SIRA quarterly regulatory update (ending 30 June 2023)
Summary of the regulatory activity undertaken by the NSW State Insurance Regulatory Authority (SIRA) for the period 1 April 2023 to 30 June 2023.
This report is a summary of the regulatory activity undertaken by the NSW State Insurance Regulatory Authority (SIRA) relating to the motor accidents, workers compensation, home building compensation schemes and healthcare providers operating in the schemes for the period 1 April 2023 to 30 June 2023. (Figures presented are as at 31 August 2023.)
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 activities are complemented by education and support initiatives to drive better outcomes for the people who make claims and hold policies in SIRA-regulated schemes.
Compulsory Third Party (CTP) scheme
In the NSW Compulsory Third Party (CTP) Scheme, SIRA regulates six licensed insurers - Allianz, NRMA Insurance, Suncorp (brands: AAMI and GIO), QBE, and Youi.
Letters of censure issued
SIRA issued two letters of censure in the quarter for breaches of the Motor Accident Injuries Act 2017.
- One to QBE Insurance (Australia) Limited (QBE) for failure in timely determination of treatment requests.
Read more: QBE censured for failure in timely determination of treatment requests
- One to Insurance Australia Limited trading as NRMA Insurance (NRMAI) for delays in payment of weekly benefits.
Letters of compliance issued
SIRA issued a total of three letters of compliance during the period, alerting the entity to an identified risk or issue and the potential consequences of inaction.
Two letters of compliance were issued to NRMAI for:
- not utilising new information relevant to a liability decision along with delays in commencing weekly payments, and
- incorrect calculation of weekly payments.
One letter of compliance was issued to AAMI regarding suspension of weekly payments.
| Insurer | Matter |
|---|---|
| NRMAI | Not utilising new information relevant to a liability decision along with delays in commencing weekly payments |
| NRMAI | Incorrect calculation of weekly payments |
| AAMI | Suspension of weekly payments |
Remediation plans
Insurers are required to implement a remediation plan where non-compliance with their obligations has been self-reported or determined by SIRA. As at 30 June 2023, there were a total of 19 ongoing remediation plans in place for CTP insurers.
Two remediation plans were commenced this quarter in response to SIRA supervision of insurers:
| Insurer | Date commenced | Matter |
|---|---|---|
| Allianz | 28/05/2023 | Overcharged premiums |
| NRMAI | 08/06/2023 | Incorrect calculation of weekly benefits |
Seventeen remediation plans were ongoing:
| Insurer | Date commenced | Matter |
|---|---|---|
| AAMI & GIO | 29/07/2022 | Delay to weekly benefit payment |
| AAMI & GIO | 03/09/2022 | Non-compliance with treatment and care obligations |
| AAMI & GIO | 20/01/2023 | Insurer obligations self-assessment 2022 |
| AAMI & GIO | 23/01/2023 | Non-compliance with recovery planning obligations |
| Allianz | 15/12/2022 | Insurer obligations self-assessment 2022 |
| Allianz | 10/02/2023 | Non-compliance with recovery planning obligations |
| NRMAI | 10/12/2021 | Non-compliance with weekly payment obligations |
| NRMAI | 30/09/2022 | Non-compliance with treatment and care obligations |
| NRMAI | 16/12/2022 | Insurer obligations self-assessment 2022 |
| NRMAI | 10/02/2023 | Non-compliance with recovery planning obligations |
| QBE | 30/09/2022 | Non-compliance with treatment and care obligations |
| QBE | 24/10/2022 | Injury coding data quality issues |
| QBE | 31/01/2023 | Insurer obligations self-assessment 2022 |
| QBE | 27/02/2023 | Non-compliance with recovery planning obligations |
| Youi | 05/09/2022 | Non-compliance with treatment and care obligations |
| Youi | 15/12/2022 | Insurer obligations self-assessment 2022 |
| Youi | 24/02/2023 | Non-compliance with recovery planning obligations |
Workers compensation scheme
In the NSW workers compensation scheme, SIRA regulates four different types of insurers: the Nominal Insurer managed by icare, self-insurers (employers approved by SIRA to manage their own workers compensation), specialised insurers (insurers operating in a specialised industry), and government self-insurers (the Treasury Managed Fund) managed by icare and employers.
Regulation of insurers
Special licence conditions
SIRA issued two special licence conditions in the quarter to clearly establish what is required by the licensed insurer to maintain their licence.
| Insurer | Date of imposed special licence conditions | Reason for imposed licence conditions |
|---|---|---|
| Ventia Australia Pty Ltd | 15 June 2023 | Improve case management compliance and claims management practice |
| Catholic Church Insurance | 19 May 2023 | Cease to offer policies from 30 June 2023 |
Read more about these conditions:
- Special conditions imposed on the Ventia Australia Pty Ltd workers compensation licence
- SIRA takes actions to ensure CCI workers compensation policy holders remain compliant
Letters of compliance issued
During the quarter, SIRA issued six letters of compliance alerting the entity to an identified risk or issue, and the potential consequences of inaction.
One letter of compliance was issued to:
- Toll Holdings Pty Ltd on 14 April 2023 for failure to provide security within timeframes.
Five letters of compliance were issued to icare relating to:
- breaching legislative timeframes to determine liability for weekly benefits and treatment, and
- non-compliance with legislative requirements for notice of suspension of benefits.
Remediation plans
Five remediation plans were commenced this quarter where non-compliance with the insurer's obligations has been self-reported or determined by SIRA.
The following remediation plans commenced this quarter in response to SIRA supervision of insurers:
| Insurer | Date commenced | Matter |
|---|---|---|
| Life Without Barriers | 19 April 2023 | In response to SIRA audit |
| Ventia Australia Pty Ltd | 15 June 2023 | To address issues in compliance and case management |
| Helius Limited | 27 June 2023 | In response to SIRA audit |
The following remediation plans were reported to SIRA as commenced this quarter following an insurer self-assessment of their obligations:
| Insurer | Date commenced | Matter |
|---|---|---|
| ComfortDelGro Corporation Australia Pty Ltd | 22 June 2023 | In response to self-audit |
| Wesfarmers Ltd | 27 June 2023 | In response to self-audit |
Seven remediation plans were ongoing:
| Insurer | Date the plan opened | Matter |
|---|---|---|
| Boral Limited | 20 March 2023 | In response to self-audit |
| Sydney Trains | 02 March 2023 | In response to self-audit |
| NSW Trains | 02 March 2023 | In response to self-audit |
| Aldi stores - A Limited Partnership | 24 February 2023 | To address issues in compliance and case management |
| Brickworks Limited | 02 February 2023 | In response to self-audit |
| Fletcher International | 31 October 2022 | To address issues in compliance, conduct and case management |
| Toll Holdings | 31 October 2022 | To improve injury and claims management compliance |
Insurer licensing
The following insurer licences were renewed:
| Insurer | Date of renewal |
|---|---|
| Australian Unity Limited | 30 June 2023 for 5 years |
| The Star Entertainment Group | 30 June 2023 for 3 years |
| StateCover | 30 June 2023 for 5 years |
| Ausgrid Management Pty Ltd | 31 May 2023 for 5 years |
| Central Coast Council | 31 May 2023 for 3 years |
| Westpac Banking Corporation | 31 May 2023 for 3 years |
The following licence application was granted and commenced:
| Applicant | Commenced |
|---|---|
| Endeavour Group Pty Ltd | 3 April 2023 for 3 years |
Security reviews
Under the Workers Compensation Act 1987, self-insurers and specialised insurers are required to provide financial security to ensure that other employers in the State will not be required to meet the cost of claims if these entities are not able to meet their workers compensation liabilities.
Self-insurers must prepare and lodge a copy of their annual report (including audited financial statements) each financial year. SIRA reviews the annual report and financial statements and may increase, decrease or maintain the level of security.
Sixteen security reviews were conducted this quarter. As a result:
- security required for one insurer was maintained,
- security required for 10 insurers was increased,
- security required for five insurers was decreased.
SIRA quarterly supervision priorities
The focus for this quarter was on insurer conduct during disputes.
Ongoing priorities included injury reporting compliance, reviews of SIRA published insurer self-audit tool and guidance material, and reviews of insurer quality insurance processes.
Fraud on workers compensation scheme
For this quarter 70 referrals were received - ten were fraud cases, 51 were tip offs that have been referred to icare, five were insurer non-compliance, and four were general inquiries. Seventy-one matters were finalised.
Three briefs of evidence were prepared recommending the commencement of criminal proceedings.
One criminal prosecution was finalised resulting in a conviction and sentence. Read more: Workers compensation fraudster convicted and sentenced.
Regulation of Employers
SIRA regulates employers to ensure they comply with their workers compensation responsibilities, including holding a policy.
SIRA has received the following employer supervision referrals:
- 89 uninsured liability matter referrals from icare.
- 40 under-insurance and 6 non-insurance matters from SafeWork NSW.
- 23 non-insurance and 2 under-insurance matters from other referral sources.
As a result of SIRA's non-insurance investigations:
- 82 Penalty Infringement Notices (PINs) totaling $102,500, and 79 Double Avoided Premium (DAP) notices totaling $1,947,757 were issued.
- 178 workers' compensation policies were initiated, insuring an additional 471 employees with a total value of $412,753.
SIRA's Uninsured Liability Scheme matters, which were investigated, resulted in:
- 57 PINs totaling $42,750, and 56 DAP notices totaling $649,105, being issued.
Employer Enforcement's investigations into underinsurance have detected:
- $33,874,318 in undeclared wages and referred an additional $974,031 in premiums to icare for collection, thereby insuring an additional 292 workers.
In total, Employer Enforcement referred 139 PINs and 135 DAPs, totaling $2,742,112 to Revenue NSW for collection.
Other actions:
- 871 letters were issued to employers with injured workers at moderate risk of not returning to work.
- 64 employer improvement notices were issued for failure to establish a return to work (RTW) program and/or failure to appoint a RTW coordinator.
- 15 penalty notices were issued for failure to comply with improvement notices, failure to provide suitable employment, failure to notify the insurer of a workplace injury within 48 hours and failure to provide a complaint RTW program.
Home building compensation scheme
SIRA supervises and monitors the home building compensation scheme. In collaboration with NSW Fair Trading and the Office of the Building Commissioner, SIRA investigates and enforces non-compliance by building businesses.
- One application for exemption received in the previous quarter under section 97 of the Home Building Act 1989 was granted. There were no new applications received in this quarter. Read more on our HBC exemptions page.
- SIRA issued 10 notices under section 127 of the Home Building Act 1989 to builders in relation to compliance with insurance obligations.
- On 27 April, icare was advised that SIRA did not reject its premium filing (received by SIRA on 28 February 2023). This means icare’s new premium filings can commence from 1 July 2023.
- SIRA launched a new version of the public register of home building compensation insurance on the NSW Verify.licence platform.
Healthcare providers
SIRA regulates health and rehabilitation providers to ensure the services delivered within the personal injury insurance schemes are in line with the legislation and conditions of the relevant approval framework.
As at June 2023:
Workplace rehabilitation providers
- An additional three workplace rehabilitation providers have been approved to work in the workers compensation scheme taking the total to 103.
- Three providers have conditions imposed on their 12-month approval.
Authorised Health Practitioners
- There were 467 active authorised health practitioners in the motor accidents scheme.
- SIRA appointed 16 new authorised healthcare practitioners. One applicant was not approved as they did not meet the eligibility requirements.
Allied health practitioners
There are 11,443 practitioners approved to provide services in the workers compensation system and, in this quarter, SIRA approved 351 practitioners.
Health Provider Conduct Assurance Program (HPCAP)
The focus of the HPCAP for this quarter was Accredited exercise physiology supervision.
Under SIRA’s review of regulatory monitoring and performance activity, 21 Letters of Compliance were sent to accredited exercise physiologists (AEPs) suspected of billing anomalies. Further regulatory action is being considered.
Authorised hearing service providers
There are 203 providers approved to deliver services in the workers compensation scheme.
SIRA approved seven providers in this quarter and two were revoked as they no longer met conditions of approval.