Workers compensation monthly report
System overview
Key workers compensation system statistics for the 12 months ending January 2019
$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
102,307 claims were reported to SIRA
76,472 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
7,853 were reported in January 2019
7,832 were reported in December 2018
6,960 were reported in January 2018
Claim types
Of the 7,853 reportable claims in January 2019, 94.3% (7,406) were related to physical injuries and 5.7% (447) were related to psychological injuries.
Claims by body locations
Head: 9.1%
Neck: 1.6%
Upper limbs: 34.7%
Trunk: 18.6%
Lower limbs: 20.9%
Also:
Psychological: 5.7%
Multiple locations: 5.2%
To be confirmed: 3.2%
Systemic locations: 1.0%
Effectiveness
Workers’ claims journey results at January 2019
Monthly average over the last 12 months
11,312 records submittedA^
8,526 reportable claims ^
3,560 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
62.9%at 4 weeks*
78.5% at 13 weeks*
85.8% 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 January 2019, the Nominal insurer made payments of over $163 million, Government self-insurers (TMF) of nearly $48 million, specialised insurers of nearly $17 million and self-insurers of over $14 million.
Claim payment types
The breakdown of claim payment types in January 2019 is as follows:
- Weekly payments: 41.0%
- Medical payments: 21.8%
- Common law (WID): 21.0%
- Rehabilitation payments: 3.8%
- Lump sum (S66 & S67) payments: 4.9%
- Death payments: 1.2%
- Investigation payments: 1.9%
- Other payments: 1.7%
- Legal payments: 1.7%
- Commutations: 0.9%
Total claim payments made by insurers
In January 2019 $242 million dollars payed in claim payments.
In December 2018 $264 million dollars payed in claim payments.
Down 8.4% based on data provided by insurers at the end of January 2019. Please note this may increase should late running reports of payments be supplied by insurers after the January 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 2,299 enquiries in January 2019. There were 562 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 January 2019, the dispute rate was 0.6%, with 87,719 active claims and 486 disputes lodged.
Note: Including data from the Workers Compensation Commission.
Workers perceptions of equity across the workers compensation system
| Jurisdiction | Distributive Justice Average (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
The affordability of insurance is 1.4% of reported NSW wages for 2017/18.
| % share of reported wages FY 2017/18 | % share of total claims FY 2017/18 | % 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% | 67% | 66% | 98% | 0.1% | 58% | 76% | 85% |
| Government self-insurer (TMF) | 13% | 16% | 20% | 19% | 99% | 0.0% | 76% | 86% | 90% |
| Specialised Insurers | 6% | 8% | 7% | 7% | 97% | 0.1% | 73% | 83% | 86% |
| Self insurers | 7% | 9% | 6% | 8% | 96% | 0.1% | 66% | 77% | 84% |
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 January 2019.
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.
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 January 2019, the total amount of weekly benefit payments paid by insurer type was:
$66 million by the Nominal insurer
$24 million by the Government self-insurer (TMF)
$4 million by specialised insurers
$5 million by self-insurers
Note: To ensure consistency across the time series, the data excludes Section 39 claimants that exited the system.
Number of workers receiving weekly benefits per month
In January 2019, the number of workers receiving weekly benefits by insurer type was:
18,355 by the Nominal insurer
6,445 by the Government self-insurer (TMF)
1,200 by specialised insurers
1,569 by self insurers
Note: To ensure consistency across the time series, the measure excludes Section 39 claimants that exited the system. The chart shows distinct number of workers receiving weekly benefits per month.
RTW including medical only claimants rate
In January 2019, the 4 week RTW rate was:
77% for the Nominal insurer
83% for the Government self-insurer (TMF)
84% for specialised insurers
86% for self insurers
79% for the system average
In January 2019, the 13 week RTW rate was:
86% for the Nominal insurer
90% for the Government self-insurer (TMF)
89% for specialised insurers
90% for self insurers
87% for the system average
In January 2019, the 26 week RTW rate was:
91% for the Nominal insurer
92% for the Government self-insurer (TMF)
90% for specialised insurers
91% for self insurers
91% for the system average
Note: The percentage of workers at work at 4, 13, and 26 weeks is a variation of the RTW work measure reported on pages 2 and 5 of the dashboard. This measure includes medical only claims who never left work and allows an insurer type comparison of workers who are at work at 4, 13 and 26 week intervals from the date the claims entered the system. See the “Data source information” section of the Explanatory note for further details on the percentage of workers at work measure.
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 shows the average number of days of weekly benefits paid to injured workers in the first 6 months of their claim. 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. See the “Data source information” section of the Explanatory note for further details on the average duration of weekly benefits paid in the first 6 months measure.
Reportable claims development
Total reportable claims by financial year at 7 development periods
47,090 in 2015/16
47,026 in 2016/17
47,767 in 2017/18
54,437 in 2018/19
Claim payments development
Total claim payments by financial year at 7 development periods
$182 million in 2015/16
$213 million in 2016/17
$231 million in 2017/18
$239 million in 2018/19
Note: The reportable claims development chart visualises the development of reportable claims by injury financial year. Displaying reportable claims by injury financial year, across development months from claim injury date, helps to track variations in figures and also benchmark against previous injury financial years. The claim payments development chart visualises the development of claim payments by injury financial year. Displaying claim payments by injury financial year, across development months from claim injury date, allows for system payment comparisons. No indexation or adjustments have been applied to payment figures, the chart shows original dollar values.
Download the report (PDF, 756 KB) and the methodology and summary data tables (Excel worksheet, 232 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.
Website www.sira.nsw.gov.au | Catalogue no. SIRA09053 | © State Insurance Regulatory Authority 0819