Published: 03 Mar 2026

At some point during a complex ACC claim, you may receive a letter advising that ACC has arranged a Medical Case Review. For many claimants, this can feel concerning, particularly if the letter does not clearly explain what the review involves or why it has been requested.

Medical Case Reviews are typically used in more complex claims where ACC considers that additional specialist advice is required before making further decisions.

Understanding how these reviews work can help claimants better understand where they sit in the ACC process and what may happen next.

Why ACC Requests a Medical Case Review

A Medical Case Review is usually requested when ACC considers that the medical issues within a claim are complex or unclear.

This can happen when there are multiple diagnoses involved, when the medical evidence is conflicting, or when ACC requires specialist advice to determine whether an injury remains related to the original accident.

Another common reason is when multiple specialists have provided competing opinions that differ significantly from each other. In these situations ACC may consider that the existing medical evidence does not allow them to make a clear decision.

ACC must make decisions using the legal test known as the balance of probabilities. This means ACC must be satisfied that something is more likely than not to be correct. If the available medical evidence is evenly balanced or unclear, ACC may determine that they do not yet have enough information to make a robust decision.

In these circumstances ACC may refer the claim for a Medical Case Review so that an independent specialist can analyse the evidence and provide a further opinion.

What Information the Specialist Receives

Before the review takes place, ACC prepares a referral for the specialist conducting the Medical Case Review.

This referral usually includes the claimant’s medical history, imaging reports such as MRI or CT scans, previous specialist opinions, clinical advisor comments, and a list of questions that ACC would like answered.

These questions guide the specialist on the areas ACC wants addressed within the report.

Many claimants are unaware that the specialist’s report is usually structured around these referral questions, which means the focus of the review is often determined by what ACC has asked the specialist to consider.

How the Medical Case Review Is Conducted

Unlike some other types of medical assessments, a Medical Case Review does not always involve a face-to-face appointment.

In many cases the specialist reviews the medical records and imaging provided by ACC and prepares a written report based on the information available.

In other situations the specialist may request to examine the claimant in person if they believe a clinical examination is necessary.

The purpose of the review is to provide ACC with an independent specialist opinion on the medical issues within the claim.

Why Medical Case Reviews Can Be Important

Medical Case Reviews can play a significant role in how ACC evaluates complex claims.

The specialist’s report may address questions about diagnosis, causation, ongoing symptoms, or the relationship between the accident and the current medical condition.

Because the review is often requested when ACC is considering important decisions, the outcome can influence the direction of the claim going forward.

For many claimants, this is the point where the medical evidence in the claim is examined in greater detail.

What Many Claimants Do Not Realise

One of the things many people do not realise is that the questions ACC asks the reviewing specialist can shape the direction of the report.

If certain issues are not included in the referral, they may not be addressed in the specialist’s opinion.

Understanding what information has been provided to the specialist and what questions they have been asked to answer can sometimes be just as important as the review itself.

This is why many claimants want to understand what information ACC has sent to the reviewing specialist.

Why These Reviews Often Happen in Complex Claims

Medical Case Reviews are most commonly seen in claims involving complicated medical questions.

These may include situations where multiple injuries are being considered, where imaging findings are unclear, where degeneration and trauma are both being discussed, or where there is disagreement between different medical providers about the cause of the symptoms.

Because these reviews often occur after a claim has been active for some time, they can feel like a critical stage in the ACC decision making process.

Understanding the Process Before the Review Takes Place

Many claimants receive the letter advising that a Medical Case Review has been arranged without fully understanding what the process involves.

Understanding why the review has been requested, what information the specialist will be considering, and how the report may influence ACC’s decisions can help claimants approach the process with a clearer understanding of what is happening.

Learn More About ACC Medical Case Reviews

If you want to better understand how ACC Medical Case Reviews work, what information specialists receive, and how these reports influence ACC decisions, you can explore the detailed guidance available through the AccAdvisor.ai platform.

Subscribers gain access to structured guidance covering Medical Case Reviews, complex claims, specialist referrals, and how ACC evaluates medical evidence when making decisions on injury claims.

Explore the ACC digital guidance tools at
https://accadvisor.ai