Workers compensation bulletin - Issue 96

NSW Workers Compensation System Regulatory Activity

SIRA’s regulatory activities continue to be focused on areas of highest risk. SIRA takes firm and fair enforcement action as needed, based on the severity of harm or potential harm, the degree of negligence, and/or the need for deterrence. These regulatory actions, along with education and support initiatives, contribute to SIRA’s strategic goals of improving customer experience and results, maintaining scheme and policy affordability, and building public trust.

Regulatory actions for the period 1 July 2020 – 30 September 2020 includes:

Employers:

1,627 businesses purchased a workers compensation policy after SIRA commenced non-insurance investigations. This reflects almost $3.2million in additional premium raised and 5,236 more employees now being covered by a workers compensation policy
SIRA issued four penalty notices under s155 of the Workers Compensation Act 1987 for non-insurance. Each business was fined a total of $750
SIRA made referrals to Revenue NSW to commence recovery action for $86,306 of avoided premiums (under s156 of the Workers Compensation Act 1987)
SIRA undertook 39 visits to employers with injured workers at risk of not returning to work (as identified through predictive modelling).
SIRA issued 30 employer improvement notices 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 as required by the Workplace Injury Management and Workers Compensation Act 1998
SIRA commenced investigations into 35 employers following complaints about their alleged failure to comply with return to work obligations
SIRA issued 7 employer improvement notices to businesses requiring them to provide information to assist with investigations in response to complaints about the non-provision of suitable work
10 private ruling applications were finalised with 4 determinations issued to employers, constituting legally binding decisions as to whether a person performing work is a worker, a deemed worker or an independent contractor for the purposes of workers compensation premium calculation
18 regulatory reviews in relation to premium disputes between employers and their insurers were resolved

Insurers:

SIRA completed:
- 29 annual reviews of self-insurers
- 2 self-insurer performance and compliance audits, resulting in claims and data management improvement actions
- 15 security deposit reviews
- 58 performance meetings with self-insurers
- 7 performance meetings with specialised insurers
- 1 performance audit of a self-insurer
- 1 onsite claim file review
In response to SIRA’s proactive program of insurer supervision, 22 claims management self-audits were completed by self and specialised insurers, with 2 self-insurers providing improvement plans to support their results
SIRA granted 2 new self-insurer licences and is currently reviewing 5 new self-insurer applications
Review of all self and specialised insurers’ practices regarding PIAWE is underway. Following an initial 10 insurers providing information on PIAWE practices (results currently under review by SIRA), all other self and specialised insurers have been requested to complete a self-assessment to determine PIAWE accuracy, timeliness and governance
SIRA continued monitoring and supervision of icare’s performance and that of its scheme agents
A report on the first quarterly performance audit of claims management by the Nominal Insurer was published on the SIRA website. A second quarterly audit was completed in September
As a result of SIRA regulatory oversight and monitoring of market practice and premiums, icare commissioned an independent report into premium capping and renewals (June 2020)

Providers:

Provider approval to operate in the NSW workers compensation system:
- 261 new allied health providers were granted approval
- 339 allied health practitioners had approval suspended
- 74 allied health providers voluntarily deactivated their approval
- 3 allied health providers had approval reactivated
SIRA sent 75 letters to allied health providers notifying them of the outcomes of the supervision project that investigated instances of duplicate payments and above maximum fees charges

Other compliance and enforcement actions:

SIRA issued 15 notices to insurers, claimants and providers to request information in connection with allegations of fraud and potential breaches of the workers compensation legislation
SIRA referred 2 employer premium debts to Revenue NSW for collection
63 referrals for investigation of alleged workers compensation injury fraud were received and actioned
15 allegations of potential breaches of legislation involving insurers were received and actioned

SIRA Standard of practice for managing psychological injury claims: Consultation period extended

The consultation period for the new Standard of practice 33: Managing claims for psychological injury has been extended due to the high level of stakeholder interest and requests for additional time to provide feedback.

Feedback can be provided on the draft Standard of practice until 5pm, Friday 6 November 2020.

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