Workers compensation system monthly report

June 2018 report – published September 2018

1. Effectiveness

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

Reported claims

June 2018: 8,451 claims

May 2018: 9,462 claims

June 2017: 7,585 claims

Claims by body locations

Head: 10.7%

Neck: 1.8%

Upper limbs: 34%

Trunk: 18.5%

Lower limbs: 19.2%

Also:

Psychological: 6.5%

Multiple locations: 6.1%

To be confirmed: 2.4%

Systemic locations: 0.8%

Claim types

Of the 8,451 claims reported in June 2018, 93% (7,901) were related to physical injuries and 7% (550) were related to psychological injuries.

Return to work rates

4 weeks: 69%

13 weeks: 82%

26 weeks: 89%

Note: SIRA identified data quality issues with the completeness of the work status code data submitted by the Nominal Insurer (NI). This impacts the quality of the Return to Work data. SIRA determined this needed to be swiftly corrected and instructed the NI to improve the quality of this data. The NI has advised this will be rectified by the October data submission.

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

May 2018: $254 million claim payments

June 2018: $228 million claim payments

Down 10.2 %

Claim payment types

Breakdown of claim payment types in June 2018 was:

Weekly payments: 36.7%

Medical payments: 28.2%

Common law (WID): 15.7%

Rehabilitation payments: 6.5%

Lump sum (S66 & S67) payments: 4.3%

Investigation payments: 2.2%

Other payments: 2.2%

Legal payments: 2.2%

Death payments: 1.6%

Commutations: 0.4%

Note: Insurers reported this data to SIRA. Data is as at June 2018.

3. Viability

Sustainability and viability for generations to come

Total claim payments made by insurers

In June 2018, the Nominal insurer made payments worth near $153 million followed by Government self-insurers (TMF) $46.7 million, self-insurers $14.6 million and $13.6 million by specialised insurers.

4. Affordability

Insurance affordability: 1.4%

This is the affordability of insurance as a percentage of NSW wages for 2016/17.

5. Customer experience

Customer experience with the system

Enquiries and complaints received by SIRA

SIRA received 2,216 enquiries in June 2018. There were 233 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 1) reported to SIRA

In June 2018, SIRA received 138 level 1 complaints. The top 5 level 1 complaints were as follows:

Medical practitioner – treating specialist: Fees/Billing: 33

Weekly payments: 20

Case management practice: Insurer conduct/behaviour: 17

Medical: Payments: 12

Workplace injury management: Suitable employment: 7

Disputes lodged for June 2018

In June 2018, the dispute rate was 0.6%, with 82,906 active claims and 521 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.

	% share of premium paid FY 2016/17	% 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	% Level 2 complaints resolved within 20 business days	RTW 4 weeks	RTW 13 weeks	RTW 26 weeks
Nominal Insurer	74%	68%	67%	65%	98%	0.16%	90%	65%*	81%*	89%*
Government self-insurers (TMF)	14%	16%	21%	20%	98%	0.13%	100%	80%	88%	89%
Specialised Insurers	5%	8%	6%	7%	95%	0.23%	100%	74%	84%	88%
Self-insurers	7%	8%	6%	8%	96%	0.23%	100%	77%	86%	90%

Note: Insurers reported this data to SIRA. Data is as at June 2018.

*SIRA identified data quality issues with the completeness of the work status code data submitted by the Nominal Insurer (NI). This impacts the quality of the Return to Work data. SIRA determined this needed to be swiftly corrected and instructed the NI to improve the quality of this data. The NI has advised this will be rectified by the October data submission.

Download the report (PDF, 385 KB) and the methodology and summary data tables (Excel worksheet, 271 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.

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.