Review of the Nominal Insurer
The Compliance and Performance Review of the Workers Compensation Nominal Insurer managed by icare (the Review) forms part of SIRA’s regulatory role.
SIRA is responsible for regulating all workers compensation insurers in NSW, the largest of which is the Nominal Insurer (NI) managed by icare. The success of the NI is critical to the performance of the NSW workers compensation system.
This Review is part of SIRA’s role as a strong, independent regulator monitoring scheme performance and compliance, and holding all insurers to account for the services and outcomes they deliver for scheme customers - people who are injured at work and employers required to purchase workers compensation insurance.
In February 2019, the SIRA Chief Executive commissioned the Independent Compliance and Performance Review of the workers compensation Nominal Insurer (NI) managed by icare and appointed Independent Reviewer, Ms Janet Dore. The Review was supported by independent actuaries from EY and authorised officers of SIRA. The terms of reference for the Review are available here.
Reports now available
The Review and associated documents are now published:
Notice of correction: icare and EML have advised that some information icare provided to SIRA and Ms Dore that was used in her report was incorrect, and they have requested SIRA publish a note that the EML staff turnover rate referenced on page 68 of the report was 22.7 per cent per year rather than the stated 22.7 per cent per month based on the information provided by icare during the review.
- Three supporting reports prepared by scheme actuaries EY:
- SIRA’s response to the Review, including a 21-Point Action Plan
- The icare response to the Review
SIRA thanks the following:
- Ms Janet Dore and EY for their work and insights,
- the Board, Executive team and staff at icare and its agents for their constructive engagement.
- SIRA Tripartite reference group for their input and contribution throughout the Review.
- The many customers and stakeholders who provided input and openly shared their personal experiences through detailed submissions through the public consultation and many hours of meetings.
Findings
The Review contains findings on the operation and sustainability of the NI and recommends significant steps for improvement. It is an important contribution to maintaining a fair and sustainable workers compensation system for New South Wales.
In tabling the Review and the actions that flow from it, SIRA has highlighted a range of issues that need to be addressed in the interests of current and future customers and stakeholders of the workers compensation scheme.
Priorities for improvement include early and safe return to work outcomes, claims management and improving premium transparency and volatility.
The Review assessed progress and performance through audits and stakeholder consultation, and was undertaken immediately following a period of significant transformation of the NI. icare continued to introduce changes to the NI operations over 2019 while the Review was underway. A further program of audits in 2020 will assess the impact of changes made since the Review audits and stakeholder consultation.
21-Point Action Plan
The Independent Reviewer made thirteen findings, twelve of which are operational or regulatory in nature.
SIRA supports eleven of the findings, as does icare. Both SIRA and icare support an additional finding in principle (Finding 4) and have agreed that SIRA, rather than icare, will take action on this finding. One finding (Finding 12) would require consideration of legislative amendment and is matter for the Government and Parliament.
21-Point Action Plan update (as the the 23 August 2021)
21-Point Action Plan update (as at the 3 March 2021)
21-Point Action Plan update (as at 30 October 2020)
21-Point Action Plan update (as at 3 August 2020)
Quarterly audit of the Nominal Insurer
In action 10 of the 21 Point Action Plan, SIRA committed to conducting and publishing a quarterly compliance and performance audit of claims management by the Nominal Insurer.
The quarterly audit reports are published here:
Nominal Insurer 2020 quarter 1 claims file review
Nominal Insurer 2020 quarter 2 claims file review
Independent Reviewer - Ms Janet Dore
Ms Dore is an accomplished senior leader who has modelled trust and integrity in her varied roles across government and not-for-profit sectors.
She is a public advocate for safety and wellbeing and for economic development to benefit communities, with a strong background in implementing operational models for achieving outcomes in personal injury schemes.
Ms Dore was the chief executive officer of the Transport Accident Commission in Victoria from 2008 to 2015 and has previously held senior executive roles in local government as chief executive officer of the Cities of Ballarat and Newcastle NSW.
Ms Dore has been Chair of the Committee for Ballarat since October 2015 and is currently Deputy Chair of the Central Highlands Water Board, Victorian Taxi Services Commissioner, Municipal Monitor at the Rural City of Ararat, and Director of the Municipal Association of Victoria (MVA) WorkCare. Her previous Board experience has included nib Health Funds, Newcastle Airport, and the Institute for Safety Compensation and Recovery Research (ISCRR).
Ms Dore is an independent member of the State Insurance Regulatory Authority’s (SIRA) CTP Premium Committee, a subcommittee of the SIRA Board, and is familiar with SIRA’s premium regulation methodologies.
Ms Dore holds a Master of Business Administration from Deakin University and is a Fellow of the Australian Institute of Company Directors.
