What's behind the big rise in ACC claims being rejected?

The number of people sent letters suspending their ACC entitlements has quadrupled in the past five years, with one advocate claiming politics is driving the change.Figures released by ACC show the number of letters created in 2021 was 17,310. That number has risen to 68,147 in the first 10 months of 2026.And figures reported by the Post in September found more claims were being denied, up from 2.21 percent in 2023/4 to 2.54 percent in 2025/6, and there had been a near-doubling in the number of ACC decisions being sent for independent review.The number of people declined elective surgery has also jumped significantly over the past two years.Lawyer Warren Forster, a longtime advocate for ACC claimants, says what's missing is genuine rehabilitation."ACC says: 'Well, you're off the books, therefore we don't have to worry about you anymore.' And that's happening at scale," he told Nine to Noon on Monday."This year we're tracking towards 85,000 people being effectively thrown on the scrapheap."Forster said the law had not changed to warrant such a spike in claimants being dropped."I don't even know if there's an official policy, but ACC has changed its behaviour. It's hired a number of clinical advisors that are generally physiotherapists, no disrespecting to them, but they're not looking at incapacity. They're not looking at whether or not the person can medically sustain things."They're looking at causation and they're basically saying, 'You have a sprain or strain. The reason you can't work is a tendon tear, a disc injury or something else, and that's degenerative, and see you later.'He said the scale of the change was "unprecedented" in ACC's history.Part of the issue was ACC case managers getting "pushed from person to person to person" without any long-term rehabilitation plans being made.As for the jump in elective surgeries being declined cover, Forster said it was just a "deliberate decision" by ACC."They say, 'Well, you need surgery to treat XYZ. You don't have cover for XYZ. You've only got cover for a sprain or strain.'"And this will be familiar to thousands of New Zealanders. You've only got cover for a sprain… but the reason you need surgery is something else, and therefore we're going to decline your surgery and decline cover."Warren Forster.RNZ / Ian TelferHe said without any formal change in the law, the changes had to be "politically driven"."[A patient] had an injury 20 years ago to their knee and yes, they have osteoarthritis, but the reason they have osteoarthritis was they injured their knee 10 years ago and ACC covered that."And these are the kind of things that we see every day. And people, because they have such trouble getting through the review process - because those numbers have skyrocketed too - people give up."But not all of the rejections could be related to age, Forster said, because ACC was also declining claims at greater rates to young people. Nor were all patients actually being asked by ACC directly what had happened, "and you have to do that before you can have any confidence that your decision's right."ACC also wasn't tracking what happened to people after they were exited, he said. What data there is, Forster said, suggested many were just relying on their partner's income or getting a benefit, particularly if they had a long-term claim."But ACC says it doesn't know and it's not its problem, and I just think that's not okay."ACC in a statement has said cover and entitlement decisions are assessed on a case-by-case basis. A spokesperson told RNZ that ACC supports more than 2 million injury claims each year and funded treatment, rehabilitation and compensation worth more than $8 billion in 2025-26.During that time, ACC supported around 40,000 elective surgery claims, spending $616 million on elective surgery, and that decisions on surgery requests were made in line with ACC legislation and clinical evidence.