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Insurers

Guidance material for insurers will differ depending on which system you operate in.

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Motor accidents

We expect insurers to operate with honesty, due care and diligence and in accordance with our guidelines.

Selling green slips

Insurers are licensed to sell Green Slips. In general insurers must:

  • act in good faith with all customers
  • never unfairly discriminate against individual customers or groups of customers
  • have clear and practical processes for issuing Green Slips to customers
  • make sure their Green Slip insurance is readily accessible and available to all customers

Insurers must comply with guidelines for selling, issuing and administering Green Slips.

For all policies issued on or after 1 December 2017:

For policies before 1 December 2017:

Managing claims made under the Motor Accident Injuries Act 2017

Insurers have specific obligations when managing claims. The objective of these is to optimise claimants' recovery from injury and resolve claims as quickly as possible.

The insurer is obliged to:

  • accept or deny liability for the claim within a prescribed timeframe under the Act

where liability is accepted:

  • commence payment of statutory benefits without delay
  • provide access to reasonable and necessary treatment, rehabilitation and care
  • make a reasonable offer of settlement of a damages claim as soon as practicable

Insurers managing claims are also required to comply with specific requirements which are contained in the:

Managing claims under the Motor Accidents Compensation Act 1999

Insurers  have specific obligations when managing claims. The objective of these is to optimise claimants' recovery from injury and resolve claims as quickly as possible.

The insurer is obliged to accept or deny liability for the claim and where the claim is accepted:

  • provide access to reasonable and necessary treatment, rehabilitation and care
  • make relevant payments
  • make a reasonable offer of settlement

Insurers managing claims are also required to comply with specific requirements which are contained in the:

Communication

Good communication and cooperation between the insurer, the injured person, their representative and treating health practitioners and others involved is important to assist in the injured person’s recovery and resolution of their claim.

Injury management and assessment

We have developed guidelines to promote best practice in managing some of the injuries that commonly occur in motor vehicle accidents.

Insurers should use evidenced based guidelines when considering requests for services for people with these injuries.

These can include:

For other advice see our Treatment Advice Centre pages:

Clinical framework

Insurers responsible for claimants with treatment, rehabilitation and care needs should be familiar with the nationally endorsed clinical framework for the Delivery of Health Services.

The framework sets out five guiding principles for health professionals to support the delivery of the right care at the right time to people with a compensable injury.  Insurers should consider these principles when reviewing treatment plans and requests for services:

  1. Measure and demonstrate the effectiveness of treatment.
  2. Adopt a biopsychosocial approach – that is consider the whole person.
  3. Empower the injured person to manage their injury.
  4. Implement goals focussed on optimising function, participation and return to work.
  5. Base treatment on the best available research evidence.

Workers compensation

This page has Fees Orders for workers compensation services as well as guidance material for licensed self and specialised insurers.

Fees Orders for workers compensation services

This list outlines maximum fees payable by employers or insurers when a worker uses medical or allied health services in association with their workers compensation claim.

2017 Fees Orders

You can find 2016 Fees Orders in our Resource Library.

Provider/assessor search

You can find a workers compensation provider/assessor here.

Market practice and premiums guidelines

The workers compensation market practice and premiums guidelines (MPPG) apply to premium filings provided to SIRA on or from 1 March 2017 until the guidelines are revised or revoked.

The MPPG includes:

The guidelines specify:

  • the minimum requirements for policies of insurance
  • how insurers are to present premium filings to the Authority (SIRA)
  • how the Authority (SIRA) will assess those filings.

Licensed insurer business plan guidelines

From 1 March 2017, the revised Workers compensation licensed insurer business plan guidelines (LIBPG) supersede the previous Licensed insurer business plan guidelines and will apply until rescinded, amended or replaced.

The business plan for each licensed insurer is to be prepared by 30 September in accordance with section 202B of the Workers Compensation Act 1987 (1987 Act) and must reflect the business plans for the financial year beginning 1 July.

The LIBPG sets out the minimum requirements for all licensed insurers in describing the manner in which their workers compensation insurance business will be conducted (including premiums, claims handling, management, expenses and systems).

The MPPG and LIBPG apply to all ‘licensed insurers’ as per the 1987 Act, including the Nominal Insurer and specialised insurers.

The MPPG and LIBPG do not apply to the following:

  • self-insurers
  • Self Insurance Corporation (SICorp)
  • Coal Mines Insurance.

Deemed Premium Calculation Methodology

For information on the calculation of deemed premium income for self-insurers and Comcare self insured employers, please see the Deemed Premium Calculation Methodology.