.

Important for: Sole traders, key personnel

Personal Accident

Lump sum payments for accidental injury, regardless of ACC coverage. Can include death benefit and disablement.

Recommended for: All employees

Key Person Insurance

Protects your business if a key employee or owner becomes seriously ill or dies, covering lost revenue and recruitment costs.

Essential for: Small businesses, partnerships

Group Life & Health

Comprehensive life and health insurance for employees, helping attract and retain talent while filling ACC gaps.

Valued by: Employees at all levels

Comparing ACC vs Additional Covers

Type of Claim ACC Employer's Liability Personal Accident
Workplace injury (accident) Yes - Yes
Mental stress / psychological Limited Yes Yes
Disease / illness Rarely Yes Yes
Pain & suffering No Yes -
Death benefit Limited Yes Yes

Real-World Case Examples

These scenarios show how ACC gaps can impact New Zealand businesses.

1

The Stress Claim Nightmare

A Wellington marketing agency faced a $45,000 claim when an employee claimed constructive dismissal due to workplace stress. ACC refused cover as it wasn't a specific workplace accident. The employer's liability insurance covered the legal defence and settlement.

Scenario

Employee mental stress claim

ACC Response

Cover declined

Solution

Employer's Liability covered

2

The Sole Trader Gap

A self-employed electrician fell from a ladder while on a job. He discovered he'd never opted into ACC cover. Medical bills and lost income cost him over $30,000. Personal accident insurance would have provided crucial support.

Scenario

Self-employed injury

ACC Response

No cover (not opted in)

Solution

Personal Accident would help

3

The Pain & Suffering Gap

An Auckland factory worker suffered a back injury that limited their life permanently. While ACC provided weekly compensation, the worker's family sought additional compensation for pain and suffering – which ACC doesn't cover. They attempted to sue the employer, highlighting the need for proper liability protection.

Scenario

Permanent injury claim

ACC Response

Basic cover only

Solution

Employer's Liability protects

Summary: ACC Cover Gaps

ACC Does Cover

  • Workplace accidents and injuries
  • Medical costs related to injuries
  • Weekly compensation (up to 80%)
  • Rehabilitation and return to work support

ACC Does NOT Cover

  • Mental stress claims (generally)
  • Pain and suffering compensation
  • Most diseases and illnesses
  • Self-employed (unless opted in)

Protect Your Business Today

Don't let ACC cover gaps leave your business exposed. Our expert brokers can help you understand your risks and find the right additional coverage.

No obligation. No pressure. Just expert advice tailored to your business.