Workers compensation system monthly report

December 2018 report - published June 2019

System overview

Key workers compensation system statistics for the 12 months ending December 2018

• $256 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
• 101,837 claims were reported to SIRA
• 76,081 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

• 7,707 were reported in December 2018
• 10,382 were reported in November 2018
• 6,977 were reported in December 2017

Claim types

Of the 7,707 reportable claims in December 2018, 93.4% (7,197) were related to physical injuries and 6.6% (510) were related to psychological injuries.

Claims by body locations

• Head: 11.2%
• Neck: 1.6%
• Upper limbs: 33.1%
• Trunk: 17.2%
• Lower limbs: 21.3%

Also:

• Psychological: 6.6%
• Multiple locations: 5.8%
• To be confirmed: 2.2%
• Systemic locations: 1.0%

Effectiveness

Workers’ claims journey results at December 2018

Average over the last 12 months

• 11,197 reported incidents^{A^}
• 8,486 reportable claims ^
• 3,515 lost time^{T^}

^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

• 63.6% at 4 weeks*
• 79.5% at 13 weeks*
• 86.3% at the 26-week interval*

Note: SIRA identified data quality issues with the accuracy and completeness of data submitted by the Nominal Insurer (NI). The data revealed a significant deterioration in the NI’s RTW performance. 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 (PDF, 2.1 MB).

Efficiency & viability

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

Total claim payments made by insurers

In December 2018, the Nominal insurer made payments of nearly $171 million, Government self-insurers (TMF) of nearly $33 million, specialised insurers of nearly $16 million and self-insurers of over $14 million.

Claim payment types

The breakdown of claim payment types in December 2018 is as follows:

• Weekly payments: 39.1%
• Medical payments: 24.1%
• Common law (WID): 18.5%
• Rehabilitation payments: 5.0%
• Lump sum (S66 & S67) payments: 4.9%
• Death payments: 1.2%
• Investigation payments: 2.1%
• Other payments: 2.0%
• Legal payments: 2.0%
• Commutations: 1.2%

Total claim payments made by insurers

• December 2018: $233 million dollars paid in claim payments
• November 2018: $272 million dollars paid in claim payments
• Claim payments: Down 14.2% based on data provided by insurers at the end of December 2018. Please note this may increase should late running reports of payments be supplied by insurers after the December 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 1,767 enquiries in December 2018. There were 196 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 December 2018, the dispute rate was 0.5%, with 89,026 active claims and 485 disputes lodged.

Note: Including data from WIRO (Workers Compensation Independent Review Office) and the Workers Compensation Commission

Workers perceptions of equity across the workers compensation system

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 is about the fairness of the procedures used to determine the outcomes.

Source: Safe Work Australia 2018 Return to Work Survey

Affordability

Insurance affordability

Affordability of insurance is 1.4%, as a percentage of reported NSW wages for 2017/18.

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 December 2018.

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 December 2018, the total amount of weekly benefit payments paid by insurer type was:

• $69 million by the Nominal insurer
• $24 million by the Government self insurer (TMF)
• $4 million by specialised insurers
• $5 million by self-insurers

Note: Section 39 claimants that exited the system have been excluded from this data to ensure consistent comparisons. This measure is based on the latest data available to SIRA, the April 2019 data submission.

Number of workers receiving weekly benefits per month

In December 2018, the number of workers receiving weekly benefits by insurer type was:

• 18,145 by the Nominal insurer
• 6,341 by the Government self insurer (TMF)
• 1,230 by specialised insurers
• 1,672 by self-insurers

Note: The data is a distinct number of workers receiving weekly benefits where Section 39 claimants that exited the system have been excluded to ensure consistent comparisons. This measure based on the latest data available to SIRA, the April 2019 submission.

Additional scheme performance measures note:

Since the July 2018 dashboard, SIRA has identified deterioration in NI RTW performance for which the NI explains is due to data quality issues. In December 2018 SIRA conducted a data quality audit and in February 2019 commenced a Compliance and Performance Review. SIRA is also reviewing and adding additional measures to the dashboard to better report the scheme performance. The additional measures for December 2018 include: the cost to the scheme for weekly benefits paid per month; and the number of workers receiving weekly benefits per month.  
The additional measures included on this page are based on the most current data available to SIRA, the April 2019 submission.

Disclaimer:

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.

Download the report (PDF, 1.3 MB), explanatory note (PDF, 2.2 MB) and the methodology and summary data tables (Excel worksheet, 216 KB) used to support this report. If you have trouble accessing content within these reports, please send an email to [email protected] or call us on 13 10 50.

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