Claim expenditure

Description
This indicator shows the cost of ACC claims due to a fall. This is a complementary measure to show impact when viewed alongside outcome data. For ACC, it is also a measure of benefit and contribution to sustaining the wider ACC scheme.
Notes about this measure set
Sub-analysis available using the following filters:
  • Te Whatu Ora district
  • ethnicity (Māori, Pacific, Asian and Other [including unknown]).
Numerator
The cost (excluding GST) of accepted and active ACC claims due to a fall.
Denominator
Resident population, Stats NZ population projections.
Denominator detail
Costs of accepted ACC45 form claims, where the cause was any of the following:
  • slipping, skidding on foot
  • tripping or stumbling
  • loss of consciousness/sleep
  • something giving way underfoot
  • misjudgement of support
  • loss of balance/personal control
This includes the cost to ACC of all treatment and entitlements incurred for that claim, except for acute care at public hospitals (see exclusions).
Costs are separated into the following groups:

Entitlement claims
Claims that cover moderate to serious injuries require entitlement beyond medical treatment only. Examples of these payments include compensation for loss of earnings, allowances for attendant care and childcare, provision of wheelchairs and other equipment and modifications to homes and vehicles. Claims are recorded as an entitlement claim if they have previously received an entitlement at any point in the lifetime of the claim. They did not necessarily receive an entitlement during the corresponding period. The figures are subject to change as some claims that have not received an entitlement to date may do so in the future.

Medical fees-only claims
Where ACC has made payments to cover medical treatment costs such as those provided by a general practitioner, physiotherapist or dentist in the period but the client has not received entitlements or other payments in the period. These claims may be counted as entitlement claims in future periods if an entitlement is received after medical fees.

Other claims
Claims that have received payments from the category Other (such as death benefits, independence allowances, lump sums or miscellaneous expenses) or both Medical fees-only and Other payments.

Denominator exclusions
The cost of emergency and acute care treatment at public hospitals is not included, as this is bulk-funded. As a result, the costs of treatment are not allocated to individual claims.

Falls that did not result in an ACC claim being made or accepted.