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Workers compensation monthly report May 2020

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May 2020 report

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System overview

Key workers compensation system statistics for the 12 months ending May 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

94,713 claims were reported to SIRA

78,979 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

7,301 were reported in May 2020

5,555 were reported in April 2020

9,030 were reported in May 2019

Monthly average over the last 12 months

10,550 reports submittedA^

7,893 reportable claims ^

4,363 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 31/7/2020 there were 105 claims for workers working from home. These were being handled by the different insurer types as follows : NI (53), TMF (34), self insurers (12) and specialised insurers (6). The data does not indicate the reason the workers involved were working from home.

Effectiveness

Workers’ claims journey results at May 2020

Return to work

64%at 4 weeks

77% at 13 weeks

82% at 26-weeks

85% at 52 weeks

90% at 104-weeks

Each of these values is lower than it was in April 2020, except 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 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 7,301 reportable claims in May 2020, 93.3% (6,810) were related to physical injuries and 6.7% (491) were related to psychological injuries.

Claims by body locations

Head: 10.5%

Neck: 2.5%

Upper limbs: 34.8%

Trunk: 19.0%

Lower limbs: 19.6%

Psychological: 6.7%

To be confirmed: 2.4%

Multiple locations: 3.4%

Systemic locations: 1.1%

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

Scheme

64%

77%

82%

85%

90%

Nominal insurer

63%

76%

80%

83%

90%

(TMF)

68%

81%

86%

89%

91%

Specialised Insurers

72%

82%

86%

87%

89%

Self insurers

69%

78%

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.

5.5% maintained RTW for less than 3 months

3.9% maintained RTW for more than 3 months up to 5 months

5.2% maintained RTW for more than 5 months up to 8 months

13.0% maintained RTW for more than 8 months up to 11 months

72.3% 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 May 2020, the Nominal insurer made payments of almost $192 million, Government self-insurers (TMF) payments were more than $57 million, self-insurers had payments of almost $18 million, and specialised insurers had payments of more than $16 million.

Claim payment types

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

  • Weekly payments: 44.4%
  • Medical payments: 22.6%
  • Common law (WID): 15.3%
  • Lump sum (S66 & S67) payments: 5.2%
  • Rehabilitation payments: 4.5%
  • Investigation payments: 2.3%
  • Legal payments: 2.0%
  • Death payments: 2.0%
  • Other payments: 1.2%
  • Commutations: 0.6%

Total claim payments made by insurers

In April 2020 $305 million dollars were paid as claim payments.

In May 2020 $283 million dollars was paid in claim payments.

This 7.14% decrease is based on data provided by insurers at the end of May 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.

Late claim liability decisions

Counts of claims with late liability decision for Scheme. Data is as at May 2020.

November 2019 until March 2020, the number of 1—7 days late claim decisions ranged from 60 to 70, which then reduced to 38 claims in May 2020. The number of 8 to 14 days late claim decisions increased by about 30 from November 2019 to January 2020, when they then decreased to 14 in May 2020. 15 to 21 days late claim decisions reduced from 19 in November 2019 to 11 in May 2020. Claim decisions that are more than 21 days late reduced from 45 in November 2019 to 5 in May 2020.

Values for May 2020

1 to 7 days late — 38 claims

8 to 14 days late — 14 claims

15 to 21 days late — 11 claims

more than 21 days late — 5 claims

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 May 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 May 2020 SIRA received 1,692 enquiries and 677 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 May 2020, the dispute rate was 0.7%, with 93,943 active claims and 649 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

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

$88.5 million by the Nominal insurer

$26.3 million by the Government self-insurer (TMF)

$5.0 million by specialised insurers

$6.5 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 May 2020, the number of workers receiving weekly benefits by insurer type was:

23,805 for the Nominal insurer

7,194 for the Government self-insurer (TMF)

1,542 for specialised insurers

1,898 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 May 2020, the 4-week RTW rate was:

75.4% for the Nominal insurer

77.8% for the Government self-insurer (TMF)

82.2% for specialised insurers

85.1% for self-insurers

77.2% for the system average

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

83.7% for the Nominal insurer

86.5% for the Government self-insurer (TMF)

87.7% for specialised insurers

89.1% for self-insurers

85.0% for the system average

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

87.0% for the Nominal insurer

89.8% for the Government self-insurer (TMF)

90.0% for specialised insurers

91.2% for self-insurers

88.1% for the system average

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

In December 2019, the average was:

29 days for the Nominal insurer

32 days for the Government self-insurer (TMF)

21 days for specialised insurers

19 days for self-insurers

29 days for overall scheme

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

Scheme reportable claims development

Total reportable claims by financial year at development month 11.

78,294 in 2015/16

77,849 in 2016/17

79,744 in 2017/18

84,361 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

0.078% in 2016 AY

0.088% in 2017 AY

0.096% in 2018 AY

0.103% in 2019 AY

0.133% in 2020 AY

Nominal insurer medical payments at development quarter 3.

0.105% in 2012 AY

0.092% in 2013 AY

0.085% in 2014 AY

0.087% in 2015 AY

0.088% in 2016 AY

0.095% in 2017 AY

0.097% in 2018 AY

0.092% in 2019 AY

0.098% in 2020 AY

Self-insurer weekly payments at development quarter 3.

0.105% in 2012 AY

0.086% in 2013 AY

0.075% in 2014 AY

0.082% in 2015 AY

0.073% in 2016 AY

0.080% in 2017 AY

0.081% in 2018 AY

0.091% in 2019 AY

0.097% in 2020 AY

Self-insurer medical payments at development quarter 3.

0.132% in 2012 AY

0.122% in 2013 AY

0.101% in 2014 AY

0.106% in 2015 AY

0.096% in 2016 AY

0.100% in 2017 AY

0.093% in 2018 AY

0.096% in 2019 AY

0.090% in 2020 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

0.101% in 2020 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

0.104% in 2017 AY

0.112% in 2018 AY

0.120% in 2019 AY

0.112% in 2020 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

0.583% in 2018 AY

0.784% in 2019 AY

0.870% in 2020 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

0.238% in 2016 AY

0.292% in 2017 AY

0.294% in 2018 AY

0.379% in 2019 AY

0.235% in 2020 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

0.093% in 2016 AY

0.105% in 2017 AY

0.115% in 2018 AY

0.134% in 2019 AY

0.145% in 2020 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

0.069% in 2017 AY

0.073% in 2018 AY

0.082% in 2019 AY

0.076% in 2020 AY

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

In June 2020, the values by insurer types are :

Nominal insurer — claims are 5.6% of total and payments are 13.6% of the total.

Self-insurer — claims are 5.6% of total and payments are 16.6% of the total.

Specialised self-insurer — claims are 4.8% of total and payments are 18.7% of the total.

TMF (emergency) — claims are 17.2% of total and payments are 67.0% of the total.

TMF (non-emergency) — claims are 15.0% of total and payments are 41.0% of the total.

Insurer liability decisions by accident year and development quarter

In the 6th development quarter for accidents in 2019, the NI had 43,427 claims accepted with Provisional Liability compared with the same development quarter of 2015 where 22,388 claims had been accepted with Provisional Liability.

Accident year

Notification

Liability accepted

Liability not yet decided

Liability denied

Provisional liability

Other

Non-reportable

2015

832

28,986

114

2,299

22,986

2,119

31,717

2016

885

26,575

122

2,048

25,697

1,471

32,514

2017

853

26,595

142

1,524

27,479

1,304

32,913

2018

1,187

20,765

207

848

36,906

2,195

23,665

2019

1,138

13,030

150

667

46,159

1,543

24,370

2020

935

17,064

122

1087

38,220

1,110

21,151

Self-insurer at development quarter 3

Accident year

Notification

Liability accepted

Liability not yet decided

Liability denied

Provisional

Other

Non-reportable

2015

114

4,900

15

362

3,344

292

799

2016

90

4,181

27

338

3,431

271

676

2017

78

3,587

14

346

3,325

168

466

2018

71

3,429

21

259

3,271

177

549

2019

85

3,338

16

349

3,272

216

844

2020

91

2,772

11

362

3,242

192

1,126

In the 6th development quarter for accidents in 2019, the specialised insurer had 2,713 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

2,431

1

205

2,399

163

1,554

2016

53

2,947

2

171

2,139

156

1,600

2017

66

2,617

4

184

2,229

152

1,627

2018

76

2,890

9

176

2,582

131

1,903

2019

81

3,173

17

190

2,752

137

2,335

2020

74

2,758

5

191

2,886

156

1,887

Self-insurer at development quarter 3.

Accident year

Notification

Liability accepted

Liability not yet decided

Liability denied

Provisional

Other

Non-reportable

2015

114

4,900

15

362

3,344

292

799

2016

90

4,181

27

338

3,431

271

676

2017

78

3,587

14

346

3,325

168

466

2018

71

3,429

21

259

3,271

177

549

2019

85

3,338

16

349

3,272

216

844

2020

91

2,772

11

362

3,242

192

1,126

Despite a higher claims rate in 2015, in the 6th development quarter for accidents in 2019, 467 claims from TMF emergency services were accepted with Provisional Liability compared with the same development quarter of 2015 where 1,926 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

1,536

6

72

2,077

217

5,328

2016

95

1,701

3

110

1,942

137

5,190

2017

53

2,825

10

92

1,073

87

5,493

2018

69

3,260

6

61

847

65

3,651

2019

94

3,841

12

73

616

68

3,640

Despite a higher claims rate in 2015, in the 6th development quarter for accidents in 2019, 1,847 claims from TMF non-emergency services were accepted with Provisional Liability compared with the same development quarter of 2015 where 3,927 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

5,464

14

515

4,493

287

1,820

2016

173

5,567

12

395

3,898

231

1,263

2017

179

5,840

15

363

3,460

224

1,065

2018

122

6,847

14

241

2,485

169

987

2019

135

7,525

9

280

2,322

248

1,466

2020

136

6,203

8

331

2,740

167

1,069