Terms of Reference - Corrective Services NSW claims review
The State Insurance Regulatory Authority (SIRA) is undertaking an integrated compliance audit and performance review of Corrective Services NSW (CSNSW) workers compensation claims.
In establishing this review, SIRA is exercising its authority and undertaking responsibilities under the Workers Compensation Act 1987, the Workplace Injury Management and Workers Compensation Act 1998 and the State Insurance and Care Governance Act 2015.
The review will be undertaken by authorised SIRA officers and is planned to commence the week of 8 August 2022.
Background
CSNSW is a government employer within the Department of Communities and Justice (DCJ), the lead agency in the Stronger Communities Cluster. It is covered by the Treasury Managed Fund (TMF), a government self-insurance scheme. The TMF is administered by the NSW Self Insurance Corporation (SICorp). SICorp delegates its functions in operating the TMF to icare and icare appoints claims managers to provide claims management services to its TMF portfolio. CSNSW claims are managed by QBE Insurance Australia (QBE).
The review responds to a 2020 SIRA investigation into the management of three CSNSW workers compensation claims. The investigation delivered findings and recommendations, including a broader review of the management of CSNSW workers compensation claims and a compliance and performance review of the SICorp/ deemed government self-insurer/ claims manager arrangements.
Objectives
The primary objective of the review is to assess the compliance and performance of CSNSW and QBE claims management practices with workers compensation legislation, standards and best practice benchmarks.
A further objective is to determine whether remedial action taken by CSNSW and QBE has addressed the compliance and performance issues identified by SIRA in 2020.
Scope
The review involves an in-depth, end to end review of 100 claims assessing conformance and compliance with audit criteria. Data will be drawn from claims with a ‘date entered in insurer system’ in the financial years 2019 to 2022.
Claims will be selected for review in accordance with a risk- and outcomes-based regulatory approach, with a focus on the following:
- initial liability decisions
- return to work outcomes
- psychological injuries.
Outcome
The review will assist SIRA in determining:
- whether CSNSW claims are being managed effectively, and
- how best to support continuous improvement in public sector capability to deliver positive scheme outcomes.
A draft report is expected to be provided to the SIRA Chief Executive in November 2022, with a final report submitted in December 2022. Principal stakeholders will be given the opportunity to respond to the draft report.