Workers compensation monthly report November 2020
System overview
Key workers compensation system statistics for the 12 months ending November 2020
$282 billion of reported wages are safeguarded by the workers compensation scheme 1
$4.14 billion in premiums were collected, representing 1.5% of reported NSW wages1
$3.68 billion was paid out as costs for workers1
98,283 workers received weekly benefit payments1
94,152 claims were reported to SIRA
66.2% return to work rate in November at 4 weeks
1For the 2019/20 financial year
Effectiveness
System effectiveness in protecting workers and getting workers back to work and wellbeing
Coronavirus (COVID-19) and working from home claims
As at 30/11/2020, there were 190 claims for workers working from home. These were being handled by the different insurer types as follows: nominal insurer (NI) (87), TMF (57), self insurers (37) and specialised insurers (9).
Of these 190 claims, 3 occurred in November 2020, 7 in October, 14 in September, 30 in August, 21 in July, 18 in June. The remainder occurred earlier than June 2020.
Access the most current information on COVID-19 claims from our open data portal.
Note: The data does not indicate the reason for the injured worker to work from home.
SIRA is now reporting claim volumes for COVID-19.
Reportable claims
8,948 were reported in November 2020
8,180 were reported in October 2020
8,614 were reported in November 2019
Monthly average over the last 12 months
10,298 reports submitted A^
7,846 reportable claims ^
4,399 lost time T^
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.
Claim types
Of the 8,948 reportable claims in November 2020, 92.76% (8,300 claims) were related to physical injuries and 7.24% (648) were related to psychological injuries.
Insurer Performance
Information about the performance of insurers operating within the workers compensation system
| % share of reported wages | % share of total claims | % share of total payments made in November 2020 | % share of total active claims | % of injury notifications actioned within 7 days | % of Level 1 complaints to active claims |
|---|---|---|---|---|---|---|
Nominal insurer | 74% | 67% | 69% | 67% | 98.16% | 0.02% |
Government self insurer (TMF) | 14% | 16% | 19% | 19% | 99.42% | 0.04% |
Specialised Insurers | 5% | 8% | 5% | 6% | 95.41% | 0.05% |
Self insurers | 7% | 9% | 7% | 8% | 98.77% | 0.04% |
Note: Insurers reported this data to SIRA. Data is as at November 2020
SIRA published the NI Compliance and Performance Review in December 2019 and a status report on the 21 point action plan is now available.
Effectiveness
Workers’ claims journey results at November 2020
System return to work rates
Note: Data based on a rolling 12 month cohort.
| RTW rate 4 weeks | RTW rate 13 weeks | RTW rate 26 weeks | RTW rate 52 weeks | RTW rate 104 weeks |
|---|---|---|---|---|---|
Scheme | 66.61% | 79.65% | 84.46% | 87.05% | 86.87% |
Monthly change in scheme RTW rate | Down 1.02 p.p.* | Down 0.34 p.p. | Down 0.15 p.p. | Up 0.23 p.p. | Down 0.62 p.p. |
Nominal Insurer | 66% | 79% | 84% | 86% | 86% |
Government Self Insurer (TMF) | 68% | 82% | 87% | 89% | 91% |
Specialised Insurers | 72% | 81% | 84% | 87% | 88% |
Self Insurers | 68% | 78% | 80% | 85% | 86% |
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. In addition, SIRA has a 21-point action plan for the NI.
* p.p. refers to percentage points
Maintaining a significant period of work
Maintaining a significant RTW measures monitors the length of time workers were 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 November 2020.
2.3% maintained RTW for less than 3 months
3.4% maintained RTW for more than 3 months up to 5 months
4.0% maintained RTW for more than 5 months up to 8 months
9.4% maintained RTW for more than 8 months up to 11 months
80.9% 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 November 2020, the Nominal insurer made payments of about $221.3 million, Government self-insurers (TMF) payments were about $61.3 million, self-insurers had payments of about $22.2 million, and specialised insurers had payments of about $17.6 million.
Claim payment types
The breakdown of claim payment types in November 2020 is as follows:
- Weekly payments: 41.9%
- Medical payments: 24.7%
- Common law (WID): 16.6%
- Lump sum (S66 & S67) payments: 5.0%
- Rehabilitation payments: 4.7%
- Investigation payments: 2.3%
- Legal payments: 1.9%
- Other payments: 1.6%
- Death payments: 0.8%
- Commutations: 0.6%
Total claim payments made by insurers
In October 2020, $350 million were paid in claim payments.
In November 2020, $322 million was paid in claim payments.
There was a 7.98% decrease in claim payments.
Note – Insurers regularly update claims data based on the progression of a claim. This has been observed to result in changing payment details month on month.
Benefits paid to and for workers as a percentage of total claims expenditure
Of the total expenditure across the system in 2020 payment year, 48% was spent on direct payments to claimants and 24% was spent on payments for services to claimants, 28% was spent on insurer expenses.
Among all the insurers, the NI (31%) and specialised insurer (34%) spent a greater percentage on insurer expenses than self-insurers (12%), TMF (16%) and scheme overall (28%). Percentage of payments made directly to the claimants are 42% for specialised insurer, 45% for nominal insurer, 57% for self-insurers and 61% for TMF, scheme overall was 48%.
Note: The benefits paid to and for workers is calculated annually. Data is based on expenditure 2020 payment year, as at 30 September 2020.
Customer experience
Customers’ experience with the system is positive
Enquiries and complaints
In November 2020, SIRA received 1,830 enquiries and 788 complaints.
Note: These are the complaints and enquiries numbers received by SIRA and WIRO. 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 2020, the dispute rate was 0.67%, with 104,703 active claims and 703 disputes.
Note: Including data from the Workers Compensation Commission.
Engagement with work
Remaining, returning and maintaining engagement with work
Cost to the scheme for weekly benefits paid per month
In November 2020, the total amount of weekly benefit payments paid by insurer type was:
$94.4 million by the Nominal insurer
$28.6 million by the Government self-insurer (TMF)
$5.1 million by specialised insurers
$7.8 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 November 2020, the number of workers receiving weekly benefits by insurer type was:
25,851 for the Nominal insurer
7,876 for the Government self-insurer (TMF)
1,586 for specialised insurers
2,158 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 November 2020, the 4-week RTW rate was:
75.7% for the Nominal insurer
76.7% for the Government self-insurer (TMF)
81.6% for specialised insurers
84.9% for self-insurers
77.1% for the system average
In November 2020, the 13-week RTW rate was:
85.0% for the Nominal insurer
86.4% for the Government self-insurer (TMF)
86.8% for specialised insurers
88.9% for self-insurers
85.8% for the system average
In November 2020, the 26-week RTW rate was:
88.7% for the Nominal insurer
90.0% for the Government self-insurer (TMF)
88.8% for specialised insurers
89.7% for self-insurers
89.0% for the system average
Average days duration of weekly benefits paid in the first 6 months
In March 2020, the average was:
30.8 days for the Nominal insurer
31.0 days for the Government self-insurer (TMF)
24.2 days for specialised insurers
22.9 days for self-insurers
Note: This measure uses work hours lost and injury quarter to calculate average days, it is reported to March 2020 to allow for claim data development. This latest data is as at September 2020.
Scheme reportable claims development
Total reportable claims by financial year at development month 5.
34,495 in 2015/16
34,480 in 2016/17
34,474 in 2017/18
37,471 in 2018/19
37,589 in 2019/20
36,818 in 2020/21
Scheme claim payments development
Total claim payments by financial year at development month 5.
$96.0 million in 2015/16
$113.6 million in 2016/17
$125.2 million in 2017/18
$132.9 million in 2018/19
$145.0 million in 2019/20
$150.9 million in 2020/21