Covid vaccines, health insurance and ACC: yes, you’re covered

By Stuff reporter

The Whole Truth: Covid-19 Vaccination | By Stuff reporter Florence Kerr.

Severe reactions to the Pfizer Covid-19 vaccine being used in New Zealand are rare, but when they do happen, these events - known as ‘treatment injuries’ - will be covered by ACC if the criteria for treatment injury are met. 

The ACC Treatment Injury Guide contains three core requirements that need to be met in order for a claim to be accepted. 

Firstly, the injury has to result in physical harm or damage to the patient. Next, the injury must have been caused by the treatment - in this case the vaccine - and finally, the injury cannot be an ordinary consequence of getting a vaccination. 

The more common, mild reactions that some people experience when they get a vaccine, such as inflammation around the site of the injection, is unlikely to be covered. 

But infections such as cellulitis or septic arthritis due to the vaccination, or anaphylaxis,  are not ordinary consequences and are likely to be covered.

As of August 2021, more than 2.5 million doses of the Pfizer vaccine have been administered in Aotearoa, and from that figure, ACC have received 201 claims for treatment injury.

Sixty-seven claims have been accepted, 39 have been declined and 95 are still awaiting a decision - either because they have only recently been lodged or ACC is still waiting for medical notes.  

Most accepted claims are for allergic reactions to the Pfizer vaccine, ACC says.

The number of treatment injury claims - and what they are for - are similar to the numbers of serious adverse events reported to the Centre for Adverse Monitoring (CARM).

Up to August 7, CARM had received 385 reports of a serious adverse event following Covid-19 vaccination, from 2,188,771 doses given (about two reports per 10,000 doses).

For both the CARM and ACC numbers, a report or a claim does not confirm the vaccine caused the event - this is determined by reviewing the medical notes and other information for each case.

ACC has a dedicated section on its website with information for patients and a form for those who want to make a Covid-19 vaccine treatment injury claim. 

Two of New Zealand’s largest health insurers, Southern Cross and AIA, have also recently reassured customers that getting a Medsafe-approved Covid-19 vaccine (at this stage, the Pfizer vaccine) won’t invalidate or otherwise affect your insurance policy.

The Financial Services Council confirmed this is the case for all its member companies, which include New Zealand’s major health insurers.

These insurers have excluded injuries from Covid-19 vaccinations from their cover but this is not new or exclusive to the Covid-19 vaccine: it is a standard health insurance clause that applies to all vaccine treatment injuries in New Zealand, because this is already covered by - you guessed it - ACC.

Reporting disclosure statement: This post was reviewed by The Whole Truth: Covid-19 Vaccination expert panel member Dr Dianne Sika-Paotonu, Associate Dean Pacific and senior lecturer in pathology and molecular medicine at Otago University.