Regulatory Framework
SIRA’s Regulatory Framework includes monitoring insurer compliance and performance, with activities that include:
- enhancing return to work/activity and value-based care outcomes
- upholding Customer Service Conduct Principles
- improving complaints handling and dispute management practices
- overseeing pricing, underwriting and market practices
- ensuring data quality and reporting.
SIRA focuses 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.
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#1 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
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#2 Thematic reviews
The CTP Supervision Assurance Program (SAP) is designed to address risks and issues which cannot be identified through core activities, focusing on insurer compliance and performance.
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#3 Remediation
Based on the outcomes from core and thematic reviews, insurers must undertake remediation as required by SIRA, with specific plans and reporting expectations.
Supervision Assurance Program
The Supervision Assurance Program (SAP) aligns with SIRA’s strategy to be a customer-centric, intelligence-led and risk-based regulator. The program conducts reviews based on existing or emerging risks and issues with insurer compliance or performance. The SAP is conducted in addition to core supervision and individual insurer remediation activities.
SIRA informs insurers of the review schedule and publishes outcomes, enhancing transparency and accountability. Although review timings are flexible, they adapt to new risk and challenges.
Supervision Assurance Program reports
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2024
Claims related to a death (re-audit)
- Objective: Re-audit how insurers systematically handle claims related to a death, simplifying the claims process.
- Claims Involving a Death Re-audit Scheme Report
Damages
- Objective: Ensure that licensed insurers were meeting their obligations as it relates to a claim for damages.
- Damages scheme report - SIRA
Annual self-assessment
- Objective: Licensed insurers are required to complete an annual review of their pricing, claims and data practices.
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2023
Claims related to a death
- Objective: Ensure insurers systematically handle claims related to a death, simplifying the claims process
- Claims involving a death report - November 2023
Inactive claims and communication of entitlements
- Objective: Ensure clear communication from insurers about entitlements after claim lodgement and before claims become inactive.
- Communication of entitlements report – October 2023
Recovery plans (re-audit)
- Objective: Re-audit how insurers screen and assess risks of poor recovery and establish tailored recovery plans.
- Recovery plans re-audit scheme report - December 2023
Weekly benefits
- Objective: Ensure insurers maintain practices to provide accurate and timely payment of weekly benefits to people with an injury across all entitlement periods.
- Weekly payments of statutory benefits report - August 2023
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2022
Treatment and care decisions
- Objective: Review insurer obligations in relation to treatment and care requests and internal review decisions.
Treatment and Care Decisions Activity Report - August 2022 PDF, 199.1 KB
- Treatment and Care Re-Audit Report - March 2023
PDF, 203.76 KB
Recovery plans
- Objective: Assess how insurers screen for and manage risks of poor recovery and establish appropriate recovery plans to return the person to work or activity.
- Scheme Report - Insurance Claims and Conduct Assurance Program - December 2022
Annual self-assessment
- Objective: Licensed insurers are required to complete an annual review of their pricing, claims and data practices.
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2021
Contributory negligence assurance activity
SIRA reviewed how licensed insurers applied the contributory negligence threshold in the CTP Scheme, analysing claims data and conducting interviews with 40 claims personnel from five insurers.
Updated 30 May 2025