Ninety-five per cent of sexual abuse claims are failing to get through the ACC system.
The vast majority give up their claims for long-term support because they say the process is too traumatic.
Advocates say the low acceptance shows the system is not working for survivors, but the ACC Minister says it doesn't mean survivors are not getting the help they need.
Figures obtained by RNZ under the Official Information Act, and also by Green Party ACC spokeswoman Jan Logie, show sexual abuse is the most commonly denied ACC claim for women.
More than 76 per cent of all sex abuse claims are lodged by women, but only 5 per cent - or 280 - were accepted last year. Only 3 per cent of claims by men are accepted.
"That's shockingly low," Logie said.
Sex abuse survivors were pulling out of ACC's formal claims process because it was too stressful, she said.
"That really is a red flag for us to re-look at the process because it's not survivor-centred."
Of the 5370 new sexual abuse claims lodged with ACC in the year ending June 30, 2020, 339 were accepted. Overall, more than two-thirds of all sensitive claims, which include sexual abuse, are denied by ACC.
But the low acceptance rate did not mean survivors were not getting help, ACC Minister Carmel Sepuloni said.
"Anyone making a sensitive claim gets up to 14 hours of therapy, 10 hours of cultural support, 10 hours of social work support and 20 hours of whānau support before deciding to undergo a formal assessment."
ACC Minister Carmel Sepuloni. Photo / Mark Mitchell
This assessment establishes whether the survivor has a mental injury as a result of the abuse, which makes them eligible for longer-term ACC cover.
Those who decline to undergo an assessment are recorded in ACC's system as being declined, says Sepuloni.
"It's the system's way of recording it as opposed to a true reflection of women actually having genuine claims turned down."
Just over 82 per cent of people making sensitive claims who do choose to undergo a formal assessment have their claim approved, Sepuloni said.
ACC could not say what the acceptance rate was for sexual abuse claimants undergoing this assessment.
Advocates say they've been telling ACC for years that its assessments are flawed.
One support group says the requirement to have a mental health diagnosis in order to get claims approved puts many survivors off.
"An assessment requires bringing in a psychologist or a psychiatrist to essentially diagnose a client with the right type of mental illness to allow them to access long-term care from ACC," said the support group, which cannot be named because its ACC contract prevents it speaking publicly.
"They're medicalising it, whereas we know that is off-putting to a lot of survivors who don't want to come away with a mental health diagnosis, as it might show up for them in the future in their medical records or when they're applying for insurance.
"This highlights that assessment process isn't working and it's creating barriers for people getting help."
Women's Refuge principal policy advisor Natalie Thorburn. Photo / Nick Reed
A formal assessment can also be re-traumatising for survivors as they often have to tell their stories over and over again to different agencies before even being referred to ACC, Women's Refuge principal policy advisor Natalie Thorburn said.
"Going through a supported assessment is often a prohibitively hard prospect for a woman to face when they're seeking counselling.
"Many health practitioners aren't aware that people can even get that funded support through an ACC claim, so they get passed around from person to person before getting a referral to an ACC-registered practitioner.
"Having to repeat their story and catalogue the range of impacts it's had on their lives can be retraumatising and deeply distressing.
"Having to do a lengthy supported assessment with yet another professional deters many women from continuing with their claim, and effectively lets ACC off the hook in terms of providing them with funded counselling."
ACC needs to stop treating sensitive claims the same as physical injuries, Thorburn said.
"The onus to go through an assessment is offensive. The process forces women to talk about what happened to them so that ACC can decide whether it's truthful and whether they need support.
"Victims know if they need support, and only they should be making those decisions.
"It is rare for people to lie about abuse, and the obligations placed on victims make it almost impossible for them to get the support they need."
ACC was unable to say how many sex abuse survivors had declined a formal assessment, or the reasons why. Sepuloni said she had asked the agency to look into the issue.