icare Workers Insurance claims performance data

Latest figures published 5 December 2019.

We're committed to creating a fairer workers insurance scheme for employers and injured workers in NSW. As part of this commitment, we regularly publish a range of data to provide transparency into the performance of the management of claims.

You can find a description of the terms used in the graphs below in our glossary.

You can also view our Claim Service Provider performance data.

Return to work: 81% at 26 weeks

At the end of September 2019 the return to work (RTW) rate after 26 weeks returned to an equal 12-month high of 81 per cent after sitting at 79 per cent for the previous four months.

This improved rate was anticipated after we observed in past months an improvement in the 13-week RTW rate that we expected would flow through to the 26-week measure.

The improved result reflects the recent work with our service partners to improve RTW rates. This has involved a number of initiatives including a targeted review of specific cohorts of claims to ensure accurate decision-making, service improvements including assigning a dedicated case manager for claims expected to go beyond two weeks, and ensuring case conferences take place within seven days of a claim exceeding its expected duration.

This work on improving RTW rates through a range of measures is continuing with our service partners and reflects our efforts to deliver long-term sustainable return to work outcomes for injured workers.

This graph shows the percentage of all claims where the injured employer returned to work at or before 26 weeks. For numerical data contained within this graph, please contact us.

Data shows from 1 Jan 18 – 30 Sept 19. It is based on reporting month and weekly payment transaction dates. The reporting month is the month that is 26 weeks after the claim has been reported. The data we use to report the RTW rate is different to that used and reported by the State Insurance Regulatory Authority.

  • View data for the return to work graph
    Months RTW at 26 weeks
    January 2018 86%
    February 2018 85%
    March 2018 84%
    April 2018 84%
    May 2018 83%
    June 2018 83%
    July 2018 82%
    August 2018 80%
    September 2018 80%
    October 2018 79%
    November 2018 80%
    December 2018 80%
    January 2019 80%
    February 2019 81%
    March 2019 80%
    April 2019 80%
    May 2019 79%
    June 2019 79%
    July 2019 79%
    August 2019 79%
    September 2019 81%

Liability decision timeliness: 98% within 7 days

The timeliness of initial liability decisions has continued to improve in October 2019 and exceed our target of 95 per cent of decisions made within seven days.

While we have reduced the number of claims where we accept full liability at first decision, the number of claims where we accept provisional liability has increased. This enables quicker time to treatment and more time to investigate before liability decisions are made.

We experienced two periods of decline in liability decision timeliness since January 2018, both related to the introduction of new technology where we experienced implementation problems. Since working through the backlog these issues created, the timeliness of initial liability decisions has continued to improve throughout 2019 and in October the majority of decisions are made within an average of 4.9 days.

This graph shows the percentage of all claims where the Liability Decision was made within seven days, and the average days to initial liability decision. For numerical data contained within this graph, please contact us.

Data shows from 1 Jan 18 – 31 Oct 19. Jan 18 – Jul 19 (inclusive) captures all claims in the scheme, Aug 19 – Oct 19 only include EML claims.

  • View data for the liability decision timeliness graph
    Months Liability Decision Timeliness (decision within 7 days) Average days to initial liability decision
    January 2018 72% 8.3
    February 2018 74% 8.6
    March 2018 97% 5.0
    April 2018 98% 6.1
    May 2018 98% 5.2
    June 2018 98% 5.5
    July 2018 99% 5.5
    August 2018 98% 6.0
    September 2018 99% 5.3
    October 2018 99% 4.8
    November 2018 98% 5.4
    December 2018 97% 5.4
    January 2019 97% 5.0
    February 2019 79% 7.0
    March 2019 67% 8.5
    April 2019 84% 6.5
    May 2019 92% 5.5
    June 2019 89% 6.1
    July 2019 94% 5.3
    August 2019 94% 5.6
    September 2019 97% 5.2
    October 2019 98% 4.9

Active claims: 44,980 for September 2019

The total number of active workers insurance claims has remained relatively stable since January 2018 with on average around 38,000 to 40,000 active claims per month.

From May to July 2019 there was an increase in active claims due to normal seasonal differences and a backlog in payments we experienced after implementation challenges of a major technology upgrade in February 2019. The drop in active claims numbers from the end of July onwards is the beginning of this backlog being cleared which is expected to continue leading to further falls in claims numbers in coming months.

This graph shows the number of active claims per month. For numerical data contained within this graph, please contact us.

Data shows from 1 Jan 18 – 30 Sept 19.

  • View data for the active claims graph
    Months Active Claims
    January 2018 38,410
    February 2018 37,935
    March 2018 39,842
    April 2018 36,750
    May 2018 37,503
    June 2018 38,304
    July 2018 42,135
    August 2018 42,820
    September 2018 41,285
    October 2018 41,048
    November 2018 42,527
    December 2018 40,862
    January 2019 39,929
    February 2019 38,699
    March 2019 39,494
    April 2019 39,441
    May 2019 43,698
    June 2019 42,379
    July 2019 46,745
     August 2019 44,868
     September 2019 44,980

Claim payments: $190m for September 2019

Growth in claim payments in 2019 has been driven by growth of the Nominal Insurer (NI), quicker payment of weekly benefits and a decline in return to work. In the last few years, the NI scheme has grown by 6.2 and 3.4 per cent per annum respectively in terms of wages covered and number of insured employers.

Medical costs continue to put pressure on claims servicing costs and on average have gone up by 40 per cent since 2015. This is due to the increase in the number of medical episodes per claim and in the number of charges per medical episode. To address this, we are implementing a Medical Strategy to enhance medical decision-making protocols and ensure there is an evidence base for treatment requests. We are also working with healthcare service providers to ensure the latest evidence better informs the treatment provided to injured workers.

This graph shows the amounts for different claim payments, weekly, medical and the total. For numerical data contained within this graph, please contact us.

Data shows from 1 Jan 18 – 30 Sept 19.

  • View data for the claim payments graph
    Months Weekly Claim Payments Medical Claim Payments Total Claim Payments
    January 2018 $54,200,000 $48,000,000 $157,600,000
    February 2018 $50,700,000 $45,900,000 $138,200,000
    March 2018 $53,300,000 $55,700,000 $162,100,000
    April 2018 $52,400,000 $42,600,000 $149,600,000
    May 2018 $61,000,000 $46,900,000 $166,500,000
    June 2018 $56,800,000 $51,000,000 $151,100,000
    July 2018 $61,200,000 $65,300,000 $191,200,000
    August 2018 $71,300,000 $69,400,000 $198,500,000
    September 2018 $63,000,000 $57,600,000 $175,500,000
    October 2018 $62,600,000 $54,600,000 $173,000,000
    November 2018 $66,400,000 $54,500,000 $187,100,000
    December 2018 $69,100,000 $53,000,000 $175,300,000
    January 2019 $67,500,000 $43,400,000 $167,500,000
    February 2019 $62,500,000 $46,900,000 $145,400,000
    March 2019 $66,100,000 $55,900,000 $169,000,000
    April 2019 $68,100,000 $54,700,000 $170,700,000
    May 2019 $74,900,000 $59,100,000 $189,700,000
    June 2019 $68,800,000 $51,200,000 $168,900,000
    July 2019 $81,800,000 $74,500,000 $215,200,000
    August 2019 $75,500,000 $62,200,000 $189,600,000
    September 2019 $77,500,000 $55,800,000 $190,000,000

Service Levels (EML): 87% of inbound calls answered within 60 seconds

There has been a further improvement in EML service levels in October 2019. This month the percentage of calls answered within 60 seconds (defined as Grade of Service) rose to a high of 87 per cent, while call wait times dropped to 30 seconds.

Recent changes to call routing continues to help improve service to our customers. These changes allow customers’ calls to more accurately reach their dedicated Case Manager or someone within their team, enabling customers to talk to someone who can answer their claim queries on the spot, reducing the number of overflow calls to the EML Support Centre.

This graph shows the percentage of telephone calls answered within our target of less than 60 seconds, and the average call wait time. For numerical data contained within this graph, please contact us.

Data shows from 1 Jan 18 – 31 Oct 19.

  • View data for the service levels (EML) graph
    Months Grade of Service — Calls Answered within 60 Seconds (%) Average Call Wait Time (Seconds)
    January 2018 29% 317
    February 2018 19% 467
    March 2018 59% 148
    April 2018 83% 32
    May 2018 76% 46
    June 2018 64% 70
    July 2018 70% 63
    August 2018 80% 36
    September 2018 75% 48
    October 2018 81% 36
    November 2018 79% 36
    December 2018 75% 45
    January 2019 70% 54
    February 2019 64% 65
    March 2019 68% 67
    April 2019 76% 53
    May 2019 83% 34
    June 2019 85% 31
    July 2019 85% 31
    August 2019 86% 30
    September 2019 85% 31
    October 2019 87% 30

Net Promoter Score: +12 for Workers Insurance

The Net Promoter Score (NPS) for October 2019 climbed to a six-month high of 12 for the workers insurance scheme, while the monthly scores for both injured workers and employers also improved.

The NPS has remained strong for injured workers over 2018 and throughout 2019, with a score consistently above +20. For employers, the NPS score declined from May 2018 but has improved over recent months rising to a 17-month high in October 2019.

The improvement to the employer NPS has been the result of several initiatives to ensure the needs of our employer customers are being met. This has included remediation of outstanding wages and a backlog reduction resulting in faster response times as well as a program of continuous improvement to the claims management system.

The introduction of the Authorised Provider model is designed to further meet the needs of larger employer customers by providing greater choice of claims management service provider. During 2020 we will deliver a phased approach for eligible customers to nominate and transfer to an Authorised Provider.

This graph shows the Net Promoter Scores for Workers Insurance, Employers and Injured workers. For numerical data contained within this graph, please contact us.

Data shows from 1 Jan 18 – 31 Oct 19.

  • View data for the Net Promoter Score graph
    Months WI NPS Employer NPS Injured Worker NPS
    January 2018 19 -6 24
    February 2018 19 -11 24
    March 2018 17 -9 25
    April 2018 14 -14 23
    May 2018 14 -13 24
    June 2018 14 -18 23
    July 2018 16 -16 25
    August 2018 16 -16 26
    September 2018 18 -19 28
    October 2018 19 -18 26
    November 2018 22 -25 27
    December 2018 21 -25 26
    January 2019 19 -26 24
    February 2019 21 -22 25
    March 2019 21 -20 26
    April 2019 18 -27 25
    May 2019 6 -31 20
    June 2019 6 -30 20
    July 2019 5 -26 20
    August 2019 8 -20 21
    September 2019 9 -17 20
    October 2019 12 -13 21

Glossary

Return to work
Return to work is defined as the proportion of claims that are eligible for a weekly benefit compared with those that are no longer receiving a weekly benefit payment at or on 26 weeks after the injury date. The data we use to report the RTW rate is different to that used and reported by the State Insurance Regulatory Authority.
Liability decisions on time
Liability decisions that are made on individual claims within seven days.
Active claims
Claims that have had a payment or recovery activity in a particular month.
Claims payments
Gross expenses for claims payments — includes the two most costly expenses: weekly payments and medical expenses.
Weekly payments
The weekly payment amount is based either on weekly earnings or a maximum weekly compensation amount.
Average call wait times
The average time a customer has waited on the phone before their call is answered by support staff.
Grade of Service (GOS)
Calls from customers that have been answered within one minute by support staff.
Net Promoter Score
The Net Promoter score (NPS) is a metric that measures a customers’ experience with us. It helps us and our business partners to understand and be accountable for how we engage with our customers, the workers and employers of NSW.