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Motor accidents bulletin - February 2020

SIRA's review of the minor injury definition

SIRA has completed a review of the minor injury definition and provisions. The purpose of this review is to ensure people are getting the right level of assistance to help them recover from their injuries whilst ensuring the scheme is affordable for everyone. The report has been published on our website.

The review included an analysis of not at-fault minor injury claims. SIRA also engaged with injured people and key stakeholder groups to help inform this review.

Overall, the minor injury definition and provisions were found to be achieving the Motor Accident Injuries Act’s objective of encouraging early and appropriate treatment and care to enable people to achieve optimum recovery and maximise their return to work or other activities.

SIRA will continue to monitor the application of the provisions and will provide guidance to stakeholders where required. SIRA will also continue to identify areas for improvement to ensure that injured people are supported.

This review will also inform the statutory three-year review of the scheme.  You can find the full report on our website under the outcomes tab on the consultations page.

CTP Insurer Claims Experience and Customer Feedback Comparison – December 2019

The third issue of the CTP Insurer Claims Experience and Customer Feedback Comparison report is now published on our website.

This report compares insurers in the NSW CTP scheme on a range of evidence-based indicators which measures insurer performance over the course of an injured person’s claims journey. The data will help customers make meaningful comparisons between insurers. People injured in motor accidents may also benefit from knowing what to expect from the insurer managing their claim.

The measures presented relate to:

  • the number of statutory benefit claims accepted by insurers,
  • the speed at which insurers pay statutory benefits,
  • the number of claims referred through insurer internal review units,
  • the number and outcome of Dispute Resolution Service (DRS) referred claims,
  • compliments and complaints received about insurers,
  • the number and type of issues escalated to SIRA’s Compliance, Enforcement and Investigations team.

In this issue of the report, data for the first three measures above is presented over two time periods: 1 January - 31 December 2018 and 1 January - 31 December 2019. The other measures are presented as per the periods described in the respective sections of the report.

This information is soon to be included in our 2017 CTP Scheme Open Data which is a user-friendly interactive tool for the NSW public and CTP scheme stakeholders to see up to date information on the scheme.

Update on the review of the regulatory requirements for healthcare arrangements in SIRA regulated schemes

Healthcare costs account for more than $1 billion each year in personal injury insurance schemes in New South Wales.

To better understand healthcare costs and service utilisation, SIRA is leading a Review of regulatory requirements for health care arrangements in the NSW Workers Compensation and CTP schemes. Under the review, SIRA is considering the full range of healthcare arrangements in the Workers Compensation and CTP schemes, including fees, clinical quality, data and reporting, monitoring and compliance and regulation.

SIRA Chief Executive Carmel Donnelly said, “The review is not about reducing expenditure or the treatment available to injured people. SIRA’s objective is to make sure that every dollar spent delivers quality and value and optimises recovery.”

Submissions and themes

SIRA received 53 submissions to the review, 43 of which will be published in the coming weeks. SIRA also held a series of stakeholder briefings. A final report will be published in the second half of 2020. In the meantime, SIRA is working with insurers to tighten controls around treatment payments and approvals and with the medical community on value-based care and fees models.

The submissions include the following themes from both the Workers Compensation and CTP schemes:

  • the importance of strengthening insurer controls over health provider billing
  • the need for insurers to more closely scrutinise proposed treatments
  • the importance of early treatment in medical costs across the life of a claim
  • the need for insurers to better identify injured people at risk of not returning to work
  • a link between adversarial claims and disputes and non-medically appropriate care
  • an increase in degenerative, rather than traumatic injuries
  • health providers seeing patients for long periods without clinical justification
  • the need for increased data publication
  • consideration of outcome-based fee models
  • the need for SIRA to set clinical frameworks and standards

For general enquiries

Enquiries, help with claims, feedback, complaints or disputes with insurers or others phone:  1300 656 919 -  8:30 am to 5:00 pm, Monday to Friday or email: ctpassist@sira.nsw.gov.au

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