icare Workers Insurance claims performance data

Latest figures published March 2020.

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

The 26-week return to work (RTW) rate saw a slight decline in December 2019 but remains up from a low of 79 per cent in August 2019.

The steady improvement to RTW rates in late 2019 reflects a number of initiatives we undertook with our service partners. This included 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 with our service partners on improving RTW rates is continuing 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. Contact icare for details.

Graph shows from 1 Jan 18 – 31 Dec 19. Note: Return to work data is based on reporting month and weekly payment transaction dates. Note: 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 return to work from January 2018
    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%
    October 2019 82%
    November 2019 82%
    December 2019 81%

Liability decision timeliness: 99% within 7 days

In January 2020, some 99 per cent of liability decisions were made within seven days, and the average of 3.7 days for initial liability decisions was the lowest over the previous two years.

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.

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. Contact icare for details.

Graph shows 24 months from 1 Feb 18 – 31 Jan 20. Feb 18 – Jul 19 (inclusive) captures all claims in the scheme. Aug 19 – Jan 20 only includes EML claims.

  • View data for liability decision timeliness from January 2018
    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 95% 5.0
    September 2019 98% 4.7
    October 2019 98% 4.7
    November 2019 99% 4.7
    December 2019 97% 3.8
    January 2020 99% 3.7

Active claims: 46,079 for December 2019

The number of active claims in December 2019 decreased slightly from the previous month, this decline is consistent with claims numbers seen in the same period in 2018.

From May to July 2019 there was an increase in active claims in part due to a backlog in payments we experienced after implementation challenges of a major technology upgrade in February 2019. The increase in active claims October 2019 which was in part the result of an adjustment in weekly payments.

This graph shows the number of active claims per month. Contact icare for details.

Data shows from 1 Jan 18 – 31 Dec 19.

  • View data for active claims from January 2018
    Months Active Claims
    January 2018 38,411
    February 2018 37,936
    March 2018 39,844
    April 2018 36,752
    May 2018 37,502
    June 2018 38,290
    July 2018 42,132
    August 2018 42,823
    September 2018 41,280
    October 2018 41,051
    November 2018 42,530
    December 2018 40,867
    January 2019 39,938
    February 2019 38,704
    March 2019 39,499
    April 2019 39,446
    May 2019 43,702
    June 2019 42,382
    July 2019 46,757
    August 2019 45,023
    September 2019 45,097
    October 2019 48,035
    November 2019 46,943
    December 2019 46,079

Claim payments: $213m for December 2019

 The steady growth in claim payments over 2018 and 2019 has been driven by growth of the Nominal Insurer (NI) scheme, quicker payment of weekly benefits and to some extent the  decline in return to work up until mid-2019. 

The increase in claims payments over the last three months of 2019  reflects adjustments based on reviews of claim files made earlier in the year.

Medical costs decreased in December 2019, however this is consistent with previous years and due to many practices and businesses closing through the Christmas/New Year period.

Under the legislation, a decision regarding a treatment approval must be made within 21 days of the treatment request being received. Compliance with this timeframe was 99% in December 2019 with treatment approval decisions made in an average of 4.4 days, up from a low of 17.5 days in April 2019.

Medical costs have continued 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. Contact icare for details.

Graph shows from 1 Jan 18 – 31 Dec 19

  • View data for claim payments from January 2018
    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 $68,200,000 $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 $169,000,000
    July 2019 $81,800,000 $74,600,000 $215,300,000
    August 2019 $75,600,000 $64,300,000 $192,300,000
    September 2019 $77,600,000 $60,200,000 $194,700,000
    October 2019 $90,800,000 $64,500,000 $219,300,000
    November 2019 $79,600,000 $61,200,000 $207,800,000
    December 2019 $92,900,000 $56,900,000 $213,300,000

Service Levels (EML): 90% of inbound calls answered within 60 seconds

EML service levels continued to improve over January 2020 recording the best figures in 24 months for call wait times and the percentage of calls answered within 60 seconds (defined as Grade of Service). For January the Grade of Service figure rose to a high of 91 per cent, while call wait times remained below 30 seconds for the third consecutive month.

Changes to call routing made late in 2019 continue to improve our Customer Service, with calls being answered more accurately by case managers and their team members. In addition, a significant increase in outbound calls and proactive case management has resulted in less inbound calls from customers seeking information on the progress of their claim.

This graph shows the percentage of telephone calls answered within our target of less than 60 seconds, and the average call wait time. Contact icare for details.

Data shows from 1 Feb 18 – 31 Jan 20.

  • View data for service levels (EML) from January 2018
    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
    November 2019 88% 28
    December 2019 88% 28
    January 2020 91% 24

Net Promoter Score: +14 for Workers Insurance

The Net Promoter Score (NPS) for workers insurance has continued to rise in recent months, reaching an eight-month high of +14 in January 2020.

The NPS has remained strong for injured workers over 2018 and throughout 2019, with a score consistently above +20. For employers, the NPS score has continued to improve over recent months rising to a 22-month high in January. This improvement 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 this year has been designed to further meet the needs of larger employer customers by providing greater choice of claims management service provider.

This graph shows the Net Promoter Scores for Workers Insurance, Employers and Injured workers. Contact icare for details.

Graph shows 24 months from 1 Feb 18 – 31 Jan 20.

  • View data for the Net Promoter Score from January 2018
    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
    November 2019 13 -11 21
    December 2019 13 -8 21
    January 2020 14 -4 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.