SIRA commences audits of weekly payments to injured workers and directs icare to take action
SIRA commences audits of weekly payments to injured workers and directs icare to take action
On 27 February 2020 SIRA was notified by icare that errors have been detected in weekly payment calculations in a sample of closed Nominal Insurer workers compensation claims.
The errors were found during an icare risk discovery review in 2019. The review, which excluded the Treasury Managed Fund, was designed to test the extent to which the initial Pre-Injury Average Weekly Earnings (PIAWE) calculation was correct from 2012-2019.
The scope and results of the review as advised by icare as follows:
- approximately 3,000 claim files were reviewed
- where there was sufficient information on file to recalculate PIAWE, approximately one-quarter of the claims were potentially underpaid, at least initially, and a similar proportion were potentially overpaid
- in instances where weekly payments were incorrect, premium calculations for experience-rated medium to large businesses may also be incorrect
The issue relates to the complexity of the PIAWE determination under legislation passed in 2012 and therefore the Legislative reforms implemented in 2019 simplified the calculation of PIAWE and the risk review did not cover more recent or open claims. The 2019 reforms implemented were in response to reviews and stakeholder concern about the complexity of PIAWE.
Icare is inviting injured workers who received weekly workers compensation payments between 2012 and 2019 in NSW to come forward if they believe they may have been underpaid their weekly entitlements from their insurer.
Icare will not recover any overpayments and is remediating underpayments as files from the seven-year period are reviewed.
At this stage the remediation program covers workers compensation payments for private sector employees in NSW (under the Nominal Insurer).
Workers compensation payments for NSW Government employees (under the Treasury Managed Fund) and payments by Specialised Insurers and Self Insurers are being handled separately. icare has specialist resources in place and has set up quality assurance checks to assess any payments in question.
Any worker who was paid weekly benefits for injuries notified between 1 October 2012 and 20 October 2019 can check on the icare website if they are eligible for their payments to be assessed.
Injured workers customer can visit the icare website to find further information to understand the PIAWE assessment or if they are eligible for payments to be assessed
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