Getting Started

Use this form to arrange conciliation for an ACC related matter. Fair Way will share your request with ACC and get in touch with you to discuss your request.

At any point if you would like to switch to having a phone conversation with one of our team, this is easy to do – you can simply phone us on 0800 77 44 14

About you

Which best describes you? *

ACC claimantEmployer or self-employedAccredited employerThird party administratorRepresentative

Full name: *

Phone: *

Email address: *

Organisation:

How would you like us to contact you? *

PhoneEmail

When is the best time for us to contact you? (Please select any that would suit)

8.30 am - 10 am10 am - 12.30 pm12.30 pm - 3 pm3 pm - 5 pm

About this request

Are you making this request on someone else’s behalf?

YesNo

Do you have authority to act for them?

YesNo

In which capacity are you acting?

Support person / Friend or family memberAdvocate / Legal representativeOther

Do you have someone acting on your behalf?

YesNo

Their name:

Relationship to you?

Support person / Friend or family memberAdvocate / Legal representativeOther

About the issue

ACC claim number (if known):

ACC review number (if known):

Do you have a preferred Conciliator? *

YesNo

Please select your preferred Conciliator:

Please click here if you'd like to learn more about our Practitioners

Is there anything else you would like us to be aware of?Max 100 words

Disclosure

In order to progress with your request for conciliation, Fair Way require you to confirm the below statements:

I agree to a staff member from Fair Way contacting me *

I confirm I am making this request on my behalf, or I have permission to make this request on someone else’s behalf *

I agree to Fair Way sharing this request with ACC *

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