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Workers compensation monthly report October 2019

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October 2019 report

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System overview

Key workers compensation system statistics for the 12 months ending October 2019

$258 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

$3.2 billion was paid out as costs for workers claims

101,265 claims were reported to SIRA

78,961 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

8,997 were reported in October 2019

8,735 were reported in September 2019

8,527 were reported in October 2018

Claim types

Of the 8,997 reportable claims in October 2019, 93.0% (8,370) were related to physical injuries and 7.0% (627) were related to psychological injuries.

Claims by body locations

Head: 10.0%

Neck: 2.3%

Upper limbs: 35.3%

Trunk: 18.2%

Lower limbs: 20.6%

Also:

Psychological: 7.0%

To be confirmed: 2.9%

Multiple locations: 2.7%

Systemic locations: 1.1%

Effectiveness

Workers’ claims journey results at October 2019

Monthly average over the last 12 months

11,325 reports submittedA^

8,439 reportable claims ^

4,072 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

62.3% at 4 weeks*

75.6% at 13 weeks*

81.4% 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.

Efficiency and viability

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

Total claim payments made by insurers

In October 2019, the Nominal insurer made payments of more than $221 million, Government self-insurers (TMF) of over $60 million, and self-insurers and specialised insurers each had payments of almost $18 million .

Claim payment types

The breakdown of claim payment types in October 2019 is as follows:

  • Weekly payments: 39.8%
  • Medical payments: 25.4%
  • Common law (WID): 16.5%
  • Lump sum (S66 & S67) payments: 5.5%
  • Rehabilitation payments: 4.7%
  • Investigation payments: 2.4%
  • Other payments: 1.9%
  • Legal payments: 1.7%
  • Death payments: 1.4%
  • Commutations: 0.8%

Total claim payments made by insurers

In September 2019 $297 million dollars were paid as claim payments.

In October 2019 $317 million dollars payed in claim payments.

This 6.7% increase is based on data provided by insurers at the end of October 2019. Please note this may increase should late running reports of payments be supplied by insurers after the April data submission.

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.

Customer experience and equity

Customers’ experience with the system is positive and equitable

Enquiries and complaints

During October 2019 SIRA received 2,538 enquiries and 818 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 October 2019, the dispute rate was 0.6%, with 100,222 active claims and 629 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

This is the affordability of insurance is 1.4%, as a percentage of NSW wages for 2017/18.

 

% 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%

70%

67%

98.0%

0.11%

59%

73%

79%

Government self-insurer (TMF)

13%

17%

19%

19%

99.5%

0.02%

71%

83%

87%

Specialised Insurers

6%

8%

6%

7%

93.8%

0.03%

72%

83%

86%

Self insurers

7%

9%

6%

8%

92.3%

0.24%

69%

78%

83%
83%
83%

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 October 2019.


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.

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 October 2019, the total amount of weekly benefit payments paid by insurer type was:

$91 million by the Nominal insurer

$24 million by the Government self-insurer (TMF)

$5 million by specialised insurers

$6 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 October 2019, the number of workers receiving weekly benefits by insurer type was:

25,150 for the Nominal insurer

6,841 for the Government self-insurer (TMF)

1,430 for specialised insurers

1,959 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 October 2019, the 4 week RTW rate was:

74.5% for the Nominal insurer

79.2% for the Government self-insurer (TMF)

83.5% for specialised insurers

86.0% for self insurers

77.0% for the system average

In October 2019, the 13 week RTW rate was:

82.9% for the Nominal insurer

87.5% for the Government self-insurer (TMF)

88.9% for specialised insurers

89.2% for self insurers

84.7% for the system average

In October 2019, the 26 week RTW rate was:

87.2% for the Nominal insurer

90.5% for the Government self-insurer (TMF)

90.7% for specialised insurers

91.0% for self insurers

88.4% for the system average

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

In March 2019, the average was:

30 days for the Nominal insurer

28 days for the Government self-insurer (TMF)

19 days for specialised insurers

19 days for self insurers

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

Reportable claims development

Total reportable claims by financial year at 11 development periods

78,293 in 2015/16

77,842 in 2016/17

79,719 in 2017/18

84,303 in 2018/19

Claim payments development

Total claim payments by financial year at 11 development periods

$418 million in 2015/16

$479 million in 2016/17

$502 million in 2017/18

$534 million in 2018/19