Written by · Reviewed by Smiths Insurance & KiwiSaver — licensed Financial Advice Provider (FSP712931) · Last updated 2026-08-20

ACC Mental Injury Claims: Four Routes to Cover, and Three of Them Need Something Else First

ACC covers four kinds of mental injury, and its own list is specific: mental injury caused by a covered physical injury, mental injury resulting from a treatment injury, work-related mental injury from a traumatic event experienced at work, and mental injury caused by sexual abuse or assault (ACC, mental injury services, last published 5 September 2025, retrieved 20 August 2026). Work stress, burnout, bullying and a mental health condition with no triggering event are on none of those four lists, and no amount of medical evidence moves them onto one.

That is the whole answer to the question people usually mean when they ask whether ACC covers mental health. The detail below is about which route a real claim runs down, and what each route requires.

A person seated with a clipboard beside four separate doorways

What counts as a mental injury in the Act?

Mental injury means "a clinically significant behavioural, cognitive, or psychological dysfunction" (Accident Compensation Act 2001, s27, retrieved 20 August 2026). That is the entire definition. It sets a clinical bar, not a legal one, and it is deliberately silent on cause.

Cause is handled somewhere else, and that is where claims are won and lost. Personal injury under the Act includes mental injury only in three described circumstances: mental injury suffered because of physical injuries suffered by the person, mental injury in the circumstances described in section 21, and work-related mental injury in the circumstances described in section 21B (s26(1)(c), (d) and (da), retrieved 20 August 2026). A clinically significant psychological dysfunction that does not fit one of those three descriptions is not a personal injury at all, so there is nothing for ACC to cover.

Route What it requires Statutory basis
Mental injury caused by a covered physical injury ACC has accepted a claim for the physical injury, and the mental injury follows from it s26(1)(c) with s20
Mental injury resulting from a treatment injury A physical injury caused by medical treatment s20(2)(b) and (d) with s26(1)(c)
Work-related mental injury A single sudden event at work, experienced directly, of a kind that could reasonably be expected to cause mental injury to people generally s21B
Mental injury caused by sexual abuse or assault Handled through ACC's separate Sensitive Claims Service s21

Routes and requirements summarised from ACC, mental injury services (last published 5 September 2025) and the Accident Compensation Act 2001, both retrieved 20 August 2026. The mapping of ACC's four categories onto sections of the Act is ours.

The fourth route is outside the scope of this page. ACC sets out how the Sensitive Claims Service works, including that support is fully funded and that it does not matter how long ago the events happened, on its own page: support if you have experienced sexual abuse or assault.

Route one: mental injury that follows a physical injury

This is the most common route and the simplest. ACC states it plainly: if it accepts your claim for a physical injury, it can also cover mental injuries resulting from that injury, giving post-traumatic stress disorder after a physical assault as its example (ACC, injuries we cover, last published 1 September 2025, retrieved 20 August 2026).

Two consequences follow from the wording. The physical injury has to be covered first, so if the physical claim is declined the mental injury claim has nothing to attach to. And the date matters: the date on which a person suffers mental injury because of physical injuries is the date the physical injuries were suffered, not the date the psychological symptoms appeared or were diagnosed (s36(2), retrieved 20 August 2026).

There is also a fallback that almost nobody knows about. For clients who do not have a covered mental injury but are experiencing psychological difficulties following their accident, ACC says it may be able to fund counselling support (ACC, mental injury services, retrieved 20 August 2026). That is funded treatment, not cover, and it does not bring weekly compensation with it.

Route two: mental injury from a treatment injury

ACC's wording here is worth reading twice: "If a physical injury is caused by medical treatment we may also be able to cover a resulting mental injury, even if the physical injury isn't covered" (same page, retrieved 20 August 2026).

The Act supports that by treating two separate things as covered personal injury: a treatment injury itself, and personal injury that is a consequence of treatment given for another personal injury for which the person has cover (s20(2)(b) and (d), retrieved 20 August 2026). What a treatment injury is, what ACC declines and the three-part test in section 32 are set out in our guide to ACC treatment injury claims.

Route three: the single-event test in section 21B

Work-related mental injury has only existed as a category since 1 October 2008, when section 21B was inserted by the Injury Prevention, Rehabilitation, and Compensation Amendment Act 2008. You have cover for a work-related mental injury if you suffer the mental injury on or after that date and it is caused by a single event of the kind the section describes (s21B(1), retrieved 20 August 2026).

Four gates, all of which have to be passed.

Gate What section 21B requires
A single event An event that is sudden, or a direct outcome of a sudden event. A series of events counts only if they arise from the same cause and together comprise a single incident or occasion. A gradual process is expressly excluded
Experienced directly You were involved in or witnessed the event yourself, and were in close physical proximity to it at the time it occurred
Not through a secondary source Seeing it on television or closed circuit television, seeing pictures of it or reading about it in news media, hearing it on the radio or by telephone, or hearing about it from another person all fail this gate
Objectively capable of causing injury The event must be one that could reasonably be expected to cause mental injury to people generally, not only to you

All four gates quoted or summarised from Accident Compensation Act 2001, s21B(2), (5), (6) and (7) (retrieved 20 August 2026). The event must also have happened at work as defined in section 28(1).

ACC's illustration is a shop worker present during a robbery, and it makes the point that cover applies even if the person was not physically injured (ACC, injuries we cover, retrieved 20 August 2026).

The gate that does the most excluding is the first one. Section 21B(7)(c) states that "event" does not include a gradual process. Chronic workload, a long-running conflict with a manager, sustained bullying and burnout are gradual by definition, so they fail at the first gate regardless of how severe the resulting dysfunction is or how clearly a clinician documents it. The third gate excludes the control-room operator who watched the incident on a monitor from another building, and the family member who was told about it afterwards.

What ACC does not cover

Putting the exclusions in one place, because they are scattered across four sections of the Act.

All retrieved 20 August 2026. What ACC leaves out across the whole scheme, not only for mental injury, is set out in what ACC does not cover.

What an accepted mental injury claim pays

The same entitlements as any other accepted claim. There is no separate mental injury payment rate.

That means treatment, which for mental injury means counselling and therapy, psychiatric and psychological assessments, day programmes and residential rehabilitation (ACC, mental injury services, retrieved 20 August 2026). It means weekly compensation at up to 80% of pre-injury earnings if you cannot work, capped at a gross maximum of $2,466.20 a week from 1 July 2026 (ACC, 11 June 2026, retrieved 20 August 2026). It can mean lump sum compensation for permanent impairment, with one specific rule attached: where the claimant is under 16, ACC must not assess entitlement to a lump sum for a mental injury until they turn 16, unless there are compelling reasons to assess earlier (Schedule 1, clause 57(2), retrieved 20 August 2026), and any medical certificate about a mental injury must come from a medical practitioner suitably qualified to assess mental injury.

One further provision is worth stating because it is not obvious. ACC is generally not liable to provide entitlements where a claimant dies by suicide, but that disentitlement does not apply if the death was the result of a mental injury suffered because of covered physical injuries, or a mental injury in the circumstances described in section 21 or 21B (s119(1)(c) and s119(3), retrieved 20 August 2026).

How long a decision takes, and when your claim is dated from

A mental injury claim under section 21 or 21B is a complicated claim. ACC must investigate at its own expense and either decide within two months of lodgement or tell you it needs an extension of no more than two further months, and the decision must be made within nine months of lodgement (s57, retrieved 20 August 2026). If ACC misses the limit you are regarded as having a decision that you have cover (s58, retrieved 20 August 2026). ACC lists work-related mental injury among its complicated claim types, and reports that complicated claims were 2.5% of all new claims in 2025 and take an average of 39 days for a cover decision (ACC, injury claim statistics, retrieved 20 August 2026).

The date your claim runs from is unusual and it works in your favour. For mental injury under section 21 or 21B, the date on which you suffer the injury is the date you first receive treatment for that mental injury as that mental injury (s36(1), retrieved 20 August 2026). Not the date of the event. The 12-month lodgement clock in section 53 runs from that treatment date, and ACC must not decline a late claim on lateness alone unless the delay prejudices its ability to make decisions.

What is not published

ACC does not publish how many work-related mental injury claims it receives, how many it accepts, or what proportion it declines. Its public injury claim statistics break claims down by year, industry and region, not by cover type, and its work injury statistics pages carry no mental injury line (ACC, work injury statistics, data covering 1 January 2026 to 30 June 2026, retrieved 20 August 2026). We have not estimated a figure from the complicated claim total, because that total also contains treatment injury, hearing loss, gradual process and late-lodged claims.

ACC also does not publish average payment amounts or average claim durations for mental injury claims. Where a page quotes you one, ask where it came from.

Where private cover sits

The line ACC draws is between a mental injury with a qualifying physical or event-based cause and a mental health condition without one, and almost all long-term inability to work from mental health sits on the uncovered side. Income protection and trauma policies underwrite illness rather than accident, and their mental health terms, exclusions and stand-down periods differ by insurer and are set at underwriting rather than at claim time.

If you want to size the shortfall before you shop, start with our income protection calculator, then read the ACC gap explained. QuoteHub is operated by Craig Smith Business Services Limited, trading as Smiths Insurance and KiwiSaver, a licensed Financial Advice Provider (FSP712931). Our panel is listed on our disclosure page.

References

Disclaimer: This article is general information only and does not constitute personalised financial advice, legal advice or medical advice. Every statement of law on this page is sourced to the Accident Compensation Act 2001 as at the date stated beside it, and whether any particular mental injury is covered is a decision for ACC on the facts of that 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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