icare workers compensation Claims Service Provider Quarterly Performance Data

icare has six Claims Service Providers: Allianz, DXC Technology, EML, Gallagher Bassett (GB), GIO and QBE to manage workers compensation for the NSW Nominal Insurer.

To address the rise of mental health claims, four providers – Allianz, DXC, EML and GB – will provide specialist psychological claims capability with skilled and experienced case managers dedicated to managing psychological claims. This means employers will have greater options to choose the provider to best care and support their injured worker when they need it most.

The Nominal Insurer monitors Claims Service Provider performance to ensure a high and consistent standard of service is being delivered and to continue to improve return to work outcomes.

We also want to be transparent about how we are tracking provider performance and will publish claims performance data and Claims Service Provider data on a quarterly basis. This ensures that employers eligible to choose their CSP have the information available to them to assist in choosing a provider that best serves the needs of their injured workers.

This performance data is for the Nominal Insurer Workers Compensation Scheme for the private sector in NSW. It does not include data for NSW Government departments or agencies.

Claims Service Provider performance data relating to the claims journey of injured workers will be published on a quarterly basis focusing on service, capability and outcome measures. Additional measures will be added overtime as data becomes available.

A new claims and injury management model was introduced by icare for the NSW Nominal Insurer scheme from 1 January 2023 that provides employers access to a larger choice of Claims Service Providers, delivers greater transparency of provider performance and helps injured workers get back to health and work faster.

icare now has six Claims Service Providers: Allianz, EML, GIO, QBE, and two providers that entered the scheme in 2023 - DXC Technology and Gallagher Bassett (GB).

The State Insurance Regulatory Authority (SIRA) publishes a range of data in relation to the Nominal Insurer. Any differences with icare's CSP performance data will be due to the parameters and the timing of the data sets.

Each Claims Service Provider has a different mix of open claims. These differences include the total number of open claims they manage, employer sizes and employer industries, and mixes of physical and psychological injury claims.

Users should be aware that the results across CSPs will reflect these differences and may lead to different results that do not correspond to the underlying claims performance of each CSP.

icare measures the Satisfaction of injured workers and employers throughout their journey with icare, whether directly or through Claims Service Providers, with a Customer Satisfaction (CSAT) score. The CSAT is a globally recognised metric and it helps us and our providers understand how we engage with injured workers and employers, and take action to improve outcomes.

Injured workers and their employers receive survey invitations at multiple points of their claims journey (such as claim notification, payments, 12 weeks after notification, claim closure). Exclusions will apply for surveys based on sensitivity reasons or rest periods.

The CSAT score is expressed as a percentage and represents all respondents scoring 4 or 5 on a 5-point scale, where 1 is extremely dissatisfied and 5 is extremely satisfied.

Workers injured at work may be entitled to weekly payments. Sometimes the Claims Service Provider will start paying the injured worker weekly payments and medical expenses while they assess the claim.

Where there has been a loss of earnings leading to an entitlement to weekly payments, the provider will commence provisional weekly payments within the legislated requirement of seven days of being notified of the injury. Results exclude employers and claims where there is a Wage Reimbursement Agreement in place for paying weekly benefits.

Claims Service Providers must make an initial liability decision on a claim within the legislated timeframe (seven calendar days). Making initial liability decisions promptly, informed by careful consideration of available information and proactive consultation with key stakeholders will ensure that workers and employers can focus on recovery and return to work.

The provider may make a decision to accept or decline full liability. When full liability is not initially accepted, the CSP can be obliged to start provisional liability (PL) payments or notify parties of a 'reasonable excuse' (RE) where additional information is required to make a liability decision.

The Workers Compensation scheme is designed to assist injured workers to return to full participation in work and life. Evidence indicates that the faster a worker returns to work in some capacity, the greater their chances are of making a full recovery.

The return to work (RTW) rate and working rate (WR) are two primary measures of success on the effectiveness in returning workers to work in some capacity.

Return to work rate is the percentage of workers who have been off work for at least one day and returned to work with the same or different employer at full or current work capacity.

Working rate is the percentage of workers who have been off work for at least one day and returned to work with the same or different employer at full or current work capacity (that is, RTW) and workers who have not been off work and remained at work with the same or different employer at full or current work capacity (also known as 'stay at work').

Caseloads refer to the average number of open claims managed by case managers for each Claims Service Provider.

Case managers are the foundation of our support system for injured workers; they play a crucial role in the delivery of treatment and optimal return to work outcomes. The Nominal Insurer monitors Claims Service Provider case management practices to ensure providers have access to the appropriate number and level of expertise of case managers.

Ensuring Claims Service Providers have adequate and appropriate caseloads underpins our goal to help injured workers in their recovery and return to work, and to provide both employers and injured workers with an improved workers compensation experience.

The data is provided to complement and inform any decision made. Claims performance indicators are one of many factors an employer or their representative(s) may weigh in choosing the Claims Service Provider that best fits their needs.

There is no requirement to view and acknowledge performance before choosing a Claims Service Provider.

Employers should make their own assessment when selecting a Claims Service Provider, and if necessary seek independent professional advice.

Claims performance indicators are one of many factors an employer or their representative(s) may weigh in choosing the Claims Service Provider that best fits their needs. icare encourages employers to speak with their Claims Service Provider about their individual claims experience to work through any barriers to return to work outcomes, or remedial activity required.

You can select a Claims Service provider on your annual policy renewal date.

Each Claims Service Provider has an employer engagement team that can articulate the service, claims management, and support offerings. You can find their contact details on the Workers insurance claims enquiry page.

You can select a Claims Service Provider on your annual policy renewal date. At that time information will be provided to you on the process for selecting a new Claims Service Provider should you choose to make a change.

Medium-sized employers will be able to choose a Claims Service Provider from mid-2024.

These are employers that have an Average Performance Premium (APP) or Group Average Performance Premium (GAPP) of more than $200,000.

For more information on these classifications see:

• GAPP - What is Grouping Insurance for Related Businesses?
• APP - Premium calculation for experience-rated employers.

Medium-sized employers will be notified when they are eligible to choose their Claims Service Provider. 

icare categorises employers by their size based on the annual premiums they pay for their workers compensation policy.

These categories are:

• Small Employers – annual premium of less than $30,000. (Usually these are businesses with up to 20 employees.)
• Small-Medium Enterprises (SME) – annual premium of $30,000 -$200,000. (Usually these are businesses with around 20-300 employees.)
• Medium and Large Employers – annual premium of more than $200,000. (Usually these are businesses with more than 300 employees.)

Note that employers with an annual premium of more than $30,000 are Experience Rated, which means their premiums are impacted by their claims performance. Large employers with an Average Performance Premium (APP) or Group Average Performance Premium (GAPP) of more than $500,000 can currently choose their Claims Service Provider, while medium employers with an APP or GAPP of more than $200,000 will be able to choose their CSP after 30 June 2024.