The return to work (RTW) rate is the percentage of workers who have been off work as a result of their work related injury/disease and have returned to work in any capacity at 4 weeks, 13 weeks, 26 weeks,52 weeks and 104 week from the date of injury.

The cohort for each RTW measure for each reporting month is based on claims with injuries occurring in a 12 month period, with a lag period corresponding to the measure timeframe, to allow for claim development. This ensures that the newest claims to reach maturity for that particular measure are included in the relevant reporting month.

The RTW rates published do not include Coal Mines Insurance (CMI) data. CMI is currently building a new IT platform which is intended to provide SIRA data in line with the broader data requirements of insurers which SIRA licenses (Workers Compensation Insurer Data Reporting Requirements).

Note due to remediation of reported data relating to COVID claims, RTW results using data from January 2023 onwards have significantly increased. This is due to a high number of short-term time loss claims being added to the metric. SIRA will be monitoring the data closely to ensure the results published are an accurate reflection of RTW rates.

SIRA requires that all claims are classified in accordance with the Type Of Occurrence Classification System version 3.1.

This classification system allows claims to be classified in accordance with the type of injury/disease, bodily location of injury as well as incident details.

The bodily location of injury/disease identifies the part of the body affected by the most serious injury or disease.

Psychological injury claims are where the primary injury is psychological. For example, these conditions may include post-traumatic stress disorder, anxiety/stress disorder, clinical depression and short term shock from exposure to disturbing circumstances.

The financial and cost information in this report is presented in original dollar values with no indexation applied. Costs in the workers compensation system are subject to a variety of potential inflationary factors including wage and salary rates, medical fee schedules, statutory benefit indexation and general price inflation. As there is no single index which adjusts for all potential factors, costs have been shown in their original dollar values for simplicity.

There are a number of areas where SIRA is actively working on the methodologies for the metrics reported and the data provided from a number of sources including insurers. SIRAs goal is to improve the data and evidence to monitor the system.

Weekly payments: Weekly payments paid to an injured worker.

Medical payments: Payments for ambulance services, medical treatment, hospital treatment, physiotherapy treatment and chiropractic treatment.

Common Law (WID) payments: Lump sum payments for damages and common law legal expenses incurred by the worker or agent/insurer, pursuant to Part 5 Common Law remedies, Sections 149 to 151AD, Workers Compensation Act 1987 and Section 318H, Workplace Injury Management and Workers Compensation Act 1998.

See Glossary for other terms.

The number of customer enquiries and complaints, and the number who seek a review of an aspect of their claim offer some insight into a customer’s satisfaction with component parts of the system. The interactions workers and employers have with other participants in the system are an important indication of a customer’s experience with the system. Workers in the compensation system are more likely to be satisfied with their general practitioner compared with the national data, however less satisfied with their interactions with insurers and claim managers. (Safe Work Australia 2018 Return to Work Survey)

To support the customers’ experience there are a number of services available within the workers compensation system. These services support system participants, primarily workers and employers with enquiries, complaints and disputes. These services may vary in purpose and process. For example, some form part of a legal process while others seek to review decisions about an aspect of the workers compensation system. They all aim to provide a positive experience for customers.

SIRA has developed an insurer scorecard which is intended to provide stakeholders and customers with regular and timely information on the performance of insurer types within the workers compensation system.

Performance measures included in the scorecard are as follows.

Share of active claims: an active claim is a claim that has had any payment in the last three months. Measuring this enables SIRA to monitor and benchmark how claims are being managed by each insurer. This measure looks at the percentage of all the active claims of an insurer.

Injury notifications actioned within 7 days: insurers are required to process claims and determine liability within prescribed timeframes. The timeliness of insurers’ decisions is both a key legislative component and an important aspect for workers. This measure looks at the percentage of claims whereby the insurer has made a liability decision within 7 days of notifying the insurer.

Percentage of level 1 complaints to active claims: a level 1 complaint is defined as a complaint received where an insurer is notified by the Customer Advisory Service on behalf of the complainant. This measure looks at the percentage of level 1 complaints an insurer receives as a percentage of total active claims for that insurer.

Percentage of level 2 complaints resolved within 20 business days: a level 2 complaint is an escalation of an unresolved level 1 complaint. This measure looks at the percentage of level 2 complaints an insurer resolves within 20 days of notification from Customer Care.

Return to work rates: the return to work rate is the percentage of workers who have been off work as a result of their employment related injury/disease and have returned to work at different points in time from the date of injury (i.e. 4, 13 and 26 weeks).