Insurer compliance

CTP insurer compliance

We monitor and regulate the six insurers who issue Compulsory Third Party (CTP) policies under the Motor Accident Injuries Act 2017 (effective from 1 December 2017), Motor Accidents Compensation Act 1999 and the Motor Accident Guidelines (the guidelines).

Under the guidelines, we require CTP insurers to:

• provide policies that are competitively priced
• manage claims in accordance with the guidelines
• resolve claims in fair and timely manner

We identify non-compliance using data analytics and applying a risk-based regulatory approach, which can include:

• reviews of insurer self-assessments reports
• investigating insurer complaints we received
• reviews of insurer complaint reports
• targeted claims audits
• reviews of CTP scheme claims data
• monitoring the outcomes of insurer court appeals
• meetings with insurers’ senior claims management personnel
• conducting inspections of insurer claim files.

The regulatory tools available to us when dealing with minor compliance issues include education, persuasion and warning. In instances of major non-compliance we issue notices, censures or penalties.

Minor non-compliances are those that are not likely to cause much harm to people or the scheme. Major non-compliances have caused or have the potential to cause significant harm to claimants, stakeholders and/or the objectives of the scheme.

Workers compensation insurer compliance

We regulate icare (which issues most workers compensation policies), as well as self-insurers and specialised insurers under the Workers Compensation Act 1987 and the Workplace Injury Management and Worker Compensation Act 1998. Our regulatory activities aim to ensure legislative requirements are met.

Under the guidelines, we require workers compensation insurers to:

• keep premiums stable, fair and affordable
• ensure premiums adequately reflect the risks presented in the industries they insure
• strike a balance between premium costs in relation to employer size types and capacity to achieve insurer principles
• provide incentives to employers to improve risk management and good claims outcomes
• have a sound capital management plan

We identify non-compliance via audits, data analysis, complaints and also through our dispute resolution services. Our compliance activities include:

• reviewing insurer performance reports
• investigating complaints made through Dispute Resolution Services
• conducting insurer audits as per the licensing framework
• regular communication between portfolio managers and insurers
• conducting inspections of insurer claim files.

We also work with the Workers Compensation Commission and the Workers Compensation Independent Review Office to identify and resolve complaints and disputes.

Our regulatory tools include education, support, persuasion, improvement planning, and cautions, as well as audits and in some cases, censure. Where an insurer fails to meet legislative requirements we can suspend or cancel the licence, impose penalties and/or prosecute.

Home building compensation insurer and provider compliance

From January 1 2018, SIRA will regulate all home building compensation (HBC) insurers and providers.

Home building compensation insurers and providers are required to comply with a number of HBC insurance guidelines including but not limited to:

• Home building compensation (claims handling) insurance guidelines
• Home building compensation (eligibility) insurance guidelines
• Home building compensation (premium) insurance guidelines
• Home building compensation (prudential) insurance guidelines
• Home building compensation (contribution) AIP guidelines

If you have any concerns about the conduct of a building or trades contractor, these can be reported to NSW Fair Trading, who may be able to assist resolving the issue or investigate any relevant legal non-compliance.

If you have any concerns about the conduct of a licensed HBC insurer or provider you can submit a complaint to us at the State Insurance Regulatory Authority.

How to report non-compliance

If you believe a CTP, workers compensation or home building compensation insurer has breached their obligations, read complaints about insurers for more information (includes how to make a complaint for insurer non-compliance).

Disputes about a claim

If you have a dispute with your insurer about your claim, visit disputes for more information (includes how we can help resolve it).

Compliance guidance material