Workers compensation system monthly report

First report - published May 2018

1. Effectiveness

System effectiveness in protecting workers and getting workers back to work and well-being

Reported claims

Dec 2017 7,712 claims

Nov 2017 9,506 claims

Dec 2016 6,905 claims

Claims by body locations

Head 10.2%

Neck 1.5%

Upper limbs 33.5%

Trunk 17.7%

Lower limbs 19.9%

Also:

Psychological 5.3%

Multiple locations 5.8%

To be confirmed 2.3%

Systemic locations 1.0%

Not stated 2.8%

Claim types

Of the 7,712 claims reported in December 2017, 95% (7,292) were related to physical injuries and 5% (420) were related to psychological injuries.

Return to work rates

4 weeks 73%

13 weeks 85%

26 weeks 89%

Note: Insurers reported this data to SIRA as at December 2017.

The return to work (RTW) rate is the percentage of time lost by claimants who have been off work as a result of their employment-related injury/disease and have returned to work at different points in time from the date the claim was reported (i.e. 4, 13 and 26 weeks for the Workers Compensation monthly dashboard). RTW rates are calculated monthly for the last 13 months up to the date of data. The cohort for each RTW measure is based on claims reported in a 12-month period, with a lag to allow for claim development (i.e., the lag for the 4-week measure is 28 days; the lag for the 13-week measure is 91 days; and the lag for the 26-week measure is 182 days).

2. Efficiency

Efficient system delivery in terms of cost, time and process

Claim payments

Nov 2017 $231M claim payments

Dec 2017 $234M claim payments

Up 1.1 %

Claim payment types

Breakdown of claim payment types in December 2017 was:

Weekly payments: 37.5%

Medical payments: 24%

Common law (WID): 17.5%

Rehabilitation payments: 6.8%

Lump sum (S66 & S67) payments: 4.7%

Death payments: 2.5%

Legal payments: 2.3%

Investigation payments: 2.1%

Commutations: 0.6%

Other: 1.9%

Note: Insurers reported this data to SIRA as at December 2017.

3. Viability

Sustainability and viability for generations to come

Total claim payments made by insurers

In December 2017, the Nominal insurer made payments worth over $161 million followed by Government self-insurer (TMF) $43 million, self-insurers $15 million and $13 million by specialised insurers.

4. Affordability

Insurance affordability

1.4%

Affordability of insurance as a percentage of NSW wages for 2016/17

5. Customer experience

Customer experience with the system

SIRA received 3,474 enquiries in March 2018. There were 214 complaints received in the same period.

Note: Complaint data, including the name of the relevant insurers etc is derived from verbatim reports from customers. Whilst some data cleansing processes are undertaken by SIRA the reporting is verbatim from customers and may from time to time reference an incorrect insurer and/or insurer type.

Complaint types (Level 2) reported to SIRA

The breakdown of level 2 complaints received by SIRA in March 2018:

Weekly payments: 43%

Medical timeframes: 15%

Case management practice: Insurer conduct/behaviour: 15%

Medical payments: 12%

Medical liability: 15%

Disputes lodged for January 2018

In January 2018, the dispute rate was 0.7%, with 80,106 active claims and 552 disputes lodged.

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

6. Equity

System equity and fairness

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

Of the total expenditure across the system in 2016/17, 47% was made on payments to claimants and 23% was spent to make payments for the claimants. Insurer expenses across the system was 30% 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 2016/17.

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.

Website www.sira.nsw.gov.au