SIRA quarterly regulatory update (period ending 31 December 2025)

Executive summary

During the quarter, 1 October to 31 December 2025, SIRA undertook significant regulatory activities across the Schemes it regulates, underpinned by its Regulatory Priorities 2025-26.

SIRA is dedicated to strengthening scheme design, holding regulated entities to account and helping deliver better results for people who access the schemes.

In the Compulsory Third Party (CTP) Scheme, SIRA issued 8 letters of compliance and progressed 13 remediation plans, 3 of which started during the quarter. Fourteen matters are currently before the NSW Local Court for prosecution, and 10 matters are pending the commencement of criminal proceedings. SIRA received 12 new referrals for fraud during the reporting period, with a total of 37 open investigations. Fourteen matters are currently before the NSW Local Court for prosecution.

In the Workers Compensation Scheme, SIRA imposed special licence conditions on one insurer and commenced 6 new remediation plans with self and specialised insurers. Employer compliance recovered over $3.5 million in unpaid workers compensation insurance premiums.

In the Home Building Compensation (HBC) Scheme, SIRA issued 3 cautions to builders who failed to include the cost of insurance cover in their residential building contract.

Data included is correct as of 31 December 2025.

Insurer	Date issued	Matter
AAMI/GIO	10/12/2025	Annual self-audit (Motor Accident Injuries Act 2017 (MAIA)) 2025
Allianz	11/12/2025	Annual self-audit (MAIA) 2025
NRMAI	02/12/2025	Non-compliance in relation to misleading policy information
NRMAI	11/12/2025	Annual self-audit (MAIA) 2025
QBE	14/11/2025	Non-compliance in relation to claims involving a death obligations
QBE	11/12/2025	Annual self-audit (MAIA) 2025
QBE	16/12/2025	Non-compliance in relation to recovery plan obligations
Youi	11/12/2025	Annual self-audit (MAIA) 2025

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 substantial and sustained compliance is demonstrated.

There is a total of 13 remediation plans for CTP insurers. Four remediation plans were closed during the period because substantial and sustained compliance was demonstrated.

Three new remediation plans commenced during the period:

Insurer	Date commenced	Matter
NRMAI	17/10/2025	Incorrect refunds on mid-term policy cancellations
NRMAI	17/10/2025	Incorrect premium charged due to change in rating districts
Youi	07/10/2025	Non-compliance in relation to risk screening obligations

Fraud in the CTP Scheme

SIRA received 12 new fraud referrals during the reporting period, with a total of 37 open investigations. Fourteen matters are currently before the NSW Local Court for prosecution, and 10 matters are pending the commencement of criminal proceedings.

Significant matters in the CTP Scheme

Significant matters are defined in the SIRA significant matter notification requirements and may include:

• legal matters (Part 6.1)
• privacy or information breaches (Part 6.2)
• regulated entity obligation breaches (Part 6.3)
• other* (as specified in the requirements – Part 6.4)
• investigations (Part 7)

During this quarter, SIRA was notified of 19 significant matters in the CTP Scheme that were categorised at the time of reporting as:

• 5 legal matters
• 1 privacy or information breach
• zero regulated entities obligation breaches
• 9 other notifications
• 4 investigations

* Other notifications includes matters that have the potential to affect the ability of the regulated entity to carry out its obligations under the relevant scheme legislation, or involves an actual or alleged incidence of serious or systemic fraud against a scheme regulated by the Authority, or involves the regulated entity (or its employees or representatives) having engaged in conduct constituting gross negligence, intentionally misleading or deceptive conduct or fraud.

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. In addition, SIRA regulates employers.

Regulation of Nominal Insurer (NI) and Treasury Managed Fund (TMF)

In December 2025, SIRA published an audit report on Claims Management by QBE in the NI and TMF. The report can be found here.

Regulation of self and specialised insurers

Special licence conditions

Special licence conditions were imposed on one insurer in the reporting period:

Insurer	Date commenced	Matter
Woolworths Group Limited	10/10/2025	Improve claims management practices

Two insurers had special licence conditions imposed in quarter 3 2025 that were not previously reported:

Insurer	Date commenced	Matter
Thomas Foods	31/08/2025	Improve claims management practices
Kelsian Group Limited	14/07/2025	Improve claims management practices

Special licence conditions remain in place for 18 insurers.

Remediation plans

Six remediation plans commenced during the period:

Insurer	Date	Matter
Toll Holdings Limited	17/12/2025	Remediation plan required following claims performance audit
Coca-Cola Europacific Partners API Pty Ltd	16/12/2025	Remediation plan required following claims performance audit
Sonic Healthcare Limited	27/11/2025	Remediation plan required following claims performance audit
Council of the City of Sydney	27/11/2025	Remediation plan required following claims performance audit
Guild Insurance Limited	28/10/2025	Remediation plan required following claims performance audit
Randstad Holdings Pty Ltd	3/10/2025	Remediation plan required following claims performance audit

Four remediation plans were reported to SIRA following an insurer self-assessment of their obligations in the quarter.

Insurer	Date	Matter
Coles Group Limited	12/12/2025	In response to annual self-audit
Council of the City of Blacktown	21/11/2025	In response to annual self-audit
CSR Pty Ltd	7/11/2025	In response to annual self-audit
Endeavour Group Limited	24/10/2025	In response to annual self-audit

Another 21 remediation plans remain open.

Claims performance audits

SIRA conducts claim performance audits under section 202A 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 7 audits in the quarter on the following insurers:

• Council of the City of Sydney
• Sonic Healthcare Limited
• Coca-Cola Europacific Partners API Pty Ltd
• NSW Trains
• Toll Holdings Limited
• Sydney Trains
• The Star Entertainment Group Ltd

Any regulatory action (such as a remediation plan) arising out of these audits will be reported 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 SIRA. This ensures 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 financial security these insurers must pay.

SIRA completed 21 insurer security level reviews during this quarter, resulting in:

• 12 increases
• 3 decreases
• 6 maintained.

Regulation of employers

Employer insurance obligations

Proactive employer engagement about non-insurance

SIRA proactively contacts employers who are highly likely to have employer insurance obligations, but do not have a current workers compensation insurance policy.

This period, these investigations resulted in:

• 5,031 employers issued an email outlining their obligations to have a valid policy in place
• 1,500 employers issued a letter prompting them to purchase a policy
• 1,371 employers incepting a new policy
• 4,186 additional employees covered by a policy
• $3,780,765 in additional premium to be collected.

Proactive employer engagement about under-insurance

SIRA is conducting a pilot project with icare to contact large employers that have failed to submit their Actual Wage Declarations (AWD) within the required timeframe.

This period, the pilot project resulted in AWD’s being submitted that resulted in a total hindsight adjustment of $1,657,478.

Investigations leading to issuing notices

SIRA issued 89 Penalty Infringement (PIN) notices and 40 Double Avoided Premium (DAP) notices to be collected via Revenue NSW, totalling $85,350 and $693,372.15 respectively in the period.

Uninsured Liability Scheme investigations resulted in:

• 49 PIN notices, totalling $61,250
• 37 DAP notices, totalling $608,581.27

Non-insurance investigations resulted in:

• 3 PIN notices, totalling $3,750
• 3 DAP notices, totalling $84,790.88

Under-insurance investigations resulted in:

• 37 PIN notices issued, totalling $20,350
• $1,249,731.43 in premiums identified for icare to collect, resulting in 962 additional workers being insured.

Employer workplace injury management obligations

Under its Regulatory Framework, SIRA uses predictive modelling, targeted project work and regulatory complaints to identify employers at risk of poor return to work (RTW) performance.

During this period, SIRA:

• Engaged with 23 employers at higher risk of poor RTW performance to promote and assess compliance with their workplace injury management obligations.
• Issued one new employer improvement notices for failure to establish a compliant RTW Program.
• Issued 3 penalty notices totalling $1,650 for legislative breaches, including:
  • failure to notify the insurer of a workplace injury within 48 hours
  • failure to supply actual wage declarations on time.
• Issued 3 notices requesting information relating to an employer’s workers compensation obligations.
• Issued 13 caution letters officially warning employer’s for:
  • failure to notify the insurer of a workplace injury within 48 hours
  • failure to establish a compliant RTW program
  • failure to submit Actual Wage Declarations on time
  • failure to comply with Improvement Notices.

Fraud in the Workers Compensation Scheme

During this period, 37 new cases were referred to SIRA for review with a further 6 cases triaged. SIRA currently has 50 cases under investigation.

Significant matters in the Workers Compensation Scheme

Significant matters are defined in the SIRA significant matter notification requirements and may include:

• legal matters (Part 6.1)
• privacy or information breaches (Part 6.2)
• regulated entity obligation breaches (Part 6.3)
• other (as specified in the requirements – Part 6.4)
• investigations (Part 7)

During this quarter, SIRA was notified of 10 significant matters in the Workers Compensation Scheme:

• 5 legal matters
• 3 privacy or information breaches
• 2 regulated entities obligation breaches.

Home Building Compensation Scheme

Regulation of insurers

SIRA regulates icare Home Building Compensation Fund (HBCF), the sole insurer in the Home Building Compensation (HBC) scheme, for performance and compliance with the Home Building Act 1989 and relevant Insurance Guidelines.

During this quarter:

SIRA assessed and did not to reject icare HBCF’s updated eligibility model so that it can be applied without discretion from 2 March 2026.

SIRA assessed and approved icare HBCF’s updated claims management model so that it can be applied without discretion from 12 January 2026.

Cautions

During this quarter, SIRA issued three cautions:

Builder	Date issued	Matter
Zreika Group Pty Ltd	03/10/2025	Builder failed to include the cost of insurance cover in the residential building contract.
PCM Pty Ltd	09/10/2025	Builder failed to include the cost of insurance cover in the residential building contract.
Five River Construction NSW Pty Ltd	15/10/2025	Builder failed to include the cost of insurance cover in the residential building contract.

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 2025:

Category	New	Revoked/Cancelled	Withdrawn	Total approved providers
Allied health practitioners	540	21	12	15,564
Health practitioners authorised to give evidence	16	20	5	527
Injury management consultants	2	0	1	69
Hearing service providers	15	0	1	258
Workplace rehabilitation providers	0	2	0	100

Workplace Rehabilitation Providers

During the reporting period, SIRA performed the following regulatory action:

• 2 onsite evaluations of Workplace Rehabilitation Providers (WRPs) to assess their compliance to the additional conditions imposed on their SIRA approval and the Workers Compensation Workplace Rehabilitation Provider Approval Framework (the Framework)
• one provider had additional conditions imposed on their certificate of approval to reflect the onsite evaluation findings
• 2 cancellations of the certificate of approval for WRPs that failed to comply with the Framework.

Relevant Service Providers

SIRA issued the following to providers during the period:

• 8 Directions to Relevant Service Providers to provide information
• one Direction to cease providing psychological and counselling services, as the service provider was referred to and was under investigation by the Health Care Complaints Commission
• one letter of compliance to an allied health provider for non-compliance with obligations to collaborate with the person with an injury’s support team and take part in peer reviews.