Insurer performance

CTP, workers compensation, and home building compensation insurers are governed by legislation, guidelines and licence conditions. Their performance needs to meet these requirements. SIRA provides frameworks for licensing, issues guidelines and works with insurers to build capability and improve performance.

On this page:

• CTP insurer supervision
• Workers compensation insurer supervision

CTP insurer supervision

SIRA monitors CTP insurer performance so that people injured on our roads are supported to recover. CTP insurers are held to account, legislative requirements are met, claims are managed justly and expeditiously, and benefits are delivered to the people of NSW.

SIRA monitors the compliance and performance of licensed insurers through its insurer supervision framework. In December 2021, SIRA communicated its 2022 to 2023 supervision priorities to insurers which include:

• Return to work/activity and value-based care outcomes for injured people
• Customer Service Conduct Principles
• Complaints handling and dispute management practice
• Pricing, underwriting and market practice
• Data quality and reporting

SIRA has focused its supervision through its core, thematic and remediation supervisory activities to hold insurers to account and ensure transparency to customers on the performance of the insurers.

Core supervision activities

Core supervision relates to the standard activities SIRA performs to monitor the compliance and performance of insurers, including:

• Business plan assessment
• Insurer metrics monitoring
• Complaints monitoring
• Significant matter assessment
• Co-regulatory engagement
• Stakeholder engagement

Thematic reviews

The CTP Insurer Conduct and Claims Assurance Program (ICCAP) is designed to review existing or emerging risks and issues with insurer compliance or performance where insurer performance cannot be identified through core supervision activities.

Remediation

SIRA assesses information and data received through its core and thematic supervision activities. Insurers are held to account for compliance and performance activities and required to perform remediation activities as required by SIRA. Expectations have been set out with insurers in relation to remediation plans and related reporting requirements.

Insurer Conduct and Claims Assurance Program

The Insurer Conduct and Claims Assurance Program (ICCAP) provides SIRA insight into insurer compliance and performance in the NSW Compulsory Third Party Insurance (CTP) scheme.

The ICCAP aligns with SIRA’s strategy to be a customer-centric, intelligence-led and risk-based regulator. The program is designed to conduct reviews based on existing or emerging risks and issues with insurer compliance or performance. The forward plan responds to themes raised in the three year Statutory Review of the CTP scheme. The ICCAP is conducted in addition to core supervision and individual insurer remediation activities.

SIRA publishes its annual assurance program and informs insurers ahead of these scheduled reviews, ensuring transparency in its approach. However, timeframes are indicative and subject to change as the ICCAP is designed to respond to emerging risks and issues. Outcomes from the reviews are published when completed.

Claims and Injury Management Assurance Program

From 2020 to 2021 SIRA implemented the Claims and Injury Management Assurance Program with a particular focus on three priorities: minor injury, liability decisions, and internal review and disputes

Internal review assurance activity

SIRA engaged an expert to conduct an independent, legal and impartial review of insurer claims files. The review focused on insurer management of the internal review process in accordance with the Motor Accidents Injuries Act 2017 (MAIA) and the Motor Accident Guidelines Version 5.1.

• Independent expert report on internal review processes - PDF (308.5KB)
• SIRA's response to independent report on internal review

Contributory negligence assurance activity

SIRA conducted a review of the application of contributory negligence threshold by licenced insurers in the 2017 scheme. The review had two components: a review of claims data where decision relating to contributory negligence was made on or before 30 November 2020 and interviews with 40 claims personnel across five NSW CTP scheme insurers.

• Contributory Negligence assurance activity: a review into Contributory Negligence

Workers compensation insurer supervision

SIRA monitors workers compensation insurers’ performance so that injured workers are supported to achieve the best possible return to work and recovery outcomes following a work-related injury, and employers receive an effective and sustainable service that mitigates the effects of workplace injuries. SIRA applies licensing and regulatory frameworks that ensures high performance standards across all insurers within the workers compensation system.

Insurer performance is administered through:

• regular engagement and feedback
• education and support
• building capability
• data analysis
• compliance and performance monitoring
• assessing risk and taking appropriate actions to address poor compliance or performance.

SIRA regulates four types of NSW workers compensation insurers, working with each insurer type to ensure that workers compensation risks are managed and mitigated and that the customer experience and outcomes for injured workers is improved. The four insurer types are:

• The Nominal Insurer (managed by icare) is funded by employers whose premiums meet the cost of claims. Claims are administered through Claims Service Providers engaged by icare.
• The Treasury Managed Fund (managed by icare) insures government self-insurers – who fund their own workers compensation claims.
• Specialised insurers that are funded by employers whose premiums meet the cost of claims in a specific industry.
• Self-insurers that fund and manage their own workers compensation claims.

Supervision priorities

Workers compensations supervision priorities have been determined for the 2022 to 2023 financial year to deliver improved outcomes for the people of NSW. SIRA will commence a new supervision priority each quarter. Regulatory action identified throughout a supervision priority may continue past the end of a quarter until SIRA is satisfied of the performance of the insurers or individual insurer