Executive Summary
During the period from 1 October to 31 December 2024, SIRA undertook significant regulatory activities across the schemes it regulates. (Figures presented are as of 31 December 2024).
In the Compulsory Third Party (CTP) Scheme, SIRA issued one compliance letter, one civil penalty, and required 2 new remediation plans. A re-audit under the Insurer Claims and Conduct Assurance Program (ICCAP) led to further remediation plans for non-compliant insurers.
In the Workers Compensation Scheme, SIRA reviewed the Nominal Insurer and audited 98 claims assessing icare’s progress in early intervention and injury management planning. Eight new remediation plans commenced. Employer compliance efforts led to 4,247 newly covered employees and $3.65M in premiums collected.
In the Home Building Compensation (HBC) Scheme, SIRA continued its compliance program targeting non-insured building projects, issuing 18 notices and bringing the cumulative total to 100 businesses audited. Ten Official Cautions were also issued for failure to meet insurance obligations.
Compulsory Third Party Scheme
In the CTP Scheme, SIRA regulates 6 licensed insurers - Allianz Insurance, Insurance Australia Limited (trading as NRMA Insurance), AAI Limited (brands: AAMI and GIO), QBE Insurance (Australia) Limited (trading as QBE), and Youi.
Regulation of insurers
Letters of censure, letters of compliance, special licence conditions
One Civil Penalty notice amounting to $10,000 was issued by SIRA for the period.
Insurer | Date issued | Matter |
Insurance Australia Limited (trading as NRMA Insurance) | 13 December 2024 | Non-disclosure and incorrect application of demerit point loading on CTP renewal policies |
One letter of compliance was issued by SIRA during the period.
Insurer | Date issued | Matter |
Insurance Australia Limited (trading as NRMA Insurance) | 16 December 2024 | Non-compliance with complaints management |
There were no letters of censure or special licence conditions issued by SIRA during the reporting period.
Remediation plans
Insurers are required to implement a remediation plan where non-compliance with their obligations has been self-reported or determined by SIRA. SIRA monitors the implementation and progress of all open remediation plans monthly until such time that sustained, substantial compliance is achieved.
There are a total of 15 remediation plans in place for CTP insurers. Three remediation plans were closed as sustained, substantial compliance was achieved.
Two new remediation plans commenced following supervisory activity during the period:
Insurer | Date commenced | Matter |
NRMAI | 17/10/2024 | Non-compliance with claims involving a death obligation |
NRMAI | 30/10/2024 | Non-compliance with CTP premium obligations |
Thirteen remediation plans remain in place.
Insurer Claims and Conduct Assurance Program (ICCAP)
During the period from 1 October 2024 to 31 December 2024 SIRA completed one Insurer ICCAP activity.
ICCAP – Claims involving a death reaudit
SIRA conducted an initial ICCAP activity during July to September 2023 for claims involving a death. Insurers were required to provide remediation plans where compliance was not at expected levels. In July to August 2024, SIRA conducted a risk-based re-audit to review the effectiveness of the remediation plans and confirm compliance with the Motor Accident Injuries Act 2017, the Motor Accident Guidelines, and licence conditions.
Based on the findings of the audit, SIRA has requested AAMI, GIO, NRMAI, and QBE submit updated or new remediation plans to ensure systemic compliance is embedded across all areas where substantial compliance was not demonstrated.
SIRA’s Scheme report provides further detail regarding the findings and actions arising out of the re-audit activity.
Insurer self assessment
SIRA required insurers to complete a self assessment of their performance against specific criteria of the Motor Accident Guidelines and the Motor Accident Injuries Act 2017 during September to November 2024.
Based on the findings of the self assessment, SIRA has requested all insurers to submit a remediation plan to ensure systemic compliance is embedded across all areas where substantial compliance was not demonstrated.
Fraud in the CTP Scheme
SIRA received 9 new fraud referrals during the period 1 October 2024 to 31 December 2024, bringing the total to 35 open investigations.
One matter was resolved at the NSW Local Court with the offender being sentenced to a 12 month Intensive Correctional Order. Two matters are currently before the NSW Local Court for prosecution and 14 matters are currently pending commencement of criminal proceedings.
Workers Compensation Scheme
In the NSW Workers Compensation Scheme, SIRA regulates 4 types of insurers - the Nominal Insurer managed by icare, self-insurers, specialised insurers, and government self-insurers (the Treasury Managed Fund) managed by icare and employers.
Regulation of the Nominal Insurer
SIRA conducted a review of the Nominal Insurer under s202A of the Workers Compensation Act 1987, auditing 98 claims to:
- evaluate icare’s progress in delivering evidence-based early intervention management and injury management planning of a claim, and
- provide an end-to-end assessment of claims management.
The report from the review of the Nominal Insurer is under review and will be published in due course.
Regulation of Self and Specialised insurers
Civil penalties, Letters of censure, Special licence conditions
No civil penalties, letters of censure, or special license conditions were issued to any self or specialised insurers in this quarter.
16 special licence conditions remain in place.
Letters of compliance
No letters of compliance were issued to any self and specialised insurers in this quarter.
Remediation plans
Eight remediation plans commenced or were requested in response to SIRA supervision activities:
Insurer | Date | Matter |
Adecco Holdings Pty Ltd | 9/12/2024 | Remediation plan required following claims performance audit |
Boral Limited | 10/10/2024 | Remediation plan required following claims performance audit |
Brambles Industries Limited | 18/11/2024 | Remediation plan required following claims performance audit |
Endeavour Group Limited | 4/11/2024 | Remediation plan required following claims performance audit |
Inghams Enterprises Pty Limited | 27/11/2024 | Remediation plan required following claims performance audit |
ISS Property Services Pty Ltd | 5/11/2024 | Remediation plan required following claims performance audit |
Liverpool City Council | 6/11/2024 | Remediation plan required following claims performance audit |
Randstad Holdings Pty Ltd | 5/11/2024 | Remediation plan required following claims performance audit |
Two remediation plans were reported to SIRA as commencing this quarter following an insurer self-assessment of their obligations.
Insurer | Date commenced | Reason |
Council of the City of Lake Macquarie | 18/11/2024 | In response to self audit |
Qantas Airways Limited | 15/11/2024 | In response to self audit |
Another 23 remediation plans remain open.
Claims performance audits
SIRA conducts claim performance audits under s202A of the Workers Compensation Act 1987 and in accordance with the requirements outlined in the SIRA Insurer audit tool and Insurer Claims Management Audit Guide. Audits measure performance across legislative compliance, case management practice and data quality. SIRA conducted 13 audits in the quarter on the following insurers.
- Adecco Holdings Pty Ltd
- Campbelltown City Council
- Coles Group Limited
- Council of the City of Newcastle
- Council of the City of Sydney
- Endeavour Group Limited
- Hays Recruitment (Australia) Pty Ltd
- Inghams Enterprises Pty Limited
- Persol Australia Holdings Pty Limited
- Sonic Healthcare Limited
- Southern Meats Pty Limited
- Unilever Australia (Holdings) Pty Ltd
- 3M Australia Pty Ltd
Any regulatory action, such as a remediation plan, arising out of these audits will be reported on as part of this or future regulatory reports.
Security reviews
Under the Workers Compensation Act 1987 self-insurers and specialised insurers are required to provide financial security to ensure that other employers in NSW will not be required to meet the cost of claims if these entities are not able to meet their workers compensation liabilities.
Self-insurers must prepare and lodge a copy of their annual report (including audited financial statements) each fiscal year. SIRA reviews the annual report and financial statements and may increase, decrease or maintain the level of security.
Fifteen insurer security reviews were completed and resulted in:
- 6 increases
- 1 decrease
- 8 maintained.
Regulation of employers
Employer insurance obligations
Proactive employer engagement about non-insurance:
SIRA is proactively contacting employers that are highly likely to have employer insurance obligations but do not have a current workers compensation insurance policy.
This period resulted in:
- 1,503 compliance letters issued to potentially non-insured employers
- 1,227 employers incepting a new policy
- 4,247 additional employees covered by a policy
- $3,653,366 in premiums collected.
Investigations leading to issuing notices:
In the period, SIRA issued 239 Penalty Infringement Notices (PINs) and 215 Double Avoided Premium (DAP) notices to Revenue NSW for collection, totalling $291,950 and $4,641,888 respectively.
Uninsured Liability Scheme investigations resulted in:
- 10 PINs, totalling $12,000 and
- 9 DAP notices, totalling $439,095.94.
Non-insurance investigations resulted in:
- 220 PINs, totalling $278,750, and
- 206 DAP notices, totalling $4,202,792.
Under-insurance investigations detected:
- $99,139,715 in undeclared wages and referred an additional $6,060,653 in premiums to icare for collection, thereby insuring an additional 864 workers.
Employer workplace injury management obligations
SIRA’s Employer Supervision Strategy uses predictive modelling, targeted project work and regulatory complaints to identify employers at risk of poor return to work performance. This is used to focus SIRA’s inspectorate activity. The inspectors have:
- engaged with 40 employers at a higher risk of poor return to work performance to promote and assess compliance with their workplace injury management obligations.
- issued 33 new employer improvement notices (EIN) and extended 9 EIN’s for failure to establish a return to work program and/or failure to notify the insurer of a workplace injury within 48 hours.
- issued 24 penalty notices for legislative breaches, including:
- failure to notify the insurer of a workplace injury within 48 hours
- failure to comply with improvement notices.
- issued 32 Section 238AA notices requesting information relating to an employer’s workers compensation obligations.
Home Building Compensation Scheme
Regulation of insurers
In December 2024, SIRA commenced a proactive supervision program to review icare Home Building Compensation Fund’ s monitoring of its distributors (brokers). The program aims to identify any broker non-compliance with icare processes and any insurer non-compliance with the Home Building Act 1989) and Guidelines.
Cautions
SIRA continues its state-wide insurance compliance audit targeting non-insured, residential building projects or projects where payments have been taken before home building insurance is in place. During this quarter, notices under Section 127 of the Home Building Act 1989 have been sent to 18 building businesses (bringing the cumulative total to 100 building businesses since the audit commenced).
During this quarter, 10 Official Cautions were issued to building businesses that the audit identified as having not complied with some insurance obligations under the Act. The audit will continue into the first quarter of 2025.
Exemptions
Four applications for insurance exemptions were received, of which 2 were granted under section 97 of the Home Building Act 1989 and 2 are currently under consideration.
Information about Home Building Compensation Exemptions and exemption applications that have been granted are published on SIRA’s website.
Regulation of healthcare providers across the CTP Scheme and Workers Compensation Scheme
SIRA regulates health and rehabilitation providers to ensure the services delivered within the personal injury insurance schemes are in line with the legislation and conditions of the relevant approval frameworks.
Regulatory action to issue, revoke or withdraw approval as of 31 December 2024:
Category | New | Revoked | Withdrawn | Total approved providers |
Allied health practitioners | 309 | 10 | 11 | 13,553 |
Health practitioners authorised to give evidence | 15 | n/a | n/a | 510 |
Injury management consultants | n/a | n/a | n/a | 63 |
Hearing service providers | 3 | n/a | n/a | 224 |
Workplace rehabilitation providers | n/a | 1 | 3 | 105 |
Health Provider Supervision Assurance Program
The Health Provider Supervision Assurance Program monitors healthcare trends, performance, compliance, and outcomes. Currently SIRA is focusing on the following health provider groups:
Chiropractor
SIRA reviewed payments made to 1,198 Chiropractors against 10 compliance indicators, focusing on excessive billing, average spend compared with peers, report writing and delayed payments. SIRA wrote to 18 Chiropractors regarding billing anomalies against these identified indicators.
Osteopath
SIRA reviewed payments made to 411 Osteopaths against 10 compliance indicators, focusing on excessive billing, average spend compared with peers, report writing and delayed payments. SIRA wrote to four Osteopaths regarding billing anomalies against these identified indicators.
Imaging
SIRA reviewed magnetic resonance imaging (MRI) services for calendar year 2023 focusing on overpayments, incorrect billing and billing delays. A comprehensive review relating to the provision of MRI services is ongoing.
Regulation of workplace rehabilitation providers
SIRA performed a review of 6 providers who applied for renewal of their conditions of approval. This resulted in:
- Five applications were approved to 30 June 2026 with additional conditions imposed on 19 December 2024.
- One application was issued with conditional approval on 18 December 2024 to 31 January 2025 for the sole purpose of transferring all cases to another SIRA approved provider. This provider was not granted approval to deliver services ongoing.
Three other providers withdrew their SIRA approval to deliver workplace rehabilitation service providers.
Updated 20 February 2025