Written by · Reviewed by Smiths Insurance & KiwiSaver — licensed Financial Advice Provider (FSP712931) · Last updated 2026-08-19

ACC Claim Declined: The Review Odds, and What Actually Comes Next

ACC changed the way it counts a review this year, and the effect is large. Under the measure published in its 2025 Annual Report, the "proportion of ACC reviews upheld (in favour of ACC)" for 2024/25 was 94.7% (ACC Annual Report 2025, Table 17, retrieved 19 August 2026). Under the restated methodology published a year later, the same year reads 68.3% (ACC Service Agreement 2026/27, Table 8, retrieved 19 August 2026).

The reviews did not change. The counting rule did. ACC states it plainly: the new method "includes review outcomes only where they were withdrawn or settled pre-formal hearing, or dismissed at a formal hearing. Decisions overturned pre-formal hearing are no longer included as upheld", and "prior results for this measure have been restated to reflect the new methodology". Decisions ACC reversed before anyone reached a hearing used to count as upheld in ACC's own favour. They no longer do.

For anyone holding a decline letter, that 26.4 point difference is the most useful fact on this page. A meaningful share of review applications produce a changed decision before anyone reaches a hearing.

A letter on a kitchen table beside a calendar with several deadlines ringed

What are the odds on an ACC review?

0%25%50%75%100%26.4 points apart, same year90.3%91.9%93.7%94.7%68.3%72.9%2021/222022/232023/242024/25Mar 2026As first reportedAs restated by ACC for 2026/27Proportion of reviews upheld in favour of ACCACC reporting period

Original series from Table 17 of the ACC Annual Report 2025; restated figures from Table 8 of the ACC Service Agreement 2026/27 (both retrieved 19 August 2026). ACC has not published a restated series before 2024/25.

Measure 2021/22 2022/23 2023/24 2024/25 Mar 2026
Reviews upheld in favour of ACC, as first reported 90.3% 91.9% 93.7% 94.7% Not published
Reviews upheld in favour of ACC, as restated Not published Not published Not published 68.3% 72.9%
Reviews as a percentage of decline decisions 7.9% 7.6% 7.5% 8.9% Not published
Average time to resolution for claims with a review 131.5 days 127.3 days 120.7 days 108.6 days 121.0 days

ACC's 2026/27 targets are above 70.0% for the restated measure and under 130 days for time to resolution.

ACC's definition of the restated measure decides what "upheld" means: "the proportion of all review outcomes, where the decision was in favour of ACC at a hearing or was withdrawn or settled before a review hearing. It excludes reviews found in favour of the client at a review hearing or overturned before a review hearing." Read that alongside section 148(3), which contemplates ACC revising its decision in the applicant's favour before a review is heard. Under the old measure that counted for ACC. Under the new one it does not.

How many claims does ACC decline?

ACC publishes the count. "We made 45,348 decline decisions in 2024", and "we accepted 99% of new claims 2025", on 2,103,485 new claims accepted (ACC, injury claim statistics, retrieved 19 August 2026). Those statements cover different calendar years, so they cannot be divided into a decline rate, and ACC does not publish one.

Set that against the review measure. If 8.9% of decline decisions were reviewed in 2024/25, roughly nine in ten declines are simply accepted by the person who received them.

Two other figures from that page are useful before you assume a slow process. Complicated claims made up 2.5% of new claims in 2025, and "on average, a complicated claim cover decision takes 39 days".

Two cautions on the original 94.7%. It sat in ACC's table of appropriation measures, which relate to outputs the Minister purchases in respect of non-earners, and it carried no published definition. The restated figure is described by ACC as a Scheme-level measure, so the two numbers differ in stated scope as well as in method. Either way, 94.7% should not be repeated as a win rate.

Why ACC declines claims

Most declines are definitional rather than evidential. The Act draws hard lines around what a personal injury is, and a claim outside them cannot be accepted however genuine the condition.

The gate What the Act says
It has to be an accident An accident is "a specific event or a series of events, other than a gradual process" involving an external force, a sudden movement to avoid one, or a twisting movement (s25(1)(a))
Gradual process, disease and infection are out Personal injury "does not include personal injury caused wholly or substantially by a gradual process, disease, or infection" unless it fits a listed work-related category (s26(2))
Ageing is out Personal injury does not include injury "caused wholly or substantially by the ageing process" (s26(4)(a))
Heart and stroke events are out, with exceptions Personal injury does not include a cardiovascular or cerebrovascular episode unless it falls within the specific work-related categories (s26(3))
Work-related gradual process has an extra test Even where the work circumstances are established, ACC may decline if "the risk of suffering the personal injury is not significantly greater for persons who perform the employment task than it is for persons who do not" (s30(2A))

Statutory text retrieved 19 August 2026. What else sits outside the scheme is in our guide to what ACC does not cover.

The last row is the one that catches people. A person with a work-caused gradual-process injury can satisfy every limb of section 30(2) and still be declined, because ACC has a separate power to decline where the occupational risk is not significantly elevated. That is a decision about epidemiology, not about your back.

ACC does not publish the number of claims it declines, or a decline rate, in its Annual Report. We looked, and we are not going to estimate one.

The deadlines, and the one that works in your favour

Two clocks matter and they run in opposite directions.

The first is ACC's. On an uncomplicated cover claim ACC must decide or extend within 21 days of lodgement, and an extended decision must be made within four months (s56). Complicated claims, including work-related gradual process and mental injury claims, run under section 57 with an outer limit of nine months. If ACC misses the applicable limit the consequence is stated plainly: "the claimant is to be regarded as having a decision by the Corporation that he or she has cover" (s58, retrieved 19 August 2026). Cover by default, dated to the day the limit expired.

The second is yours. A review application must be made within three months of the decision being notified (s135(2)(f)). A claimant can also seek review of "any delay in processing the claim for entitlement that the claimant believes is an unreasonable delay" (s134(1), retrieved 19 August 2026), a route many people do not know exists.

Your window to applyHearing date must be setDecisionAppeal windowACC's reported average resolution, 108.6 days0306090120150180210240The statutory review clock, from the date of ACC's decisionDays since ACC notified its decision

Statutory periods are expressed in months and 28-day steps, plotted here at 30.4 days a month, so the day numbers are a proxy rather than a calendar calculation. The average resolution figure is from Table 17 of ACC's Annual Report 2025.

Step The limit Source
Apply for a review Within 3 months of ACC notifying its decision s135(2)(f)
A hearing date must be set If none is set within 3 months of ACC receiving your application, and you did not cause the delay, the reviewer is deemed to have decided in your favour s146
The reviewer decides Within 28 days after the hearing finishes, in writing, with reasons and appeal information s144
Appeal to the District Court Notice must reach the registry within 28 days of the review decision, or of a deemed decision s151(3)
Appeal to the High Court on a question of law Leave must be sought within 21 days of the District Court decision s162(2)

Statutory references retrieved 19 August 2026.

Two features matter before you decide whether to bother. ACC meets the reviewer's costs, and the reviewer must award you costs and expenses if the decision goes fully or partly in your favour (s148). But the decision under review "continues to be of full effect" while the review runs (s133(1), retrieved 19 August 2026), so applying restores nothing in the meantime. That interaction, where payments have already stopped, is set out in when ACC payments stop.

What we could not verify

ACC publishes no statistical breakdown of decline reasons. Its public list of what it does not cover is qualitative, so nobody, including us, can tell you what share of declines turn on the gradual process gate rather than on causation. If you see such a split quoted, ask where it came from.

ACC also publishes no decline rate. It publishes a decline count for one calendar year and an acceptance percentage for the next, and those two cannot be combined. And it publishes no count of review applications lodged on acc.co.nz, only reviews as a percentage of decline decisions, so the number of reviews cannot be derived from its published pages.

Finally, the complement of the restated measure is not a published statistic. ACC reports 68.3% upheld in its favour for 2024/25; it does not report what the remaining share consists of, and we have not assumed.

Where cover ends and private insurance begins

The gates in the table above are not hurdles you can argue past. They are the boundary of the scheme. Illness, disease, gradual-process conditions and degeneration attributable to ageing sit outside ACC by design, and a review will not move them inside it.

That boundary is what private cover is priced against. Income protection responds to incapacity from illness as well as injury, on the policy's own definitions rather than on the definition of an accident. The structural comparison is in ACC versus private insurance, and the size of the hole in our ACC gap explainer.

If your claim was declined because the cause was not an accident, the useful question is not about the review. It is what would have paid. Start a comparison and an adviser will go through it with you.

References

Disclaimer: This article is general information about how the accident compensation scheme operates. It is not personalised financial advice and it is not legal advice about your claim or your review. Statutory time limits have exceptions and your position depends on your own facts, so take advice on your own claim. QuoteHub is operated by Craig Smith Business Services Limited, trading as Smiths Insurance and KiwiSaver, a licensed Financial Advice Provider (FSP712931), Christchurch.

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