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Workers compensation monthly report

System overview

Key workers compensation system statistics for the 12 months ending April 2019

$257 billion of reported wages are safeguarded by the workers compensation scheme

$3.6 billion in premiums were collected, representing 1.4% of reported NSW wages1

$2.9 billion was paid out as costs for workers claims

102,933 claims were reported to SIRA

76,819 workers received weekly benefit payments

1For the 2017/18 financial year

Effectiveness

System effectiveness in protecting workers and getting workers back to work and wellbeing

Reportable claims

7,713 were reported in April 2019

10,076 were reported in March 2019

7,438 were reported in April 2018

Claim types

Of the 7,713 reportable claims in April 2019, 92.9% (7,167) were related to physical injuries and 7.1% (546) were related to psychological injuries.

Claims by body locations

Head: 9.1%

Neck: 2.2%

Upper limbs: 34.0%

Trunk: 19.2%

Lower limbs: 20.3%

Also:

Psychological: 7.1%

Multiple locations: 3.1%

To be confirmed: 3.9%

Systemic locations: 1.1%

Effectiveness

Workers’ claims journey results at April 2019

Monthly average over the last 12 months

11,314 reported incidentsA^

8,578 reportable claims ^

3,406 lost timeT^

A Records submitted includes all records received from insurers across NSW. This data excludes administration errors.

T Lost time is based on workers receiving weekly benefits.

^ Figure is based on a 12 month average.

Return to work

59.3%at 4 weeks*

76.4% at 13 weeks*

84.0% at 26-weeks*

Note: SIRA identified data quality issues with the accuracy and completeness of return to work data submitted by the Nominal Insurer (NI). The data appears to indicate a significant deterioration in the NI’s RTW performance. SIRA instructed the NI to improve the quality of the data. To address the data quality and potential performance concerns with the NI, SIRA carried out a data quality audit in December 2018 and commenced a Compliance and Performance Review in February 2019. 

* Based on a rolling 12 month cohort, for further details see the Explanatory Note.

Efficiency & viability

Efficient system delivery, sustainability, and viability of the system for generations to come

Total claim payments made by insurers

In April 2019, the Nominal insurer made payments of over $167 million, Government self-insurers (TMF) of over $57 million, self-insurers of nearly $15 million and specialised insurers of over $13 million.

Claim payment types

The breakdown of claim payment types in April 2019 is as follows:

  • Weekly payments: 39.8%
  • Medical payments: 27.0%
  • Common law (WID): 16.1%
  • Rehabilitation payments: 4.6%
  • Lump sum (S66 & S67) payments: 5.7%
  • Death payments: 0.5%
  • Investigation payments: 2.3%
  • Other payments: 1.9%
  • Legal payments: 1.8%
  • Commutations: 0.2%

Total claim payments made by insurers

In April 2019 $252 million dollars payed in claim payments.

In March 2019 $253 million dollars payed in claim payments.

Down 0.4% based on data provided by insurers at the end of April 2019. Please note this may increase should late running reports of payments be supplied by insurers after the April data submission.

Benefits paid to and for workers as a percentage of total claims expenditure

Of the total expenditure across the system in 2017/18, 45% was made on payments to claimants and 24% was spent to make payments for the claimants. Insurer expenses across the system was 31% of the total expenditure.

Note: The benefits paid to and for workers is calculated annually. Details of definitions can be found in the methodology and data section. Data sourced from the information insurers provide to SIRA as at the financial year 2017/18.

Customer experience & equity

Customers’ experience with the system is positive and equitable

Enquiries and complaints

SIRA received 2,096 enquiries in April 2019. There were 528 complaints received in the same period.

Note: Complaint data (which may include the name of an insurer) is derived from verbatim reports from customers. While SIRA does some data cleansing, the reporting is verbatim from customers and might occasionally reference an incorrect insurer and/or insurer type.

Disputes lodged

In April 2019, the dispute rate was 0.6%, with 87,432 active claims and 533 disputes lodged.

Note: Including data from the Workers Compensation Commission.

Workers perceptions of equity across the workers compensation system

Jurisdiction

Distributive JusticeAverage (mean) on a 5 point scale

Procedural Justice

Average (mean) on a 5 point scale

Informational Justice

Average (mean) on a 5 point scale

Interpersonal Justice

Average (mean) on a 5 point scale

New South Wales

3.9

3.8

3.7

4.3

Australian Total

3.9

3.8

3.7

4.3

Definitions of dimensions used to measure customers perception of equity and perceived justice:

  • Distributive justice, relates to the fairness of their compensation.
  • Informational justice, is about receiving accurate and timely information about the rationale for decisions.
  • Interpersonal justice, relates to whether workers were treated with respect and sensitivity.
  • Procedural justice, about the fairness of the procedures used to determine the outcomes.

Source: Safe Work Australia 2018 Return to Work Survey.

Affordability

Insurance affordability

Insurance affordability

This is the affordability of insurance is 1.4%, as a percentage of NSW wages for 2017/18.


% share of reported wages
FY 2017/18


% share of total claims
FY 2017/18


% share of total payments made


% share of total active claims


% of injury notifications actioned within 7 days


% of Level 1 complaints to active claims


RTW rate
4 weeks


RTW rate
13 weeks


RTW rate
26 weeks

Nominal insurer

74%

67%

66%

64%

85%

0.1%

53%

73%

83%

Government self-insurer (TMF)

13%

16%

23%

21%

99%

0.0%

74%

84%

88%

Specialised Insurers

6%

8%

5%

7%

97%

0.1%

73%

83%

86%

Self insurers

7%

9%  

6%

8%

97%

0.1%

65%

76%

82%

NSW workers compensation insurer scorecard

Information about the performance of insurers operating within the workers compensation system

Note: Insurers reported this data to SIRA. Data is as at April 2019.

_____________________________________________________________________________________________________________

While reasonable care has been taken in preparing this document, the State Insurance Regulatory Authority (SIRA) makes no warranties of any kind about its accuracy, currency or suitability for any particular purpose. SIRA disclaims liability for any kind of loss or damages arising from, or in connection with, the use of any information in this document.

SIRA identified data quality issues with the accuracy and completeness of return to work data submitted by the Nominal Insurer (NI). The data appears to indicate a significant deterioration in the NI’s RTW performance. SIRA instructed the NI to improve the quality of the data. To address the data quality and potential performance concerns with the NI, SIRA carried out a data quality audit in December 2018 and commenced a Compliance and Performance Review in February 2019.

Additional scheme performance measures

Information about the performance of insurers operating within the workers compensation system

Cost to the scheme for weekly benefits paid per month

In April 2019, the total amount of weekly benefit payments paid by insurer type was:

$67 million by the Nominal insurer

$25 million by the Government self-insurer (TMF)

$4 million by specialised insurers

$4 million by self-insurers

Note: to ensure consistency across the time series the data excludes Section 39 claimants that exited the system up to June 2018.

Number of workers receiving weekly benefits per month

In April 2019, the number of workers receiving weekly benefits by insurer type was:

17,402 by the Nominal insurer

6,833 by the Government self-insurer (TMF)

1,216 by specialised insurers

1,633 by self insurers

Note: The data is a distinct number of workers receiving weekly benefits and to ensure consistency across the time series, the data excludes Section 39 claimants that exited the that exited the system up to June 2018.

RTW including medical only claimants rate

In April 2019, the 4 week RTW rate was:

74% for the Nominal insurer

82% for the Government self-insurer (TMF)

84% for specialised insurers

86% for self insurers

77% for the system average

In April 2019, the 13 week RTW rate was:

85% for the Nominal insurer

89% for the Government self-insurer (TMF)

89% for specialised insurers

89% for self insurers

86% for the system average

In April 2019, the 26 week RTW rate was:

90% for the Nominal insurer

89% for the Government self-insurer (TMF)

90% for specialised insurers

91% for self insurers

90% for the system average

Average duration of weekly benefits paid in the first 6 months

In September 2018, the average was:

29 days for the Nominal insurer

27 days for the Government self-insurer (TMF)

18 days for specialised insurers

15 days for self insurers

Note: This measure uses work hours lost and injury quarter to calculate average days, it is reported to September 2018 to allow for claim data development.

Reportable claims development

Total reportable claims by financial year at 10 development periods

70,260 in 2015/16

69,264 in 2016/17

71,083 in 2017/18

78,744 in 2018/19

Claim payments development

Total claim payments by financial year at 10 development periods

$351 million in 2015/16

$395 million in 2016/17

$425 million in 2017/18

$437 million in 2018/19

Download the report (PDF, 408 KB) and the methodology and summary data tables (Excel worksheet, 231 KB) used to support this report. If you have trouble accessing content within these reports, please send an email to contact@sira.nsw.gov.au or call us on 13 10 50.

Website www.sira.nsw.gov.au |  Catalogue no. SIRA09062  |  © State Insurance Regulatory Authority 09/2019