ACC8536 Specialist Cover Assessment - Adult

**ACC8536** **Specialist Cover Assessment - adult** "This report should be completed for a Specialist Cover Assessment or Function Assessment by the Named Assessment Provider." "Please refer to the Sensitive Claims Service operational guidelines and report guidelines available on our website: [www.acc.co.nz/resources](https://www.acc.co.nz/resources). Return the completed report to sensitiveclaimsreports@acc.co.nz." **Part A: Kiritaki information** **1. Kiritaki details** Kiritaki name: John Smith Date of birth: 03/03/1979 Claim number: ACC000-TESTCLAIM-01 Contact details/safe contact where appropriate: Alfred Pennyworth (support person), 03 555 0199 **Part B: Specialist Cover Assessment** **2. Sources of information** a. Dates and duration of consultations: Two consultations were undertaken: one of 90 minutes and one of 60 minutes. b. Sources of information collected, received, and considered (include dates and authors): Referral letter from Dr Sigmund Freud dated 01/09/2026. Interview with the kiritaki across two sessions. **Only complete the rest of Part B if you are providing information for cover determination.** **3. About the Schedule 3 events** The kiritaki described historical sexual abuse perpetrated by an extended family member, occurring over a period of approximately two years during his childhood, at a frequency of several times per year. The kiritaki did not disclose further specific detail regarding the nature of the abuse beyond confirming that it met the threshold of unwanted sexual contact. **4. Background kiritaki information** a. Please provide a summary of relevant background information. The kiritaki reported no significant medical history of note. He identified as New Zealand European with no specific cultural or spiritual practices reported. He described a stable upbringing overall, aside from the abuse disclosed above, and completed secondary schooling before entering employment. He reported no history of alcohol or drug use of concern and no forensic history. b. Summary of the current circumstances and presenting difficulties of the kiritaki. Current circumstances: The kiritaki currently lives independently and is self-employed, managing a family business. Presenting difficulties: The kiritaki reported ongoing anxiety, hypervigilance, intrusive memories, and sleep disturbance, which he attributes to the historical abuse. c. Summary of the mental health history of the kiritaki and any treatment delivered for historical and current presenting difficulties. Mental health history: The kiritaki reported no prior formal mental health diagnosis before the current referral. Treatment delivered: The kiritaki has engaged in individual psychological treatment since being referred, focused on trauma-related anxiety symptoms, as documented in the associated ACC266 Action Plan and Progress Report for this claim. **5. Strengths and vulnerabilities** a. Personality assessment. No personality patterns of particular clinical significance were identified during the assessment. b. Kiritaki strengths and protective factors. The kiritaki presents with strong motivation to engage in treatment, a stable living situation, and a small but supportive social network. c. Areas of vulnerability. The kiritaki reported that the demands of managing his business independently limit the time available to engage fully with treatment recommendations between sessions. d. Are there any areas of risk? Are there any risks identified? [ ] Yes [x] No e. Are any other agencies currently involved in supporting the kiritaki? [ ] Yes [x] No **6. Psychometrics** | Name of measure | Date administered | Respondents | Rating | | --- | --- | --- | --- | | DASS-21 | 01/09/2026 | Kiritaki (self-report) | Depression 8 (mild), Anxiety 14 (severe), Stress 16 (moderate) | Comment on results: The elevated anxiety score is consistent with the kiritaki's reported hypervigilance and intrusive memories, and supports the clinical presentation described above. **7. Clinical symptoms or diagnosis** 1. Diagnosis: Post-Traumatic Stress Disorder (DSM-5-TR) is proposed, based on the kiritaki's reported history of exposure to the Schedule 3 events, ongoing intrusive memories, hypervigilance, avoidance of reminders, and sleep disturbance persisting beyond one month and causing functional impairment. Formulation and summary. The kiritaki's current presentation is understood as arising from unresolved trauma related to the historical abuse disclosed above, compounded by the ongoing demands of self-employment limiting time for recovery-focused activities. Protective factors including his motivation to engage in treatment and stable social supports are expected to support a positive treatment trajectory. **8. Opinion on mental injury** a. Please describe the clinical evidence supporting a causal relationship between the Schedule 3 events and proposed mental injuries. The temporal relationship between the disclosed abuse and the onset of trauma-related symptoms, together with the specific symptom profile (intrusive memories directly referencing the abuse, hypervigilance, and avoidance), supports a causal relationship between the Schedule 3 events and the proposed diagnosis of PTSD. b. Please describe the clinical evidence supporting a causal relationship between other life factors and proposed mental injuries. No other life factors were identified as contributing to the proposed mental injury. **_Date mental injury suffered_** Proposed Mental Injury: Post-Traumatic Stress Disorder Date: 2026 (kiritaki reported symptoms becoming clinically significant within the past year) Please describe the clinical evidence and your rationale for the date(s) above. The kiritaki reported that symptoms reaching diagnostic threshold coincided with a workplace incident in 2026 that brought earlier traumatic memories to the surface. **9. Treatment** The kiritaki should continue trauma-focused individual psychological treatment, incorporating psychoeducation, graded exposure, and relapse-prevention strategies, as already underway. **10. Prognosis** The prognosis is considered good given the kiritaki's engagement with treatment to date and his stated motivation to recover. A potential barrier to treatment is the ongoing demand of managing his business independently, which limits time for between-session practice. **Part C: Function Assessment** **Only complete Part C if ACC approval has been given to complete a Function Assessment** **Part D: Other information and declarations** **13. Other information** Please provide the date of the last face-to-face meeting with the kiritaki that informed this report: Date: 20/10/2026 Date of disengagement by the kiritaki (if applicable): Please provide any other information that you consider relevant to assist in determining cover or to assist in the recovery of the kiritaki: [ ] I have attached other documents, eg clinical reports, psychometric results. List these: **14. Provider declaration** [x] "I have explained to the kiritaki that ACC will send a copy of this report to their Lead Service Provider (if relevant)." [ ] "The kiritaki would like ACC to send them a copy of this report." [x] "I have explained to the kiritaki that they can participate in a feedback session before this report is submitted to ACC." [x] "I have informed the kiritaki that the information collected for this report will be sent to ACC to support cover decisions and treatment and rehabilitation needs. I have kiritaki authority for this." [x] "I confirm that the information contained in this report is accurate and that I have followed the standards set out in the Sensitive Claims Service operational guidelines." The kiritaki: [x] Participated in the feedback session. [ ] Did not participate in the feedback session. Provide reasons why: Assessment Provider name and profession: Dr Sigmund Freud, Psychiatrist Provider ID: TEST-PROV-01 Supplier name: Berggasse Wellbeing Clinic Supplier ID: TEST-SUP-01 Date: 20/10/2026 "In the collection, use, disclosure, and storage of information, ACC will at all times comply with the obligations of the Privacy Act 2020, the Health Information Privacy Code 2020 and the Official Information Act 1982." **Items for Clinician Review** [ ] Section 3 – About the Schedule 3 events: the kiritaki did not specify an exact date range for the abuse beyond "approximately two years during his childhood"; please confirm whether a more precise range is available. [ ] Section 8 – Date mental injury suffered: only a year (2026), not a specific date, was given for when symptoms reached diagnostic threshold; please confirm or refine. [ ] Section 6 – Psychometrics: only the DASS-21 was administered; consider whether a trauma-specific measure (eg PCL-5) should also be included.