Treatment

We may be able to help with treatment costs for your service-related injury or illness.

Injuries & illnesses covered

To qualify for treatment, your injury or illness must be accepted as linked to qualifying service; that is:

It’s already accepted as service-related if you have one of these for it:

Application & approval

Application for injury of illness

You can apply for your injury or illness to be accepted for treatment, by either:

We may seek more information, or arrange assessments.

Approval of treatment

These costs are approved automatically for your accepted injury or illness (don’t need specific approval):

  • GP visits
  • medicines for approved treatment (if on Pharmac’s list of subsidised medicines)
  • diagnostic x-rays and scans up to $1000 each, if linked to approved treatment (but all MRIs need pre-approval).

Any other costs must be pre-approved—except in an emergency (acute) situation when you:

  • can’t reasonably seek and get pre-approval; and
  • can’t get the treatment through the public health system.

You can seek pre-approval through your case manager.

Treatment card

We’ll send you a treatment card for your accepted injuries or illnesses. Take it with you to your:

  • health providers (as it tells them which injuries and illnesses we’ll cover)
  • pharmacist (when collecting medicines for accepted injuries or illnesses).

Treatment plan

We’ll work with you to draw up a treatment plan, covering:

  • injuries or illnesses we’ll fund treatment for
  • medicines and treatments we’ll fund, including how often and how long (or how many sessions)
  • treatment goals, your progress toward them, and any reassessment needed.

If a treatment isn’t meeting the goals, we may look at:

  • changing provider
  • ending funding for the treatment
  • funding another treatment (as well as the current one)
  • funding another treatment (instead of the current one).

 Contact us (external link)  to discuss with your case manager, if you think a change is needed to your treatment plan. You can seek funding for more treatment, another treatment, or both.

Treatments funded

To decide on funding a treatment for your accepted injury or illness, we’ll look at:

  • nature and severity of your condition
  • treatments used for it in New Zealand
  • quality of the treatment sought; how it meets your needs; how it will affect your work or living situation
  • provider’s qualifications and experience
  • public health system, ACC, other government agencies—what they’ll cover
  • potential harm from delay.

Medicines

We’ll usually only fund medicines on Pharmac’s subsidised list.

For medicines not on that list, your doctor may apply for individual funding from Pharmac. If Pharmac declines this, we may consider funding the medicine ourselves—we’d need copies of the application to Pharmac and the decision. We look at:

  • research-based evidence the medicine works
  • your situation and needs (anything special about these)
  • cost.

Food substitutes

We may fund food substitutes. These must be prescribed by the treatment provider (who should first apply to Pharmac for special authority).

Specialist & private-hospital treatment

Requests for specialist or private-hospital treatment are assessed case-by-case. Specialist treatment should be in your local area, where possible.

Long-term treatment

We may approve a course of treatment for up to 12 months or 12 sessions (whichever’s less). We need full details from the provider, including expected outcomes.

Before deciding on further sessions we need a full report from the provider, and may seek a second medical opinion.

Services to support treatment

We may fund other services, such as accommodation or laboratory tests, you need to:

  • have an approved treatment; and
  • meet its goals.

Alternative treatment

We may fund alternative treatment, if prescribed and monitored by an approved treatment provider. We won’t fund if you could have had standard treatment but refused.

Overseas veterans

When you’re living overseas, we may fund treatment if it’s all of the following:

  • generally accepted in New Zealand
  • carried out by a certified practitioner (registered with the relevant professional body)
  • pre-approved.

We won’t pay costs covered by the public-health or accident-compensation system of your country of residence.

More information

One-page summary

Related information

  • Medical travel: travel for assessment, treatment & rehabilitation
  • Rehabilitation: services to help you back toward independence
  • Reviews: your rights if you disagree with a decision about whether you qualify for treatment
  • Complaints: your rights if you disagree with how we’ve administered support for your accepted injury or illness

Relevant legislation