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ACC Client Forms – What You Need and When to Use Them

ACC has a range of forms that clients may need at different stages of their claim.
This page explains what each form is for, when you should use it, and provides direct download links for convenience.

1. ACC1 – Request for Assistance

Use this form if you already have accepted cover and need additional support beyond basic treatment.

You can request:

Home help, personal care, childcare support
Equipment (crutches, braces, wheelchairs)
Home or vehicle modifications
Transport assistance (mileage, taxis, escorts)
Consumables (Incontinence pads etc..)

Attach any relevant medical certificates, receipts, or supporting documents.

2. ACC5937 – Authority to Act

Complete this form if you want someone else (friend, whānau, advocate, lawyer) to speak to ACC on your behalf.

This form allows your authorised person to:

Receive information about your claim
Make enquiries
Request documents
Communicate with ACC on your behalf

You remain the claimant and stay in full control of decisions.

3. ACC250 – Travel Reimbursement Form

Use this form to claim back travel costs for approved ACC-related treatment or rehabilitation that has already occurred.

You can claim:

Private vehicle mileage
Public transport fares
Taxi costs (usually requires prior approval unless medically justified)

You can claim travel for the previous 12 months.

4. ACC253 – Request for Prior Approval (Transport & Accommodation)

Use this form when you need ACC’s approval before travelling, especially when the travel is substantial or not routine.

Typical uses include –

Air travel for treatment
Taxi or shuttle transport instead of private vehicle
Accommodation near hospitals or rehabilitation providers
Escort/support person costs when needed due to your injury

This form can be completed by you, a family member, or your treatment provider.

5. Private Care / Home Help Forms (ACC84 & ACC86)

These forms are used when ACC has agreed to fund home and community support such as personal care or home help.

ACC84 – How would you like us to pay for your care?

This form lets you choose –

Whether ACC pays you, and you then pay your carers, or
Whether ACC pays the support agency/workers directly

ACC usually sends this form to you once support is approved.

ACC86 – Weekly Care Summary

Used to record –

What care was provided
When, and by whom

This ensures correct payment to you or your care provider.

To obtain these forms –
Request them from your ACC case owner, or
Call 0800 101 996 and ask for ACC84 and/or ACC86 for your claim.

6. ACC45 – Injury Claim Form (Client Section)

This form is how a new claim is created and cover is requested for a personal injury.

Although the ACC45 is a provider form, you must complete and sign the client details and consent section.

Used for:

New accident-related injuries
Some mental injuries linked to physical injuries
Your GP, physiotherapist, or other registered treatment provider lodges it with ACC.

Sample (for reference only) –

7. ACC2152 – Treatment Injury Claim Form

Use this form if you believe you have been injured as a result of medical or dental treatment (rather than an accident).

Examples:

Surgical complications
Medication injury
Failure to diagnose or delayed diagnosis
This form is completed with your treatment provider and is submitted together with an ACC45.

8. MyACC – Online Alternative to Many Forms

Instead of using paper forms, you can log into MyACC to –

Request travel reimbursement
Upload medical certificates
Submit receipts
Ask for equipment or some types of assistance
Check your claim status and entitlements
Communicate with your ACC recovery team

Need Help Completing These Forms?

Our AI Claim Navigator can –

Explain which forms apply to your situation
Help you gather the right evidence
Draft supporting letters to your specialists
Prepare review submissions if ACC declines your request

Just let us know what you need!