How to Make an Insurance Claim in New Zealand

How to Make an Insurance Claim in New Zealand

Most claims in New Zealand are not made to a private insurer first. They are made to ACC, or to the Natural Hazards Commission, or through a vet clinic or a GP. That single fact changes almost everything about how you should approach a claim.

The other thing worth knowing is that the claim itself is usually the easy part. What determines whether you are paid fairly is what you set up months earlier — the sum insured on your house, the excess you chose, whether you disclosed a pre-existing condition, whether the policy was in the right name.

So this guide covers both. The steps for lodging a claim, and the decisions that decide how it lands.

How We Researched This Guide

We went to the providers and the regulators rather than to anyone else's summary. That means insurer policy documents for Southern Cross, nib, AIA, Partners Life, Fidelity Life, AA Insurance, Tower, PD Insurance, Pet-n-Sur and Cover-More, plus the Natural Hazards Commission, ACC, the Financial Markets Authority and MBIE.

Two things surprised us. The first is that the Commission's building cap sits at $300,000 plus GST per dwelling per event, but it can be lower than that if your own sum insured is lower — so underinsuring your house quietly shrinks the Crown-backed part too. The second is how much the non-Pharmac drug rules vary between health insurers, with some covering a defined annual amount and others far more. We also cross-checked the financial advice duties, which are set out in full on legislation.govt.nz.

The Quick Summary (60-Second Version)

If you only read one part, read this.

• ACC claims go through a GP, physio, after-hours clinic or hospital, and can be lodged up to 12 months after the injury.
• ACC covers injury, not illness — cancer, heart disease, stroke and diabetes get no income replacement and no treatment funding.
• Natural hazard damage before 1 July 2024 is an EQCover claim; on or after that date it is an NHCover claim.
• The Commission pays first, up to $300,000 plus GST per dwelling, and your private policy covers the rest up to your sum insured.
• For travel, ACC stops at the border — it does not pay medical evacuation or repatriation, which are the bills that hurt.
• Ask your adviser how they are paid, because commissions remain legal in New Zealand and disclosure is the safeguard.

Claims That Go to ACC First

ACC covers everyone in New Zealand — children, beneficiaries, students, the retired, and visitors. It does not matter what you were doing or who was at fault, as long as the injury falls within the legislation. In exchange, you give up the right to sue for personal injury in most circumstances.

Claims must be made through a medical professional. Your GP, a physiotherapist, an after-hours medical centre or a hospital emergency department can all lodge one. ACC pays part of the appointment fee and you pay the rest, under the ACC cost of treatment regulations. Most GPs charge nothing for children under 14, and a Community Services Card can reduce a visit cost for dependants aged 14 to 17.

What ACC covers is physical injury from an accident — sprains, wounds, burns, fractures, dislocations, dental injuries, hearing loss, concussion. It also covers gradual process conditions caused by your work, treatment injuries, and maternal birth injuries from 12:00am on 1 October 2022. A treatment injury needs three things to be true: the treatment directly caused your injury, a registered health professional was treating you, and it is not a normal side-effect.

Where the ACC Gap Opens Up

Home, Car and Natural Hazard Claims

Property claims follow a similar shape across insurers. You report the loss, an assessor inspects, and the insurer settles by payment, repair or replacement. What differs is who pays first, and that is where the Commission matters.

The Natural Hazards Commission Toka Tu Ake, formerly the Earthquake Commission, runs a scheme that changed on 1 July 2024 under the Natural Hazards Insurance Act 2023. Cover is automatic if you hold a home policy that includes fire insurance, which most do. The levy sits inside your premium at 16 cents per $100 of cover, capped at $480 plus GST a year — about $552 including GST. You cannot buy extra cover from the Commission.

The building cap is $300,000 plus GST per dwelling, per event. It rose from $150,000 plus GST on 1 October 2022. Anything above the cap comes from your own policy, subject to your sum insured. That is why the sum insured matters more than the cap. The scheme targets earthquakes, volcanic eruptions and tsunamis, and to a much lesser degree storm and flood, where only limited land damage is covered. Driveway surfaces and landscaping are not covered by the Commission, though your private insurer may offer it.

Car Cover: Three Levels, One Honest Test

Car insurance is not legally required here. ACC covers personal injuries, not vehicles, so an at-fault driver is personally liable for the damage they cause. The three levels are comprehensive, third party fire and theft, and third party only. AA Insurance's third party fire and theft option carries liability cover up to $20 million for damage you cause to someone else's car or property.

Health, Life and Travel Claims

Roughly 30 per cent of New Zealanders hold private health insurance, and the market is dominated by Southern Cross Health Insurance, a not-for-profit Friendly Society that returns 94 cents of every premium dollar as claims. nib, AIA, Partners Life and UniMed make up most of the rest.

Health policies generally do not cover what ACC already covers, because ACC pays. Most offer an ACC top-up benefit for any shortfall. The tiers run from hospital surgical only, which is cheapest and covers surgery, cancer treatment and hospital stays but excludes specialists and diagnostics, through hospital plus specialist, up to comprehensive, which adds GP visits, prescriptions, dental, optical and physiotherapy.

Non-Pharmac drugs are where the fine print bites, because high-cost cancer drugs often sit outside the public list. Southern Cross KiwiCare includes Pharmac-approved chemotherapy plus up to $8,000 each claims year for non-Pharmac but Medsafe-indicated drugs. UltraCare covers Pharmac-approved chemotherapy up to $55,000 per policy year and non-Pharmac but Medsafe-approved chemotherapy up to $8,500 a year. On nib, non-Pharmac chemotherapy drugs that are Medsafe approved are covered up to $8,500 a year.

Life Cover and the Definitions That Decide

Life cover pays a lump sum on death or terminal illness with less than 12 months to live. Trauma cover, also called critical illness, pays while you are alive if you are diagnosed with a condition meeting the policy definition. Most policies cover 40 to 50 conditions, but the definitions vary by provider.

Travel: What ACC Will Not Pay For

Questions You Might Have

How long do I have to lodge a claim?

ACC claims can be made up to 12 months after the injury. Private insurers set their own windows in the policy wording, and property policies generally expect prompt notification because delay makes assessment harder. Check your policy document rather than assuming, and report early even if you are still gathering quotes.

Can I claim on both ACC and my health insurance?

Generally no, because health insurance does not cover what ACC already pays. Most policies include an ACC top-up benefit for any shortfall between what ACC covers and the actual cost. Southern Cross Travel Insurance will not accept a claim at all unless you provide written confirmation that ACC has declined to pay some or all of the cost.

What happens if my house is damaged in an earthquake?

You claim through your private insurer, who passes the natural hazard portion to the Commission. The Commission pays first, up to $300,000 plus GST per dwelling per event, and your policy covers the rest up to your sum insured. If your sum insured is lower than the cap, your Commission cover is lower too.

Do I have to accept the insurer's repairer?

Not always, but there are good reasons to. AA Insurance guarantees its repairs for the life of the car, even after you sell it, and Southern Cross pet policies with Pet Easy-Claim let partner vets claim on your behalf so you pay only the balance. Ask before you arrange your own.

What do I do if my claim is declined?

Ask for the decision in writing, with the policy clause they relied on. Then use the insurer's internal complaints process, and if that does not resolve it, their dispute resolution scheme. Financial advice providers must also disclose their complaints and dispute resolution process to you up front, so it should be easy to find.

What Matters Most

The claim conversation happens at the worst possible moment, which is why the decisions that matter are made long before it. Your sum insured, your excess, your disclosure at application, and whether anyone relies on your income — those four things decide most outcomes.

Ask your adviser how they are paid. Commissions are still permitted here, and the FMA has said it is targeting unmanaged upfront and ongoing commission conflicts, unsuitable replacement business and inadequate disclosure. The duty requires an adviser to prioritise your interests where a conflict exists. A useful test is whether the advice would be the same without the commission.

Then read the definitions, not the headlines. A condition name on a policy schedule tells you very little about whether a claim will be paid.