NSW Workers Compensation System Regulatory Activity 2020-21

• 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