Motor accidents regulatory bulletin - Issue 1
The State Insurance Regulatory Authority (SIRA) is publishing its first quarterly Motor accidents regulatory bulletin.
SIRA’s regulatory activities are focused on areas of highest risk. Firm and fair enforcement action is taken as needed, based on the severity of harm or potential harm, the degree of negligence, and/or the need for deterrence.
The regulatory activities outlined below, combined with SIRA’s education, performance reporting and support initiatives aim to deliver a motor accidents scheme that is fair, affordable, and effective.
This bulletin focuses on regulatory activity during the first quarter of 2021, unless stated otherwise. SIRA will continue to publish its Motor accidents regulatory bulletin on a quarterly basis.
Insurer regulatory activity
SIRA closely supervises insurers in the motor accidents scheme, holding monthly supervision meetings and engaging through other regulatory activities as outlined below.
Claims and Injury Management Assurance Program
SIRA has formalised its Claims and Injury Management Assurance Program (CAP) with insurers.
The CAP is designed to assess the extent to which insurer operations, conduct and claims management activity are in accordance with statutory requirements. CAP activities target key components of the scheme to identify any areas of non-compliance or poor performance.
Currently, the CAP is focusing on how insurers manage the lodgement process for people with a claim for damages, including determining decisions to concede that an injured person’s permanent impairment is over 10 per cent.
CAP activity: Review of insurer internal review decisions
In November 2020, SIRA engaged an independent expert to undertake a review of whether CTP insurers are meeting their obligations under section 1.3 and 7.9 of the Motor Accident Injuries Act 2017.
The review found that insurers are independent in their decision-making process and are demonstrating the required skills to make fair and just determinations. It also identified some areas of non-compliance.
SIRA has issued a Regulatory notice to each insurer, identifying areas of non-compliance related to individual claims. SIRA has also directed insurers to provide a remediation plan detailing how they will rectify the non-compliance.
For more information read the Independent expert report on internal review processes - PDF (308.5KB) report and SIRA's response to independent report on internal review.
CAP activity: Review into the award of damages
SIRA has initiated a review into the award of damages in the 2017 scheme.
The review is a response to SIRA identifying 1,853 claims with an accident date between 1 December 2017 to 1 December 2018 where the injured person may have been entitled to lodge a claim for damages, but a claim had not been lodged.
SIRA directed insurers to provide information on the status of these claims and their communication approach, and it is also undertaking a file review of other claims.
This review will lead to improved communication requirements and standards to ensure that injured people are made aware of their entitlements and properly understand the information provided.
While this review is underway, SIRA’s CTP Assist will undertake milestone calls to injured people who are potentially eligible to lodge a claim for damages.
Insurer remediation plans
Where SIRA identifies performance and compliance issues, SIRA can direct insurers to develop a formal remediation plan and oversee its implementation.
In the first quarter of 2021, SIRA directed insurers to develop a formal remediation plan on eight different occasions.
Six remediations are currently in progress. These relate to delays in determining fault, incorrect management of interstate damages claims, incorrect payment of weekly benefits, and internal review delays.
Regulatory activity
SIRA issued 26 Regulatory notices to insurers between 1 July 2020 to 31 March 2021. Five of these were issued in the first quarter of 2021.
The table below provides a summary of the notices issued:
Regulatory activity, 1 July 2020 - 31 March 2021
Notices sent | Issue |
|---|---|
4 | Timeliness of treatment decisions |
3 | Timeliness of internal review decisions |
3 | Incorrect calculation of Green Slip premiums |
2 | Management of interstate Nominal Defendant claims |
2 | Timeliness of CARS 2R replies |
2 | Timeliness of liability decisions |
2 | Incorrect determination of liability |
2 | Injury coding requirements |
1 | Offer of settlement requirements |
1 | Notice period required before discontinuing weekly benefits |
1 | Incorrect weekly benefit payments |
1 | Data requirements – ‘fault not determined’ |
1 | Claims management principles under the Motor Accident Guidelines |
1 | Conducting appropriate and timely investigations |
Enforcement and prosecution activity
SIRA is committed to making strong, consistent and evidence-based decisions on enforcement action.
SIRA engages with law enforcement agencies, particularly the NSW Police Force, to deter and investigate fraudulent activity in the CTP scheme. SIRA is also developing fraud detection, scanning and provider management analytics software and services to help with regulatory monitoring.
The table below lists the matters SIRA considered for enforcement and prosecution activity between 1 July 2020 and 30 March 2021:
Enforcement and prosecution activity, 1 July 202 - 31 March 2021
Number of matters | Issue |
|---|---|
3 | Timeliness of internal review decisions |
2 | Management of interstate Nominal Defendant claims |
2 | Timeliness of Claims Assessment and Resolution Services replies |
1 | Injury coding requirements |
1 | Incorrect weekly benefit payments |
1 | Timeliness of treatment decisions |
Provider regulatory activity
SIRA appoints Authorised health practitioners to work in the motor accidents scheme, under section 7.52 of the 2017 Act and Part 8 of the Motor Accident Guidelines.
As at 31 March 2021, there were 427 active practitioners.
SIRA received 26 new applications in the first quarter of 2021. Of these, 18 were approved, seven were unsuccessful and one is still under consideration.
Since July 2020, SIRA has approved two practitioner requests to withdraw their appointment and revoked one practitioner’s appointment.
SIRA will soon announce details of a post-implementation review of the Authorised health practitioner framework and will invite feedback from stakeholders.
Contact details
For enquiries, help with claims, feedback, complaints or disputes with insurers or others please call 1300 656 919, 8:30am to 5:00pm, Monday to Friday or email: [email protected].
For complaints, contact the Independant Review Office: 13 94 76 or email: [email protected]
For disputes contact the Personal Injury Commission: 1800 742 679 or email; [email protected]
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