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Workers compensation system monthly report April 2020

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April 2020 report

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System overview

Key workers compensation system statistics for the 12 months ending April 2020

$271 billion of reported wages are safeguarded by the workers compensation scheme 1

$3.8 billion in premiums were collected, representing 1.4% of reported NSW wages1

$3.2 billion was paid out as costs for workers

96,688 claims were reported to SIRA

78,981 workers received weekly benefit payments

SIRA is now reporting claim volumes for COVID-19.  Use this link to access this information

1For the 2018/19 financial year

Effectiveness

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

Reportable claims

5,658 were reported in April 2020

8,217 were reported in March 2020

7,215 were reported in April 2019

Monthly average over the last 12 months

10,781 reports submittedA^

8,057 reportable claims ^

4,437 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.

Working from home claims

As at 31/5/2020 there were 50 claims for workers working from home. These were being handled by the different insurer types as follows : NI (26), TMF (18), self insurers and specialised insurers (3 each). The data does not indicate the reason the workers involved were working from home.

Effectiveness

Workers’ claims journey results at April 2020

Return to work

64.2%at 4 weeks

77.1% at 13 weeks

81.6% at 26-weeks

84.6% at 52 weeks

90.2% at 104-weeks

Each of these values is lower than it was in March 2020.

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 both the data quality and performance concerns with the NI, SIRA carried out a data quality audit in December 2018 and completed a Compliance and Performance Review in December 2019.
* Based on a rolling 12 month cohort, for further details see the Explanatory Note.

Claim types

Of the 5,658 reportable claims in April 2020, 92.8% (5,251) were related to physical injuries and 7.2% (407) were related to psychological injuries.

Claims by body locations

Head: 10.5%

Neck: 2.2%

Upper limbs: 33.4%

Trunk: 19.3%

Lower limbs: 19.8%

Psychological: 7.2%

To be confirmed: 2.9%

Multiple locations: 3.0%

Systemic locations: 1.8%

System return to work rates

 RTW rate
4 weeks
RTW rate
13 weeks
RTW rate
26 weeks
RTW rate
52 weeks
RTW rate
104 weeks
Scheme64.20%77.10%81.60%84.60%90.20%
Nominal insurer62%75%80%83%90%
TMF68%81%86%89%91%
Specialised insurers72%83%85%88%89%
Self insurers68%79%84%85%90%

Maintaining a significant period of work

Maintaining a significant RTW measures how long the worker was reported to be working in a 12-month period following their initial return to work.

Note - This analysis requires a 12-month data development period and data is as at May 2020.

4% maintained RTW for less than 3 months

3% maintained RTW for more than 3 months up to 5 months

4% maintained RTW for more than 5 months up to 8 months

11% maintained RTW for more than 8 months up to 11 months

78% maintained RTW for 12 months

Efficiency & viability

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

Total claim payments made by insurers

In April 2020, the Nominal insurer made payments of almost $205 million, Government self-insurers (TMF) payments were more than $57 million, self-insurers had payments of more than $19 million, and specialised insurers had payments of almost $14 million.

Claim payment types

The breakdown of claim payment types in April 2020 is as follows:

  • Weekly payments: 43.2%
  • Medical payments: 23.9%
  • Common law (WID): 14.3%
  • Lump sum (S66 & S67) payments: 5.7%
  • Rehabilitation payments: 5.0%
  • Investigation payments: 2.3%
  • Legal payments: 2.1%
  • Death payments: 1.6%
  • Other payments: 1.5%
  • Commutations: 0.3%

Total claim payments made by insurers

In March 2020 $300 million dollars were paid as claim payments.

In April 2020 $296 million dollars was paid in claim payments.

This 1.6% decrease is based on data provided by insurers at the end of April 2020.

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

Of the total expenditure across the system in 2018/19, 46% was made on payments to claimants and 26% was spent to make payments for the claimants. Insurer expenses across the system was 28% 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 2018/19.

NSW workers compensation insurer scorecard

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

 % share or reported wages FY 2018/19% share of total claims FY 2018/19%share of total payments made in April% share of total active claims% of injury notifications actioned within 7 days% of Level 1 complaints to active claims
Nominal insurer74%67%69%66%98.15%0.03%
Government self insurer (TMF)13%17%19%20%98.87%0.02%
Specialised Insurers6%8%5%7%99.68%0.00%
Self insurers7%9%7%8%97.89%0.07%

Note: Insurers reported this data to SIRA. Data is as at April 2020

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 both the data quality and performance concerns with the NI, SIRA carried out a data quality audit in December 2018 and completed a Compliance and Performance Review in December 2019.

Customer experience & equity

Customers’ experience with the system is positive and equitable

Enquiries and complaints

During April 2020 SIRA received 1,729 enquiries and 710 complaints.

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 2020, the dispute rate was 0.6%, with 95,063 active claims and 607 disputes lodged.

Note: Including data from the Workers Compensation Commission.

Perceived justice of the compensation process

Insurer type

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

Nominal Insurer

4.0

3.9

4.3

Self and Specialised

3.9

3.9

4.3

Treasury Managed Fund

4.0

3.7

4.4

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

  • Procedural justice, about the fairness of the procedures used to determine the outcomes.
  • 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.

Source: Abridged Return to Work Outcomes Survey: NSW Workers Compensation System (October 2019).

Affordability

Insurance affordability

This is the affordability of insurance is 1.4%, as a percentage of NSW wages for 2018/19.

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 2020, the total amount of weekly benefit payments paid by insurer type was:

$88 million by the Nominal insurer

$29 million by the Government self-insurer (TMF)

$4 million by specialised insurers

$7 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 2020, the number of workers receiving weekly benefits by insurer type was:

23,104 for the Nominal insurer

7,295 for the Government self-insurer (TMF)

1,204 for specialised insurers

1,851 for 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 2020, the 4-week RTW rate was:

75.3% for the Nominal insurer

77.8% for the Government self-insurer (TMF)

82.4% for specialised insurers

85.2% for self-insurers

77.1% for the system average

In April 2020, the 13-week RTW rate was:

83.8% for the Nominal insurer

86.6% for the Government self-insurer (TMF)

88.2% for specialised insurers

89.5% for self-insurers

85.1% for the system average

In April 2020, the 26-week RTW rate was:

86.9% for the Nominal insurer

89.9% for the Government self-insurer (TMF)

89.7% for specialised insurers

91.1% for self-insurers

88.0% for the system average

Average days duration of weekly benefits paid in the first 6 months

In September 2019, the average was:

29 days for the Nominal insurer

31 days for the Government self-insurer (TMF)

21 days for specialised insurers

20 days for self-insurers

Note: This measure uses work hours lost and injury quarter to calculate average days, it is reported to June 2019 to allow for claim data development.

Scheme reportable claims development

Total reportable claims by financial year at development month 11.

78,293 in 2015/16

77,847 in 2016/17

79,741 in 2017/18

84,362 in 2018/19

Scheme claim payments development

Total claim payments by financial year at development month 11.

$418 million in 2015/16

$479 million in 2016/17

$502 million in 2017/18

$534 million in 2018/19

Development charts for weekly and medical payments as a percentage of wages for reportable claims by insurer type. Development quarters for injury/accident year (AY).

Nominal insurer weekly payments at development quarter 3.

0.096% in 2012 AY

0.084% in 2013 AY

0.080% in 2014 AY

0.079% in 2015 AY

0.079% in 2016 AY

0.088% in 2017 AY

0.096% in 2018 AY

0.103% in 2019 AY

Nominal insurer medical payments at development quarter 3.

0.106% in 2012 AY

0.092% in 2013 AY

0.085% in 2014 AY

0.088% in 2015 AY

0.088% in 2016 AY

0.095% in 2017 AY

0.097% in 2018 AY

0.092% in 2019 AY

Self-insurer weekly payments at development quarter 3.

0.106% in 2012 AY

0.088% in 2013 AY

0.076% in 2014 AY

0.083% in 2015 AY

0.074% in 2016 AY

0.081% in 2017 AY

0.081% in 2018 AY

0.092% in 2019 AY

Self-insurer medical payments at development quarter 3.

0.137% in 2012 AY

0.127% in 2013 AY

0.105% in 2014 AY

0.111% in 2015 AY

0.099% in 2016 AY

0.103% in 2017 AY

0.095% in 2018 AY

0.098% in 2019 AY

Specialised self-insurer weekly payments at development quarter 3.

0.116% in 2012 AY

0.092% in 2013 AY

0.090% in 2014 AY

0.095% in 2015 AY

0.088% in 2016 AY

0.078% in 2017 AY

0.084% in 2018 AY

0.088% in 2019 AY

Specialised self-insurer medical payments at development quarter 3.

0.124% in 2012 AY

0.108% in 2013 AY

0.104% in 2014 AY

0.111% in 2015 AY

0.109% in 2016 AY

0.103% in 2017 AY

0.112% in 2018 AY

0.120% in 2019 AY

TMF (emergency) weekly payments at development quarter 3. [Emergency Services covers Police, Fire and Ambulance agencies]

0.588% in 2012 AY

0.492% in 2013 AY

0.445% in 2014 AY

0.444% in 2015 AY

0.477% in 2016 AY

0.547% in 2017 AY

0.584% in 2018 AY

0.784% in 2019 AY

TMF (emergency) medical payments at development quarter 3. [Emergency Services covers Police, Fire and Ambulance agencies]

0.272% in 2012 AY

0.260% in 2013 AY

0.234% in 2014 AY

0.277% in 2015 AY

0.237% in 2016 AY

0.292% in 2017 AY

0.294% in 2018 AY

0.379% in 2019 AY

TMF (non-emergency) weekly payments at development quarter 3. [Non-emergency Services covers all agencies under TMF except Police, Fire and Ambulance agencies]

0.154% in 2012 AY

0.096% in 2013 AY

0.088% in 2014 AY

0.094% in 2015 AY

0.092% in 2016 AY

0.105% in 2017 AY

0.115% in 2018 AY

0.134% in 2019 AY

TMF (non-emergency) medical payments at development quarter 3. [Non-emergency Services covers all agencies under TMF except Police, Fire and Ambulance agencies].

0.103% in 2012 AY

0.076% in 2013 AY

0.065% in 2014 AY

0.071% in 2015 AY

0.068% in 2016 AY

0.068% in 2017 AY

0.073% in 2018 AY

0.082% in 2019 AY

Psychological claims numbers and payments as a proportion of total claim numbers and payments within each insurer type

In March 2020, the values by insurer types are :

Nominal insurer — claims are 5.7% of total and payments are 13.1% of the total.

Self-insurer — claims are 7.1% of total and payments are 13.7% of the total.

Specialised self-insurer — claims are 6.9% of total and payments are 19.8% of the total.

TMF (emergency) — claims are 18.8% of total and payments are 66.8% of the total.

TMF (non-emergency) — claims are 18.6% of total and payments are 42.3% of the total.

Insurer liability decisions by accident year and development quarter

In the 6th development quarter for accidents in 2019 the NI had 43,386 claims accepted with Provisional Liability compared with the same development quarter of 2015 where 22,388 claims had been accepted with Provisional Liability.

Nominal insurer at development quarter 3.

Accident Year

Notification

Liability accepted

Liability not yet decided

Liability denied

Provisional liability

Other

Non- reportable

2015

832

28986

114

2,299

22986

2118

31,718

2016

885

26575

122

2,048

25697

1471

32,514

2017

853

26595

142

1,524

27477

1302

32,917

2018

1187

20765

207

848

36906

2193

23,668

2019

1441

13032

151

690

46338

1577

24,027

Despite having significantly more claims in the 6th development quarter of 2015 in the 6th development quarter for accidents in 2019 self-insurers had 3,244 claims accepted with Provisional Liability compared with the same development quarter of 2015 where 3,316 claims had been accepted with Provisional liability.

Self-insurer at development quarter 3.

Accident Year

Notification

Liability accepted

Liability not yet decided

Liability denied

Provisional liability

Other

Non- reportable

2015

121

5311

15

380

3377

294

810

2016

95

4488

28

358

3498

275

683

2017

82

3716

14

363

3504

171

469

2018

75

3532

21

282

3467

181

553

2019

91

3536

16

366

3353

220

848

Despite having significantly more claims in the 6th development quarter of 2015 in the 6th development quarter for accidents in 2019 specialised insurers had 2,716 claims accepted with Provisional Liability compared with the same development quarter of 2015 where 2,410 claims had been accepted with Provisional liability.

Specialised self-insurer at development quarter 3.

Accident Year

Notification

Liability accepted

Liability not yet decided

Liability denied

Provisional liability

Other

Non- reportable

2015

74

2431

1

205

2399

163

1554

2016

53

2947

2

171

2139

156

1600

2017

66

2617

4

184

2228

152

1628

2018

76

2889

9

176

2582

131

1904

2019

81

3169

17

191

2754

136

2336

Despite a higher claims rate in 2015 in the 6th development quarter for accidents in 2019 TMF emergency services 466 claims were accepted with Provisional Liability compared with the same development quarter of 2015 where 1926 claims had been accepted with Provisional Liability.

TMF (emergency) at development quarter 3. [Emergency Services covers Police, Fire and Ambulance agencies]

Accident Year

Notification

Liability accepted

Liability not yet decided

Liability denied

Provisional liability

Other

Non- reportable

2015

124

1536

6

72

2077

217

5328

2016

95

1701

3

110

1942

137

5190

2017

53

2824

10

92

1073

87

5494

2018

69

3261

6

61

847

64

3652

2019

94

3841

12

73

616

65

3643

Despite a higher claims rate in 2015 in the 6th development quarter for accidents in 2019 TMF non-emergency services 1848 claims were accepted with Provisional Liability compared with the same development quarter of 2015 where 3927 claims had been accepted with Provisional liability.

TMF (non-emergency) at development quarter 3. [Non-emergency Services covers all agencies under TMF except Police, Fire and Ambulance agencies]

Accident Year

Notification

Liability accepted

Liability not yet decided

Liability denied

Provisional liability

Other

Non- reportable

2015

196

5464

14

515

4493

287

1820

2016

173

5567

12

395

3898

231

1263

2017

179

5840

15

363

3460

224

1065

2018

122

847

14

241

2485

169

987

2019

135

7527

9

279

2322

244

1471

Download the report (PDF, 429 KB) and the methodology and summary data tables (Excel worksheet, 280 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.