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Workers compensation system monthly report

November 2018 report - published June 2019

System overview

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

  • $255 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
  • 101,236 claims were reported to SIRA
  • 78,009 workers received weekly benefit payments

1For the 2017/18 financial year

Effectiveness

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

Reportable claims

  • 10,147 were reported in November 2018
  • 9,424 were reported in October 2018
  • 8,692 were reported in November 2017

Claim types

Of the 10,147 reportable claims in November 2018, 93.7% (9,505) were related to physical injuries and 6.3% (642) were related to psychological injuries.

Claims by body locations

  • Head: 10.5%
  • Neck: 1.9%
  • Upper limbs: 34.3%
  • Trunk: 17.6%
  • Lower limbs: 19.9%

Also:

  • Psychological: 6.3%
  • Multiple locations: 6.0%
  • To be confirmed: 2.7%
  • Systemic locations: 0.8%

Effectiveness

Workers’ claims journey results at November 2018

Average over the 12 months

  • 11,161 reported incidentsA^
  • 8,439 reportable claims ^
  • 3,491 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

  • 65.3% at 4 weeks*
  • 80.2% at 13 weeks*
  • 86.7% at the 26-week interval*

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.

Efficiency & viability

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

Total claim payments made by insurers

In November 2018, the Nominal insurer made payments of nearly $175 million, Government self-insurers (TMF) over $48 million, specialised insurers over $13 million and self-insurers over $18 million.

Claim payment types

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

  • Weekly payments: 37.3%
  • Medical payments: 25.8%
  • Common law (WID): 18.5%
  • Rehabilitation payments: 5.0%
  • Lump sum (S66 & S67) payments: 4.4%
  • Death payments: 2.1%
  • Investigation payments: 2.2%
  • Other payments: 2.2%
  • Legal payments: 1.9%
  • Commutations: 0.5%

Total claim payments made by insurers

  • November 2018: $255 million dollars paid in claim payments
  • October 2018: $267 million dollars paid in claim payments
  • Claim payments: Down 4.7% based on data provided by insurers at the end of November 2018. Please note this may increase should late running reports of payments be supplied by insurers after the November 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 2,490 enquiries in November 2018. There were 254 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 November 2018 the dispute rate was 0.6%, with 90,115 active claims and 576 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

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 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


% share of reported wages
FY 2017/18


% 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


RTW rate
4 weeks


RTW rate
13 weeks


RTW rate
26 weeks

Nominal insurer

74%

67%

69%

66%

98%

0.2%

61%

78%

86%

Government self insurer (TMF)

13%

16%

19%

20%

99%

0.2%

77%

87%

89%

Specialised Insurers

6%

8%

5%

6%

95%

0.2%

73%

82%

87%

Self insurers

7%

9%  

7%

8%

93%

0.3%

68%

79%

87%

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

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, 1.2MB) and the methodology and summary data tables (Excel worksheet, 212 KB) used to support this report. If you have trouble accessing content within these reports, please send an email to contact@sira.nsw.gov.au or call us on 13 10 50.

Website www.sira.nsw.gov.au |  Catalogue no. SIRA08973  |  © State Insurance Regulatory Authority 0619