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Regulatory activity

SIRA publishes information about its regulatory actions including compliance activities, enforcement actions and prosecutions. This is done to advance transparency, accountability and confidence in the motor accidents, workers compensation and home building compensation schemes in NSW.

The quarterly regulatory updates below provide details of regulatory action against insurers, employers, healthcare providers and other regulated entities.

SIRA quarterly reports

SIRA quarterly regulatory update (ending 31 December 2021)

SIRA has published a summary of regulatory activity in the motor accidents, workers compensation and home building compensation schemes for the period 1 October to31 December 2021.

SIRA’s compliance and enforcement activities target the areas of highest risk. The actions taken are commensurate to the level of real or potential harm, the scope of non-compliance, the severity of wrongdoing and the need for deterrence. These regulatory activities are complemented by education and support initiatives to drive better outcomes for the people who make claims and hold policies in each of the schemes.

Regulation of motor accidents insurers

This infographic shows that at a glance there were 10 regulatory notices issued to CTP insurers, 6 formal remediation plans and 3 matters referred for further investigation.

SIRA regulates six licenced insurers in the NSW CTP Scheme: Allianz, NRMA Insurance, Suncorp (brands: AAMI and GIO), QBE, and Youi.

In the quarter ending 31 December 2021, SIRA issued 10 regulatory notices to CTP insurers. Of these notices, six were issued to NRMA, three to GIO and one to QBE.

SIRA directed NRMA to implement three formal remediation plans to oversee improved performance and compliance and referred three matters for further investigation. QBE were directed to implement three formal remediation plans to oversee improved performance and compliance.  As of 31 December 2021, across all insurers there were 14 remediation plans open, some of which remain ongoing since before the quarter.

The Independent Review Office (IRO) notified SIRA of 19 significant matters, resulting in eight regulatory notices being issued. SIRA’s memorandum of understanding with the IRO defines ‘significant matters’ as matters that include fraudulent conduct, a risk of substantial physical, mental health or financial harm to an injured person, aserious contravention of the law, or a serious breach of the Customer Service Conduct Principles or Guidelines.

In December 2021, SIRA wrote to all CTP insurers to advise its supervision focus for the next 12-18 months. SIRA requested that insurers consider these priorities in the development of their annual business plans to ensure a high level of compliance and better outcomes for injured people. The areas of SIRA’s supervision focus include:

  • Customer service conduct principles
  • Return to work/Return to activity and value-based care outcomes for injured people
  • Data quality and reporting, including data privacy and protection
  • Complaints handling and dispute management practice
  • Pricing, underwriting, and market practice

Detailed information on the regulatory notices issued and remediation plans requested in the quarter.

GIO

Date

Issue

Regulatory response

22/10/2021

Delay in first weekly benefit payment

Issued regulatory notice

17/12/2021

Error in Green Slip renewal notices

Issued regulatory notice

24/12/2021

Compliance with treatment and care decision timeframes

Issued regulatory notice

NRMA

Date

Issue

Regulatory response

11/11/2021

Failure to consider alternate Medicolegal providers closer to the injured person's place of residence

Issued regulatory notice

11/11/2021

Compliance issue pertaining to weekly payments of statutory benefits

Compliance with correct weekly payments of statutory benefits

Issued regulatory notice Requested remediation plan

SIRA investigation is ongoing

11/12/2021

Compliance with treatment and care decision timeframes associated with processing reimbursements

Issued regulatory notice Requested remediation plan

SIRA investigation is ongoing

12/11/2021

Delay in acknowledging and referring an application for internal review

Issued regulatory notice

12/11/2021

Failure to meet timeframes for providing liability decisions

Issued regulatory notice Requested remediation plan

SIRA investigation is ongoing

17/12/2021

Failure to demonstrate a proactive and expeditious approach to the determination of liability on claims for damages

Issued regulatory notice

QBE

Date

Issue

Regulatory response

07/10/2021

Delay in determining first liability decision

Requested remediation plan

07/10/2021

Premium price discrepancy

Requested remediation plan

18/10/2021

Compliance with treatment and care decision timeframes

Requested remediation plan

20/12/2021

Failure to demonstrate a proactive and timely approach in determining claims for damages liability

Issued regulatory notice

Regulation of workers compensation insurers

This demographic shows that at a glance there was 1 letter of caution issued to the Nominal Insurer, 9 Claims file reviews of self and specialised insurers, gathering data for the Treasury Managed Fund review and implementation of SIRA's return to work action plan

SIRA regulates four different types of workers compensation insurers: the Nominal Insurer (managed by icare), self-insurers, specialised insurers, and government self-insurers (the Treasury Managed Fund, managed by icare).

This quarter, there was a strong focus on return to work performance. In December 2021, SIRA announced a return to work action plan. As part of the action plan, SIRA required all workers compensation insurers to resubmit their business plans with detail on how they will improve return to work performance and commenced consultation on a new Standard of Practice.

Nominal Insurer

This quarter, SIRA continues to closely monitor the Nominal Insurer’s financial position and icare’s enterprise and improvement plans.

SIRA issued a letter of caution to the Nominal Insurer in response to delays in processing service provider invoicing.

Self and specialised Insurers

A series of reviews and performance meetings were held this quarter in accordance with the Self and Specialised Insurers Supervision Framework. Specifically, SIRA:

  • completed 24 annual reviews, which included the assessment of insurer annual business plans to ensure that insurers’ strategies align with the objectives of the workers compensation legislation
  • completed 19 security reviews, which entails an assessment of insurers’ current valuation of their current liability. These reviews resulted in 13 insurers increasing the security held, three insurers reducing the security held, and three remaining the same
  • completed nine claims file reviews, which are used to gain insight about how an insurer manages their workers compensation claims and facilitates recovery at work
  • reviewed nine insurers’ claims management self-audits.

Treasury Managed Fund

In October 2021, SIRA published the Terms of Reference for the Treasury Managed Fund (managed by icare) review. The objective of this review is to assess whether workers compensation activities for government agencies are being conducted effectively, economically, and in compliance with NSW workers compensation legislation. Over the quarter, SIRA commenced gathering data relevant to the scope of the review.

In December 2021, the scope of this review was expanded to include an audit of return to work performance. The expanded scope responds to Action 7 in SIRA’s return to work action plan.

Regulation of employers

This infographic shows at a glance that 1797 additional employees covered by NSW workers compensation, 30 penalty notices for non insurance, and 20 employer improvements notices

As a result of SIRA’s investigations into non-insurance this quarter, 481 businesses purchased a workers compensation policy. This means an additional 1,797 employees are now covered by workers compensation.

SIRA also issued 30 penalty notices for non-insurance and made 18 referrals to Revenue NSW to commence recovery action for $350,278 of double avoided premiums.

In the management of workplace injury obligations, SIRA issued 20 employer improvement notices for failure to establish a return to work program, failure to appoint a return to work coordinator, and failure to comply with an employer improvement notice.

Inspectors made 60 visits to employers with injured workers at risk of not returning to work.

SIRA’s apps and online support saw 881 visits to the ‘Have you been injured at work’ app and 510 visits to the Small business assist’ app. The online return to work coordinators training saw 709 new registrations, with 479 (68%) of those being employers.

Regulation of the home building compensation scheme

This infographic shows that at a glance there were 48 Home building compensation insurance policies reviewed and supervised the handling of claims following the collapse of a building company

In the home building compensation scheme, SIRA reviewed 48 policies of home building compensation insurance issued by the icare home building compensation fund (HBCF) this quarter. This review reported compliance with guideline requirements.

In November 2021, a major residential building company, Privium Group, went into voluntary administration and surrendered its contractor licence. SIRA maintained a high level of supervisory oversight to ensure that impacted homeowners were made aware of their entitlements and icare HBCF was providing timely and supportive claims management.

Regulation of healthcare providers

This infographic shows that at a glance 15667 SIRA approved healthcare providers, 1 authorised health practitioner was removed from the CTP scheme and 5 applications of healthcare providers were rejected.

At the end of December 2021, a total of 15,667 practitioners had SIRA approval to act as an authorised health practitioner, allied health practitioner, injury management consultant, or workplace rehabilitation provider in the motor accidents and workers compensation schemes.

SIRA removed one authorised health practitioner in the 2017 motor accidents scheme this quarter as they no longer met the eligibility requirements.

SIRA undertook an assessment of workers compensation workplace rehabilitation providers following the implementation of a new approval framework in September 2021. The new Workers Compensation workplace rehabilitation provider approval framework required all approved providers to renew their approval so that they could continue delivering services beyond 31 December 2021. SIRA did not approve two practitioners to continue delivering services in the NSW workers compensation scheme. Another four providers did not seek renewal of their approval to work in the scheme post 31 December 2021.

1 October 2021 to 31 December 2021

Motor accidents scheme

Workers compensation scheme

Authorised Health Practitioner

Allied Health Practitioners

Injury Management Consultants

Workplace Rehabilitation Providers

SIRA approved

9

156

0

87

Applied but not approved

2

0

1

2

Practitioner initiated cessation

1

5

1

0

SIRA initiated cessation

1

0

0

0

Total number of active practitioners at end of period

445

15,052

83

87

Workers compensation

Annual reports

NSW Workers Compensation System Regulatory Activity 2020-21

SIRA’s regulatory activities continue to be focused on areas of highest risk to injured people, policy holders and the workers compensation scheme. SIRA takes firm and fair enforcement action as needed, based on the severity of harm or potential harm, the degree of negligence, and/or the need for deterrence.

During the 2020-21 financial year SIRA maintained targeted compliance and enforcement activity alongside education and assistance initiatives to deliver on our strategic goals of improving customer experience and results, maintaining scheme and policy affordability, and building public trust.

Key regulatory activity for 1 July 2020 – 30 June 2021 included:

Employers

  • 3,119 businesses purchased a workers compensation policy after SIRA commenced non-insurance investigations. This reflects $7,052,103 in additional premium raised and 12,157 more employees now being covered by a workers compensation policy
  • $37,500 in penalty notices were issued under s155 of the Workers Compensation Act 1987 to businesses who were not insured (50 businesses received a notice for $750)
  • 39 referrals were made to Revenue NSW to commence recovery action for $843,604 of double avoided premiums under s156 of the Workers Compensation Act 1987
  • 91 notices were issued to employers who had failed to establish a return-to-work program, failed to appoint a return-to-work coordinator, or not provided suitable work pursuant to the Workplace Injury Management and Workers Compensation Act 1998
  • 2 penalty notices were issued to employers who failed to comply with employer improvement notices
  • Inspectors made 177 visits to employers with injured workers at risk of not returning to work (as identified through predictive modelling).
  • 139 complaints regarding employers not providing suitable work were referred for investigation
  • The SIRA Contact Centre received 303 complaints that related to employers’ behaviour and alleged non-compliance, with 49% alleging non-compliance with legislative obligations and 22% related to employer behaviour and engagement
  • 4,463 visits were made to the SIRA Have you been injured at work app
  • 1,659 visits were made to the Small business assist app
  • 3,579 new registrations were lodged for the free online RTW (Return to Work) Coordinator training, of which 2,558 (71%) were employers

Insurers

  • SIRA commenced an audit of the Workers Compensation Insurance Fund (WCIF) to assess compliance with s154E(2) of the 1987 Act

Nominal Insurer

  • SIRA released a 21-Point Action Plan (the Plan) in January 2020 which addressed the key issues identified in the compliance and performance review of the Nominal Insurer completed in 2019. Over the 2020-21 financial year SIRA and icare have worked collaboratively to complete 15 of the 21 actions from the Plan. Some outstanding actions have been deferred due to the impact of the COVID pandemic
  • Following focus on its performance and culture, icare has developed an Improvement Plan incorporating recommendations and findings of recent reviews (The 2020 review of the Workers Compensation Scheme undertaken by the NSW Standing Committee on Law & Justice and the Independent review of icare and State Insurance and Care Governance Act undertaken by the Hon Robert McDougall QC). SIRA has established regular monitoring against milestones and anticipated improvements within the plan
  • SIRA commenced audits of claims management by the Nominal Insurer and an audit of icare’s pre-injury average weekly earnings (PIAWE) calculations and compliance with workers compensation legislation

Self and Specialised Insurers

  • SIRA granted seven new self-insurer licences
  • SIRA granted nine licence renewals
  • Two self-insurers had a shorter 12-month licence extension granted and special licence conditions imposed due to financial concerns and claims data performance issues
  • One specialised insurer had special licence conditions placed on its licence in order to drive improvements in its claims management performance. The insurer is subject to increased reporting and regular claim file reviews throughout the term of its licence to monitor improved performance
  • A self and specialised insurer self-assessment for weekly payments of compensation was undertaken. The self-assessment reviewed actions taken by all insurers in response to a claim for weekly payment to ensure the appropriateness of actions taken to gather information to determine PIAWE – including considering accuracy, timeliness, and governance
  • One specialised insurer had special licence conditions placed on its licence
  • SIRA launched ‘supervision priorities’ to review and drive improvement in identified areas of risk. The priority of focus was building insurer capability in relation to the application of a Reasonable Excuse and Date Claim Made
  • Two performance and claims file reviews were conducted
  • 29 annual reviews of self-insurers were completed
  • 17 regulatory reviews in relation to premium disputes between employers and their insurers were resolved, of which nine arose from claims management issues
  • Three performance audits were conducted on self and specialised insurers
  • Two audits were conducted with selected insurers to assist in testing a new claims management audit tool, which was recently updated to align with the current workers compensation guidelines and standards of practice

Providers

  • SIRA suspended the approval of 340 allied health providers to deliver services in the workers compensation scheme, for failing to meet the approval criteria
  • 228 enquiries and complaints were investigated
  • SIRA conducted one onsite visit to a medical practice to obtain information and investigate potential provision of treatment outside of NSW workers compensation legislation
  • SIRA engaged with two medical specialists; one regarding delivery of a pain management program within the NSW workers compensation scheme and, the other remaining within the delegated parameters when acting as an Injury Management Consultant
  • Ongoing liaison with Health Care Complaints Commission regarding SIRA referral of an allied health practitioner and a medical practitioner for investigation of their conduct
  • SIRA conducted five desktop evaluations of workplace rehabilitation provider conformance with the Conditions of Approval. This led to:
    • two workplace rehabilitation providers being requested to submit quarterly corrective action plans to ensure continuous improvement against the Conditions of Approval
    • escalated regulatory action resulting in an onsite evaluation of a workplace rehabilitation provider being scheduled for FY2021-22
  • SIRA engaged with 14 medical imaging providers and 7 imaging provider business entities regarding evidence of non-compliance with SIRA requirements such as maximum fee levels or billing rules
  • After receiving complaints about some Accredited Exercise Physiologists against the Guidelines for treating allied health practitioners, SIRA conducted a review of all accredited exercise physiologists’ billing against the requirements outlined in the workers compensation Accredited Exercise Physiology Fees Order
  • SIRA investigated three complaints concerning two General Practitioners. Their provider processes and standards when working in the NSW Workers Compensation System were examined
  • Letters were sent to three allied health practitioners addressing communication issues within the Independent Consultant framework

Other enforcement & prosecutions activity

  • 272 referrals for investigation were received
  • There are 27 active investigations into alleged contraventions of the Workers Compensation Insurance legislation
  • One health provider has been referred to the NSW Police Force for investigation
  • Two Court Attendance Notices have been registered by the Court for prosecution

NSW Workers Compensation System Regulatory Activity 2019-20

During the 2019-20 financial year SIRA maintained targeted compliance and enforcement activity in order to deliver on our strategic goals of improving customer experience and results, maintaining scheme and policy affordability, and building public trust.

Our regulatory activity over the last few months was affected by the need to respond to the issues arising from the COVID-19 pandemic. SIRA adapted the way we engage with insurers, providers and stakeholders in the scheme in order to comply with the COVID-19 restrictions established by Government.

SIRA’s regulatory activities continue to be focused on areas of highest risk to injured people, policy holders and the workers compensation scheme. SIRA takes firm and fair enforcement action as needed, based on the severity of harm or potential harm, the degree of negligence, and/or the need for deterrence.

Previous Regulatory Activity Bulletins have included some figures for the pilot phases of compliance and enforcement programs which were undertaken in 2018-19. This has meant that some figures from the previous financial year were included in those Bulletins which reported on later phases of those programs. Any variances have now been accounted for and verified key compliance and enforcement activity for 2019-20 is summarised below:

Employers:

  • 10,190 businesses purchased a workers compensation policy after SIRA commenced non-insurance investigations. This reflects $13.33 million in additional premium raised and 30,288 more employees now being covered by a workers compensation policy.
  • $408,000 in penalty notices issued under s155 of the Workers Compensation Act 1987 to businesses who were not insured.
  • 26 referrals were made to Revenue NSW to commence recovery action for $1,043,716 of avoided premiums under s156 of the Workers Compensation Act 1987.
  • 103 notices were issued to employers who had failed to establish a return to work program, failed to appoint a return to work coordinator, or not provided suitable work pursuant to the Workplace Injury Management and Workers Compensation Act 1998.
  • 425 visits were made by inspectors to employers with injured workers at risk of not returning to work (as identified through predictive modelling).
  • 152 complaints regarding employers not providing suitable work were referred for investigation.

Insurers:

  • SIRA issued 24 civil penalties of $5,500 each (totalling $132,000) against the Nominal Insurer, managed by icare, for failure to commence weekly payments in line with s267 of the Workplace Injury Management and Workers Compensation Act 1998 (1998 Act).
  • SIRA issued five civil penalties of $5,500 each (totalling $27,500) and five civil penalties of $11,000 (totalling $55,000) on the Nominal Insurer for failure to apply the 30 per cent cap to premium rate increases for employers, as required by the Market Practice and Premium Guidelines.
  • A compliance and performance review of the Nominal Insurer was finalised in December 2019. The review found that the deterioration in the performance of the Nominal Insurer is largely attributable to the new claims model implemented by icare in January 2018. SIRA released a 21-Point Action Plan which addresses the key issues identified in the review.
  • SIRA issued a letter of censure to icare following failure to comply with a direction requiring compliance with the provision of scheme data related to return to work data items.
  • SIRA required the provision of information/data from the Nominal Insurer under s40C of the Workplace Injury Management and Workers Compensation Act 1998 in order to review PIAWE risk, as detailed in issue 87 4/2020 of the workers compensation regulation bulletin.
  • A self and specialised insurer self-assessment for weekly payments of compensation was undertaken. The self-assessment reviewed actions taken by 10 insurers in response to a claim for weekly payment to ensure the appropriateness of actions taken to gather information to determine PIAWE – including considering accuracy, timeliness and governance.
  • Three performance audits were conducted on self and specialised insurers.
  • Two audits were conducted with selected insurers to assist in testing a new claims management audit tool, which was recently updated to align with the current workers compensation guidelines and standards of practice.
  • SIRA issued 86 notices under the Workplace Injury Management and Workers Compensation Act 1998 to obtain information for suspected breaches of the 1998 Act.
  • SIRA issued 204 notices under s238AA of the Workplace Injury Management and Workers Compensation Act 1998 to require insurers to provide claims information.
  • SIRA issued formal warnings to 10 self and specialised insurers for claims information licence breaches.
  • Special licence conditions were imposed on renewed licences for two self-insurers as a result of SafeWork NSW investigations.
  • One self-insurer was notified of SIRA’s intent to impose new licence conditions due to claims information provision licence breaches.
  • One self-insurer had special licence conditions imposed on their renewed licence as a result of financial concerns.
  • One specialised insurer was issued with two penalty notices in the amount of $500 each due to legislative breaches.  The same specialised insurer had a shorter 12-month licence extension granted and two special licence conditions imposed due to claims performance issues.
  • One self-insurer had a shorter 12-month licence extension granted and special licence conditions imposed due to financial concerns and claims data performance issues
  • One self-insurer’s licensing tier was downgraded from top tier to mid-tier.
  • Two self-insurers had their tier moved to ‘Under review’ due to ongoing wage underpayments concerns.
  • SIRA granted six new self-insurer licences.
  • SIRA extended 16 self-insurer licences due for renewal in 2020 for a 12-month period to reduce regulatory burden during the COVID-19 crisis.

Providers:

  • SIRA issued 49 caution letters to medical practitioners/providers regarding compliance obligations.
  • Two practitioners/provider compliance visits were made to obtain information under powers.
  • Investigations were conducted into two providers due to suspected duplicate invoicing, overcharging and over-servicing.
  • Investigations were conducted into one provider for failing to comply with SIRA inspectors. The same provider was also suspended from operating in the NSW workers compensation system as it no longer meets SIRA’s approval criteria for allied health practitioners.
  • SIRA suspension or revoked approval for 116 allied health providers.
  • Warning letters were issued to three medical practitioners and specialists regarding non-compliance with Fees Orders.
  • SIRA conducted meetings with two medical practitioners to address billing non-compliance.
  • Article published in AMA members publication regarding SIRA’s increased provider supervision focus.
  • SIRA made a referral to the Legal Services Commissioner regarding the business practices of a legal firm in relation to industrial deafness claims.
  • SIRA made two referrals to the Health Professional Councils Authority regarding conduct of health practitioners in the workers compensation system.
  • SIRA sent 83 letters to allied health practitioners for anomalous billing of duplicate and over-payments above maximum fee orders.

Quarterly reports

Key activity between 1 July - 30 September 2021

SIRA continues to target its enforcement activities on areas of highest risk. SIRA takes firm enforcement action which is commensurate to the level of real or potential harm, the scope of the non-compliance (e.g., whether it is systemic), the severity of the wrongdoing, and the need for general or specific deterrence.

These regulatory activities are complemented by education and support initiatives. Together these contribute to our strategic goals of improving customer experience and results, maintaining scheme and policy affordability, and building public trust.

Regulatory, education and support activities for the period 1 July – 30 September 2021 include:

Employers:

  • 778 businesses purchased a workers compensation policy after SIRA commenced non-insurance investigations. This reflects over $2,608,122 in additional premium raised and 3,061 more employees now being covered by a workers compensation policy
  • SIRA issued 121 penalty notices each for the value of $750 under s155 of the Workers Compensation Act 1987 for non-insurance totalling $90,750
  • SIRA made 78 referrals to Revenue NSW to commence recovery action for $1,102,351 of double avoided premiums under s156 of the Workers Compensation Act 1987.

Workplace injury management obligations:

  • 15 notices were issued to employers who had failed to establish a return-to-work program, failed to appoint a return-to-work coordinator, or not provided suitable work pursuant to the Workplace Injury Management and Workers Compensation Act 1998
  • Inspectors made 78 visits to employers with injured workers at risk of not returning to work
  • 263 letters were sent to employers with injured workers at risk of not returning to work
  • The SIRA Contact Centre received 55 complaints that related to employers’ behaviour and alleged non-compliance, with 38% alleging non-compliance with their return to work and suitable employment legislative obligations and 25% related to employer behaviour and engagement.

SIRA supports and resources:

  • 1,199 visits were made to the SIRA Have you been injured at work app
  • 697 visits were made to the Small business assist app
  • 921 new registrations were lodged for the free online RTW (Return to Work) Coordinator training, of which 567 (61.56%) were employers.
  • 6,800 subscribers received the Return to Work Insider publication each month
  • 615 workers used SIRA funded programs (July 2021 to September 2021) with a total spend of $1,609,115. The majority of the spend ($1,075,568) was for the JobCover Placement Program.

Insurers:

  • SIRA has provided guidance to insurers on the application of presumptive legislation and vaccine related claims
  • SIRA is undertaking risk analysis against all workers compensation insurers to consider potential financial and operational impact from a potential increased volume of COVID-19 claims
  • SIRA required insurers to confirm COVID-19 business continuity plans were in place.

Nominal Insurer

  • SIRA reviewed the icare Nominal Insurer Improvement Plan and scheduled monthly supervisory meetings
  • SIRA convened supervisory meetings covering complaints, return to work performance, financial sustainability, claims management and other focus areas
  • SIRA stress tested the Nominal Insurer 2021/22 business plan and provided recommendations to icare
  • SIRA commenced onboarding icare to the SIRA Insurer Accountability Portal.

Self and Specialised Insurers

  • SIRA conducted regular insurer supervision performance reviews
  • 105 insurer performance meetings held
  • 10 self-insurers were subject to a PIAWE file review
  • Three insurers were subject to claims file reviews
  • SIRA granted one new self-insurer licence
  • SIRA granted seven licence renewals
  • 71 insurers provided monthly performance data
  • Two insurers received performance letters
  • Six insurers were required to submit an improvement plan.

Providers:

  • SIRA has maintained ongoing supervision of workplace rehabilitation providers, including four with corrective action plans
  • A remote evaluation of a workplace rehabilitation provider was undertaken to assess their performance against the conditions of approval, resulting in the provider submitting quarterly corrective action plans
  • SIRA investigated and initiated regulatory action against two medical practitioners and one workplace rehabilitation provider
  • SIRA is in discussions with a peak association regarding outlier provider billing.

Other enforcement action:

  • Successful prosecution for fraud of approximately $108,000 under the Crimes Act 1900 on 29 September 2021 where the defendant was sentenced to a two-year Community Correction Order and was ordered to make restitution of the defrauded amount to the Workers Compensation Insurance Fund. A further matter is before the courts for an alleged fraud in the amount of $222,000.

Key activity between 1 October 2020 - 31 January 2021

SIRA’s regulatory activities continue to be focused on areas of highest risk. SIRA takes firm and fair enforcement action as needed, based on the severity of harm or potential harm, the degree of negligence, and/or the need for deterrence.

These regulatory actions, along with education and support initiatives, contribute to SIRA’s strategic goals of improving customer experience and results, maintaining scheme and policy affordability, and building public trust.

Regulatory actions and education and support activity for the period 1 October 2020 – 31 January 2021 include:

Employers:

  • 648 businesses purchased a workers compensation policy after SIRA commenced non-insurance investigations. This reflects over $1.3 million in additional premium raised and 2,218 more employees now being covered by a workers compensation policy.
  • SIRA issued nine penalty notices each for the value of $750 under s155 of the Workers Compensation Act 1987 for non-insurance.
  • SIRA made referrals to Revenue NSW to commence recovery action for $176,001 of avoided premiums (under s156 of the Workers Compensation Act 1987).
  • Two fines were issued for failing to pay workers compensation policies totalling $86,306.07 (known as double avoided premiums).
  • 24 employer improvement notices were issued to employers who had failed to establish a return to work program, failed to appoint a return to work coordinator, or not provided suitable work as required by the Workplace Injury Management and Workers Compensation Act 1998.
  • One penalty notice was issued to an employer who failed to comply with an employer improvement notice.
  • 60 proactive visits to employers with injured workers at risk of not returning to work (as identified through predictive modelling).
  • SIRA’s Customer Service Team responded to 105 complaints related to employer practices, with 47% alleging non-compliance with legislative obligations and 26% related to employer behaviour and engagement.
  • Four roundtable discussions were held with industry peak bodies to collaborate and share insights on workers compensation non-insurance in NSW.
  • There were 906 new registrations for the free online Return to Work Coordination Training, with 656 users identifying as an employer
  • There were 509 visits to the  Small business assist tool and 1,290 visits to the Have you been injured at work? tool.

For more information about these tools visit Return to work coordination training small business assist and have you been injured at work.

Insurers:

  • SIRA commenced an audit of icare’s pre-injury average weekly earnings (PIAWE) calculations and compliance with workers compensation legislation.
  • SIRA commenced an audit of the Workers Compensation Insurance Fund (WCIF) to assess compliance with s154E(2) of the 1987 Act.
  • SIRA convened monthly assurance and oversight meetings with icare covering topics such as premiums, prudential management, claims management, return to work and data quality.
  • Seven private ruling applications were finalised with two determinations issued to employers. These determinations constitute legally binding decisions as to whether a person performing work is a worker, a deemed worker or an independent contractor for the purposes of workers compensation premium calculation.
  • 17 regulatory reviews in relation to premium disputes between employers and their insurers were resolved, of which nine were arising from claims management issues.

Providers:

Provider approval to operate in the NSW workers compensation system:

  • 295 allied health practitioners were approved;
  • 206 approvals were revoked;
  • one approval was suspended;
  • seven approvals were reactivated.

Key activity between 1 February 2020 and 1 May 2020

Employers:

  • For this reporting period, 2,767 businesses purchased a workers compensation policy after SIRA commenced non-insurance investigations. This reflects $2.58 million in additional premium raised and 5,537 more employees now being covered by a workers compensation policy. This financial year, SIRA has generated $11.84 million in policy premiums and covered an additional 25,887 NSW workers by targeting uninsured businesses.
  • During this reporting period, $84,750 in penalty notices issued to businesses who were not insured.
  • During this reporting period, $62,320 was collected from businesses as a further penalty for failing to purchase a workers compensation policy.
  • 7 referrals were made to Revenue NSW to commence recovery action for $210,330 of avoided premiums under s156 of the Workers Compensation Act 1987.
  • 13 notices were issued to employers who had failed to establish a return to work program, failed to appoint a return to work coordinator, or not provided suitable work pursuant to the Workplace Injury Management and Workers Compensation Act 1998.
  • 231 visits were made by inspectors to employers with injured workers at risk of not returning to work (as identified through predictive modelling).
  • 35 complaints regarding employers not providing suitable work were referred for investigation.
  • In response to complaints about not providing suitable work, 5 businesses were issued notices to provide information.

Insurers:

  • A quarterly conduct and compliance audit of the Nominal Insurer (icare) was undertaken under s202A of the Workers Compensation Act 1987 pursuant to implementation of the 21-Point Action Plan. The action plan is SIRA’s response to the Compliance and Performance Review of the Nominal Insurer (managed by icare).
  • SIRA requested information/data from the Nominal Insurer under s40C of the Workplace Injury Management and Workers Compensation Act 1998 in order to review PIAWE risk.
  • A self and specialised insurer self-assessment for weekly payments of compensation has been undertaken. The self-assessment reviewed actions taken by 10 insurers in response to a claim for weekly payment to ensure the appropriateness of actions taken to gather timely information to determine PIAWE, accuracy, timeliness and governance.  SIRA is currently reviewing the results.

Providers:

  • Four allied health practitioners had approval to operate in the NSW workers compensation system revoked (as at 18 June 2020).
  • One referral to the Legal services commissioner regarding business practices of a legal firm in relation to industrial deafness claims.
  • Two referrals to the Health Professional Councils Authority regarding conduct of health practitioners.

Key activity between 22 November 2019 and 31 January 2020

Employers:

  • 1,205 businesses purchased a workers compensation policy after SIRA commenced investigations for being uninsured. This reflects $1.6M in additional premium raised and 4,475 more employees now being covered by a workers compensation policy. To date, SIRA has generated $9.39 million in policy premiums and covered an additional 20,350 NSW workers by targeting uninsured businesses.
  • $19,500 in penalty notices issued to businesses who were not insured.
  • $146,607 collected from businesses as a further penalty for failing to purchase a workers compensation policy.
  • SIRA inspectors visited 149 businesses checking workers compensation insurance coverage as per s238 of the Workplace Injury Management and Workers Compensation Act 1998 which relates to powers of entry by an inspector.
  • 16 notices were issued to employers who had failed to establish a return to work program, failed to appoint a return to work coordinator, or not provided suitable work.
  • A further 13 complaints regarding employers not providing suitable work were investigated by SafeWork NSW inspectors under delegations from SIRA.

Providers:

  • One chiropractor and one psychologist had their approvals to operate in the NSW workers compensation system suspended for failing to meet SIRA requirements under the Workers Compensation Act 1987.
  • Warning letters were issued to three medical practitioners and specialists regarding non-compliance with Fees Orders.
  • Insurers were advised how to reduce the potential for fraudulent medical provider behaviour.

Insurers:

  • report from the independent review into Compliance and Performance of the Nominal Insurer (managed by icare) was released in December 2019.
  • As a result of the review SIRA published a 21-point action plan.
  • Penalties totalling $82,500 were imposed on the Nominal Insurer (managed by icare) for failure to comply with the Workers Compensation Market Practice and Premiums Guidelines capping requirements.
  • The Nominal Insurer (managed by icare) was issued with a letter of censure for non-compliance with a direction issued by SIRA in relation to data accuracy requirements in accordance with the Workers Compensation Act 1987.
  • Six directions for security deposit increases were made to self-insurers under s213 of the Workers Compensation Act 1987.
  • SIRA granted the Coles Group Pty Ltd a one-year licence renewal term and requires data quality issues to be remedied.
  • SIRA imposed a special licencing condition on Catholic Church Insurance to ensure a corrective action plan is implemented to improve case management practices.

Key activity between 11 September 2019 and 22 November 2019

Employers

  • 11,169 businesses contacted by SIRA for potentially operating without the required workers compensation policy.
  • $135,750 in penalty notices issued to employers failing to take out compulsory workers compensation insurance.
  • 2,685 new workers compensation policies taken out by employers following SIRA regulatory intervention. This has resulted in approximately
  • $3.9M in additional premium raised from employers detected by SIRA as not having workers compensation insurance, and 7,578 more employees being covered by a workers compensation policy.
  • 17 referrals made to Revenue NSW to commence recovery action for $246,584 of avoided premiums under s156 of the Workers Compensation Act 1987.
  • One penalty notice for $500 was issued to an employer for failure to comply with a s174 Order under the Workers Compensation Act 1987 which relates to keeping and supplying records of wages and contracts.
  • 15 complaints regarding employers not providing suitable work were responded to by SafeWork NSW under delegations from SIRA. Of these, one employer was issued with a notice under s49 of the Workplace Injury Management and Workers Compensation Act 1998 requiring them to provide suitable work.
  • 19 notices were issued to employers for either failing to establish a return to work program or failing to appoint a return to work coordinator.
  • Three employers were the subject of return to work disputes which required further information to be sought to assist inspectors to make a determination. SIRA-authorised inspectors used powers under s238AA of the Workplace Injury Management and Workers Compensation Act 1998 to obtain information in relation to these return to work matters.

Providers

  • SIRA revoked its approval of 90 Allied Health Providers (AHPs) who no longer comply with SIRA requirements. Reasons included the provider no longer registered on the AHPRA (Allied Health Practitioner Regulation Agency) website.
  • SIRA revoked its approval for one AHP after they were found guilty of professional misconduct by the NSW Civil and Administrative Tribunal, which led to cancellation of the provider's registration as a physiotherapist.
  • SIRA detected a chiropractor with allegedly non-compliant billing practices and used its powers to require the provision of information as part of its investigation. SIRA is now requiring this provider to show cause as to why SIRA should not suspend or revoke the chiropractor’s approval as a workers compensation allied health practitioner.
  • SIRA detected a provider overcharging for services and the intervention resulted in the recovery of $154,552.

Insurers:

  • In February 2019, after having identified a deterioration in the performance of the Nominal Insurer, SIRA commissioned Ms Janet Dore as an independent reviewer to conduct a Compliance and Performance Review into the Nominal Insurer. That Review is presently in its final stages with the report of the independent reviewer due to be published by SIRA by the end of the year.
  • Three formal warnings were issued to insurers for breach of licence conditions pursuant to s181 of the Workers Compensation Act 1987. Those breaches involved failures to provide timely and/or accurate claims data to SIRA.
  • SIRA is currently reviewing the performance tier for self-insurer Woolworths in accordance with SIRA’s tiering guidelines.
  • SIRA conducted audits of icare and Toll Holding as per s202A of the Workers Compensation Act 1987.
  • Twelve directions for security deposit increases were made to self-insurers under s213 of the Workers Compensation Act 1987.
  • SIRA imposed a special licencing condition on Catholic Church Insurance as a result of a case management audit.

Key activity between 1 July 2019 and 10 September 2019

Employers

  • 155 penalty notices approved for the amount of $750 each, issued pursuant to s155 of the Workers Compensation Act 1987, for employers failing to take out compulsory workers compensation insurance.
  • $3.4M in additional premium raised, from employers detected by SIRA as not having workers compensation insurance.
  • 4,556 additional employees now covered by workers compensation insurance (noting that icare does provide cover in the event of a business failing to have a workers compensation insurance policy).

Providers

  • 49 caution letters sent to medical practitioners/providers regarding compliance obligations.
  • Seven education letters sent to insurers to leverage practitioner/provider compliance.
  • One medical practitioner and one allied health practitioner subjected to SIRA site visits using powers under s238AA of the Workplace Injury Management and Workers Compensation Act 1998 to obtain information.
  • Two providers subjected to SIRA’s investigative powers pursuant to s238AA of the Workplace Injury Management and Workers Compensation Act 1998, due to suspected duplicate invoicing, overcharging and over-servicing.
  • Investigations commenced against one provider for failure to comply with SIRA inspectors under s238 of the Workplace Injury Management and Workers Compensation Act 1998. Potential maximum penalty of $11,000.

Insurers

  • 86 notices issued under section 40B of the Workplace Injury Management and Workers Compensation Act 1998 (data gathering power) to obtain information for suspected legislative breaches.
  • Two insurers, Catholic Church Insurance Limited and Veolia Environmental Services (Australia) Pty Ltd, notified of SIRA’s intention to impose new licence conditions.
  • Catholic Church Insurance Limited was issued three penalty notices with respect to non-compliance with claims management practices within their portfolio.
  • Civil penalties imposed on the Nominal Insurer in relation to 24 breaches of s267 of the Workplace Injury Management and Workers Compensation Act 1998 (duty to commence weekly payments following initial notification of injury).
  • Direction notice issued to the Nominal Insurer under s194 of the Workers Compensation Act 1987 (directions to insurers with respect to claims procedures) requiring compliance with Return to Work data items from 1 August 2019.
  • Nine formal warnings issued for breach of licence conditions pursuant to section 181 of the Workplace Injury Management and Workers Compensation Act 1998, in respect of the failure to provide timely and/or accurate claims data to SIRA:
    • Coles Group Limited
    • Racing NSW
    • Inghams Enterprises Pty Ltd
    • Statecover Mutual Limited
    • Toll Holdings Limited
    • Central Coast Council
    • NSW Trains
    • Boral Limited
    • Bluescope Steel Limited.
  • Five notices issued under s238AA of the Workplace Injury Management and Workers Compensation Act 1998 (notice served by an inspector, with the power to obtain information) in relation to claims information.

Motor accidents

Quarterly reports

Motor accidents regulatory update for 1 July - 30 September 2021

Latest motor accidents regulatory update

An overview of SIRA’s regulatory actions in the CTP scheme is now available for the third quarter of 2021.

Insurers

SIRA regulates six licenced insurers in the NSW CTP Scheme: Allianz, NRMA, Suncorp (brands: AAMI and GIO), QBE and Youi. Youi is a recent entrant to the CTP scheme with their licence being granted in December 2020.

Regulatory activity – 1 July 2021 to 30 September 2021

  • SIRA issued 12 regulatory notices in the quarter, bringing the calendar year to date total to 28
  • Eight remediation plans from CTP insurers were ongoing as at the end of this quarter
  • Insurers completed 8 remediation plans in this quarter (including plans started prior to 1 July 2021)
ItemALLIANZAAMIGIONRMAQBEYOUI

Regulatory notice issued in the period

1

2

1

1

7

0

Remediation plans open in the period

2

1

1

2

2

0

Remediation plans closed in the period

1

1

1

2

3

0

  • SIRA has issued 28 regulatory notices and requested 16 remediation plans from CTP insurers as at 2021
  • Insurers completed 22 remediation plans in 2021, as at 30 September.

Detailed summary of current insurer regulatory activity

*Please note that some matters relate to issues identified that have ongoing remediation and/or investigations from the previous calendar year.

Insurer detailed information

Allianz

Allianz were issued one regulatory notice between 1 July 2021 and 30 September 2021. Allianz had two ongoing remediation plans, and one remediation plan was completed. Details are outlined in the table below.

Matter
Regulatory notice
Notice issued
Regulatory activity

Communication of entitlements (MAIA)

Communicating a potential entitlement to claim damages

03/08/2021

Remediation and investigation ongoing

Incorrect premiums (MAIA)

Premiums not charged in accordance with approved filings

17/06/2021

Remediation and investigation ongoing

Internal review assurance activity (MAIA)

Non-compliance with internal review requirements

5/04/2021

Remediation completed

AAMI

AAMI received two regulatory notices between 1 July 2021 and 30 September 2021, one of which required remediation. One remediation plan was completed and one is ongoing. Details are outlined in the table below.

Matter
Regulatory notice
Notice issued
Regulatory activity

CTP Greenslip refund timeframes (MAIA)

Delay in issuing a refund for an unused CTP policy

15/09/2021

No further action required

Communication of entitlements (MAIA)

Communicating a potential entitlement to claim damages

3/08/2021

Remediation and investigation ongoing

Internal review assurance activity (MAIA)

Non-compliance with internal review requirements

5/04/2021

Remediation completed

GIO

GIO received one regulatory notice between 1 July 2021 and 30 September 2021 and completed one previous remediation plan. Details are outlined in the table below.

Matter
Regulatory notice
Notice
issued
Regulatory activity

Communication of entitlements (MAIA)

Communicating a potential entitlement to claim damages

3/08/2021

Remediation and investigation ongoing

Internal review assurance activity (MAIA)

Non-compliance with internal review requirements

05/04/2021

Remediation completed

NRMA

NRMA received one regulatory notice between 1 July 2021 and 30 September 2021. Two remediation plans were completed, and two remediation plans were ongoing. Details are outlined in the table below.

Matter
Regulatory notice
Notice issued
Regulatory activity

Communication of entitlements (MAIA)

Communicating a potential Award of Damages entitlement

3/08/2021

Remediation and investigation ongoing

Internal review assurance activity (MAIA)

Non-compliance with internal review requirements

5/04/2021

Remediation completed; investigation ongoing

Data Integrity

UCD Fault Determination

25/11/2020

Remediation completed

Incorrect weekly benefits payments (MAIA)

System error resulting in miscalculation of weekly benefits

30/10/2020

Remediation and investigation ongoing

QBE

QBE received seven regulatory notices between 1 July 2021 and 30 September 2021. Six remediation plans are ongoing and three have been completed. Details are outlined in the table below.

Matter
Regulatory notice
Notice issued
Regulatory activity

Injury coding timeframes (MAIA)

Failure to meet injury coding timeframe requirements

24/08/2021

Remediation ongoing

Timeliness of decisions (MAIA)

Delay in providing treatment decisions

28/09/2021

Remediation and investigation ongoing

Incorrect premiums (MAIA)

Premiums not calculated in accordance with approved filings

17/09/2021

Remediation and investigation ongoing

Timeliness of decisions (MAIA)

Delay in providing a liability decision

17/09/2021

Remediation and investigation ongoing

Communication of entitlements (MAIA)

Communicating a potential Award of Damages entitlement

3/08/2021

Remediation and investigation ongoing

Incorrect weekly benefits payments (MAIA)

Incorrect application of indexation to weekly benefits

13/07/2021

Remediation completed; investigation ongoing

E-Greenslip timeframes (MAIA)

Failure to transmit CTP policies to Transport for NSW within timeframes

30/07/2021

No further action required

Internal review assurance activity (MAIA)

Non-compliance with internal review requirements

5/04/2021

Remediation completed; investigation ongoing

Communication of entitlements (MAIA)

Communicating a potential Award of Damages entitlement

3/08/2021

Remediation and investigation ongoing

Timeliness of decisions (MAIA)

Delay in providing a decision in relation to a treatment request and delay in providing a liability decision

25/03/2021

Remediation completed and investigation ongoing

Youi

No issues identified.

Significant matters notified to SIRA from Independent Review Office (IRO)

IRO notified 27 significant matters to SIRA between 1 July to 30 September 2021. Significant matters are defined in the Memorandum of Understanding.

Authorised Health Practitioner activity – summary of recent activity

A total of 435 practitioners were published as active as of 30 September 2021. During the quarter two practitioners ceased in the role, and SIRA received14 applications and approved 8 practitioners.

Item1 July to 30 September 20211 January 2021 to 30 September 2021

Applications received

14

53

Approved

8

37

Applications pending

2

2

Unsuccessful

212

Authorisation ceased

2

3

Total of number of active practitioners at end of period

435

435

Previous activity

Motor accidents regulatory update for 1 April - 4 August 2021

Latest motor accidents regulatory update

Detail on regulatory actions taken are now available for the second quarter of 2021 (financial year quarter 1 April 2021 to 30 June 2021). This update includes additional year to date data and information.

SIRA regulates six licenced insurers in the NSW CTP Scheme: Allianz, NRMA, Suncorp (brands: AAMI and GIO) and QBE. Youi was granted a licence and commenced in the scheme on 1 December 2020.

Regulatory activity - 1 April 2021 to 4 August 2021*

Overview of insurer regulatory activity from 1 April 2021 to 4 August 2021. Including a collective summary of total figures for the year to date given the additional reporting outside of the usual reporting quarter.

Item

ALLIANZ

AAMI

GIO

NRMA

QBE

YOUI

Regulatory notice issued in the period

4

3

3

4

4

0

Remediation plans open in the period

2

1

1

1

2

0

Remediation plans closed in the period

0

3

4

0

0

0

  • SIRA issued a total of 18 regulatory notices in the quarter, bringing the year to date total to 23 (Jan-4 Aug 2021)
  • Seven remediation plans were opened during this period, bringing the year to date total to 9
  • In the same period, seven existing remediation plans closed in the same period, bringing the year to date total to 14

Detailed summary of current insurer regulatory activity

*Please note that some matters relate to issues identified that have ongoing remediation and/or investigations from the previous calendar year.

Insurer detailed information

Allianz

Allianz received 4 regulatory notices in the period up to 4 August 2021. Details are outlined in the table below.

MatterRegulatory noticeNotice issuedRemediation plan and investigation outcome

Communication of Insurer Internal Review decisions to injured people (MAIA)

Non-compliance with requirements

1/04/2021

Remediation plan is ongoing

Not considered for further regulatory action

Incorrect calculation of premiums (MAIA)

Premiums not charged in accordance with approved filing

17/06/2021

Remediation plan and investigation ongoing

Renewal notice delays (MAIA)

Failure to comply with renewal notice requirements

24/06/2021

Not required

Communication of entitlements** (MAIA)

Communicating a potential Award of Damages entitlement

03/08/2021

TBC

AAMI

AAMI had 8 regulatory notices issued in the period to 4 August 2021. Details are outlined in the table below.

MatterRegulatory noticeNotice issuedRemediation plan and investigation outcome

Interstate at fault vehicle damages claims* (MAIA)

Interpretation of Guidelines

22/07/2020

Closed. Investigation ongoing

CARS 2R replies* (MACA)

Failure to comply with CARS 2R Reply timeframes

05/08/2020

Closed. Investigation ongoing

Internal review timeframes* (MAIA)

Non-compliance with internal review acknowledgement and decision timeframes

10/09/2020

Closed. Investigation ongoing

Incorrect Green Slip premiums* (MAIA)

System error resulted in customers being charged incorrect premiums

06/11/2020

Closed. Not considered for further regulatory action

Green Slip price discrepancy (MAIA)

Discount not applied to renewals

25/03/2021

Closed. Not considered for further regulatory action

Communication of Insurer Internal Review decisions to injured people (MAIA)

Non-compliance with requirements

05/04/2021

Ongoing. Not considered for further regulatory action

Timeliness of treatment decisions (MAIA)

Non-compliance with timely determination of treatment and care requests

5/05/2021

Not required. Not considered for further regulatory action

Communication of entitlements** (MAIA)

Communicating a potential Award of Damages entitlement

03/08/2021

TBC. Investigation ongoing

GIO

GIO received 9 regulatory notices in the period to 4 August 2021. Details are outlined in the table below.

Matter

Regulatory notice

Notice issued

Remediation plan and investigation outcome

Permanent impairment* (MAIA)

Delay in request for insurer to concede permanent impairment

21/07/2020

Closed. Not considered for further regulatory action

Interstate at fault vehicle damages claims* (MAIA)

Interpretation of Guidelines

22/07/2020

Closed. Investigation ongoing

CARS 2R replies* (MACA)

Failure to comply with CARS 2R Reply timeframes

5/08/2020

Closed. Investigation ongoing

Internal review timeframes* (MAIA)

Non-compliance with internal review acknowledgement and decision timeframes

10/09/2020

Closed. Investigation ongoing

Incorrect Green Slip premiums* (MAIA)

System error resulted in customers being charged incorrect premiums

6/11/2020

Closed. Not considered for further regulatory action

Green Slip Price Discrepancy (MAIA)

Discount not applied to renewals

25/03/2021

Closed. Not considered for further regulatory action

Communication of Insurer Internal Review decisions to injured people (MAIA)

Non-compliance with requirements

1/04/2021

Ongoing. Not considered for further regulatory action

Timeliness of treatment decisions and payments (MAIA)

Non-compliance with timely determination of treatment and care requests

5/05/2021

Not required. Not considered for further regulatory action

Communication of entitlements** (MAIA)

Communicating a potential Award of Damages entitlement

03/08/2021

TBC. Investigation ongoing

NRMA

NRMA received 8 regulatory notices to 4 August 2021. Details are outlined in the table below.

MatterRegulatory noticeNotice issuedRemediation plan and investigation outcome

Internal review timeframes* (MAIA)

Non-compliance with internal review decision timeframes

16/10/2020

Closed. Investigation ongoing

Incorrect weekly benefits payment* (MAIA)

System issue resulting in miscalculation of weekly benefits

30/10/2020

Ongoing. Investigation ongoing

Claims without a fault determination* (MAIA)

Failure to provide fault determination

25/11/2020

Ongoing. Not considered for further regulatory action

Timeframe of liability decisions (MAIA)

Failure to comply with liability decision timeframes

25/03/2021

Not required. Not considered for further regulatory action

Communication of Insurer Internal Review decisions to injured people (MAIA)

Non-compliance with requirements

5/04/2021

Ongoing. Not considered for further regulatory action

Privacy - notifiable data breach (MAIA)

Failure to report within timeframes per licence conditions

16/05/2021

Not required. Not considered for further regulatory action

Liability notice requirements (MAIA)

Failure to comply with liability notice requirements

17/05/2021

Not required. Not considered for further regulatory action

Communication of entitlements** (MAIA)

Communicating a potential Award of Damages entitlement

03/08/2021

TBC. Investigation ongoing

QBE

QBE received 8 regulatory notices issued in the period to 4 August 2021. Details are outlined in the table below.

MatterRegulatory noticeNotice issuedRemediation plan and investigation outcome

Non-compliance with injury coding* (MAIA)

Ongoing non-compliance with MAIA 2017 injury coding timeframes

09/09/2020

Closed, investigation ongoing

Non- compliance with injury coding* (MACA)

Ongoing non-compliance with MACA 2017 injury coding timeframes

09/09/2020

Closed, investigation ongoing

Incorrect decision – notice period (MAIA)

Failure to provide prescribed period of notice before ceasing weekly benefits

01/02/2021

Not required

Timeframe of liability and treatment decisions (MAIA)

Delay in providing a decision in relation to a treatment request

25/03/2021

Ongoing, investigation ongoing

Communication of Insurer Internal Review decisions to injured people (MAIA)

Non-compliance with requirements

5/04/2021

Ongoing, not considered for further regulatory action

Incorrect application of indexation to weekly benefits (MAIA)

Failure to apply indexation to weekly benefits after the second entitlement period

13/07/2021

Ongoing, investigation ongoing

Timeframes for electronically transmitting e-green slips (MAIA)

Timeframes for insurers to electronically transmitting an e-green slip

30/07/2021

Not required

Communication of entitlements** (MAIA)

Communicating a potential Award of Damages entitlement

03/08/2021

TBC, investigation ongoing

Show in Asset MapContent Container

* Remediation plan carried over from previous calendar year
** Regulatory notice issued in August 2021 are listed as ongoing in the above table

MACA - Motor Accidents Compensation Act 1999
MAIA - Motor Accident Injuries Act 2017

Escalation of significant matters from Independent Review Office (IRO) to SIRA – from commencement 1 March 2021

In the period 1 March 2021 (commencement of the IRO) to 30 June 2021, IRO received 317 complaints. A total of 418 complaints were received as of 31 July 2021, none of which were escalated to SIRA for regulatory action.

Authorised Health Practitioner activity – summary of recent activity

A total of 431 practitioners were published as active as at 30 June 2021. During the quarter SIRA received notification of one practitioner retiring and 13 applications from health practitioners, of these 10 were approved.

Item 

1 April 2021  to  

30 June 2021 

1 January 2021 to 

30 June 2021 

Application received

13

39

Approved

10

29

Applications pending

1

1

Unsuccessful

4

10

Authorisation ceased

1

1

Total of number of active practitioners at end of period

431

431


CTP Claims and Injury Management Assurance Program
- update

  • SIRA is progressing a review into insurer conduct relating to the management and settlement of claims for the award of damages (2017 Scheme). This includes examining claims resolution and insurer duty to resolve claims justly and expeditiously.
  • A review into how insurers are assisting injured people with returning to work and usual activities has commenced. It will consider how insurers engage with the injured person's treatment providers, employer (if applicable), and rehabilitation service providers to support recovery.

Previous activity

Motor Accidents Regulatory Bulletin – issue one

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