icare Workers Insurance claims performance data

Latest figures published 1 November 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.

Return to work: 79% at 26 weeks

Our focus is on delivering long-term sustainable return to work (RTW) outcomes for injured workers. As of 31 August 2019, the RTW rate after 26 weeks was 79 per cent.

We have experienced challenges embedding our new operational model, including achieving the right scale with our new claims partner. This has had a negative impact on the RTW rate since January 2018.

We are working closely with our service partners to improve RTW rates. We have commenced a targeted review of specific cohorts of claims to ensure accurate decision-making and implemented RTW interventions. Key interventions include:

  • Case conferencing to ensure the return to work plan is on track and combines technical and injury management strategies.
  • Review of workplace rehabilitation / vocational placement.
  • The application of work capacity.

We have also commenced 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. We are starting to see an improvement in the 13-week RTW measure that we expect to flow through to the 26-week measure in the coming months.

This graph shows the percentage of all claims where the injured employer returned to work at or before 26 weeks. Return to Work percentage for January, 2018 was 86%; February 2018 was 85%; March and April 2018 were 84%; May and June 2018 were 83%; July 2018 was 82%; August 2018 to January 2019 was 80%; February 2019 was 81%; March and April 2019 were 80%; May, June, July and August 2019 were 79%.

Data shows from 1 Jan 18 – 31 Aug 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%

Liability decision timeliness: 97% within 7 days

We've reduced the number of claims where we accept full liability at first decision, however 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’ve experienced two distinct periods of decline in liability decision timeliness since January 2018. Both were due 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 improved and exceeded the target of 95 per cent of decisions made within seven days, with the majority of decisions made within five 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. In January 2018 the Liability Decision for 72% was made within seven days, with an average 8.3 days to initial liability decision. In February 2018 the Liability Decision for 74% of all claims was made within seven days, with an average 8.6 days to initial liability decision. In March 2018 the Liability Decision for 97% of all claims was made within seven days, with an average 5 days to initial liability decision. In April 2018 the Liability Decision for 98% of all claims was made within seven days, with an average 6.1 days to initial liability decision. In May 2018 the Liability Decision for 98% of all claims was made within seven days, with an average 5.2 days to initial liability decision. In June 2018 the Liability Decision for 98% of all claims was made within seven days, with an average 5.5 days to initial liability decision. In July 2018 the Liability Decision for 99% of all claims was made within seven days, with an average 5.5 days to initial liability decision. In August 2018 the Liability Decision for 98% of all claims was made within seven days, with an average 6 days to initial liability decision. In September 2018 the Liability Decision for 99% of all claims was made within seven days, with an average 5.3 days to initial liability decision. In October 2018 the Liability Decision for 99% of all claims was made within seven days, with an average 4.8 days to initial liability decision. In November 2018 the Liability Decision for 98% of all claims was made within seven days, with an average 5.4 days to initial liability decision. In December 2018 the Liability Decision for 97% of all claims was made within seven days, with an average 5.4 days to initial liability decision. In January 2019 the Liability Decision for 97% of all claims was made within seven days, with an average 5 days to initial liability decision. In February 2019 the Liability Decision for 79% of all claims was made within seven days, with an average 7 days to initial liability decision. In March 2019 the Liability Decision for 67% of all claims was made within seven days, with an average 8.5 days to initial liability decision. In April 2019 the Liability Decision for 84% of all claims was made within seven days, with an average 6.5 days to initial liability decision. In May 2019 the Liability Decision for 92% of all claims was made within seven days, with an average 5.5 days to initial liability decision. In June 2019 the Liability Decision for 89% of all claims was made within seven days, with an average 6.1 days to initial liability decision. In July 2019 the Liability Decision for 94% of all claims was made within seven days, with an average 5.3 days to initial liability decision. In August 2019 the Liability Decision for 94% of all claims was made within seven days, with an average 5.6 days to initial liability decision. In September 2019 the Liability Decision for 97% of all claims was made within seven days, with an average 5.2 days to initial liability decision.

Data shows from 1 Jan 18 – 30 Sep 19. Jan 18 - Jul 19 (inclusive) captures all claims in the scheme, Aug 19 and Sep 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

Active claims: 44,576 for August 2019

The total number of active claims has remained relatively stable since January 2018. On average we have 38,000 to 40,000 active claims per month.

From May to July 2019 there was an increase in active claims. This was 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 August 2019 is the beginning of this backlog being cleared which will continue in coming months leading to further falls in claims numbers.

This graph shows the number of active claims per month. Active claims for January 2018 were 38,411; February 2018 was 37,935; March 2018 was 39,842; April 2018 was 36,753; May 2018 was 37,505; June 2018 was 38,305; July 2018 was 42,136; August 2018 was 42,822; September 2018 was 41,286; October 2018 was 41,049; November 2018 was 42,520; December 2018 was 40,865; January 2019 was 39,931; February 2019 was 38,698; March 2019 was 39,496; April 2019 was 39,439; May 2019 was 43,677; June 2019 was 42,342; July 2019 was 46,573  and for August 2019 there were 44,576 active claims.

Data shows from 1 Jan 18 – 31 Aug 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 42,519
    December 2018 40,864
    January 2019 39,931
    February 2019 38,698
    March 2019 39,495
    April 2019 39,440
    May 2019 43,696
    June 2019 42,373
    July 2019 46,698
     August 2019 44,576 

Claim payments: $185m for August 2019

There has been some growth in claim payments in 2019 driven by growth of the Nominal Insurer (NI), quicker payment of weekly benefits and a decline in return to work. In the 2017 and 2018 calendar years, we paid on average $61m per month for weekly benefits and have paid an average of $70m per month for the 2019 calendar year-to-date.

In the last three 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.  Claim payments for January 2018 were, Weekly $54,200,000, Medical $48,000,000, and total payments of $157,600,000;  Claim payments for February 2018 were, Weekly $50,700,000, Medical $45,900,000, and total payments of $138,200,000; Claim payments for March 2018 were, Weekly $53,300,000, Medical $55,700,000, and total payments of $162,100,000;  Claim payments for April 2018 were, Weekly $52,400,000, Medical $42,600,000, and total payments of $149,600,000;  Claim payments for May 2018 were, Weekly $61,000,000, Medical $46,900,000, and total payments of $166,500,000;  Claim payments for June 2018 were, Weekly $56,800,000, Medical $50,900,000, and total payments of $151,000,000;  Claim payments for July 2018 were, Weekly $61,200,000, Medical $64,500,000, and total payments of $190,300,000;  Claim payments for August 2018 were, Weekly $71,300,000, Medical $69,400,000, and total payments of $198,500,000;  Claim payments for September 2018 were, Weekly $63,800,000, Medical $57,600,000, and total payments of $175,500,000;  Claim payments for October 2018 were, Weekly $62,600,000, Medical $54,400,000, and total payments of $172,900,000;  Claim payments for November 2018 were, Weekly $64,400,000, Medical $53,800,000, and total payments of $186,300,000;  Claim payments for December 2018 were, Weekly $69,100,000, Medical $53,000,000, and total payments of $175,300,000;  Claim payments for January 2019 were, Weekly $67,500,000, Medical $43,400,000, and total payments of $167,500,000;  Claim payments for February 2019 were, Weekly $62,500,000, Medical $46,900,000, and total payments of $145,400,000;  Claim payments for March 2019 were, Weekly $66,100,000, Medical $55,900,000, and total payments of $169,000,000;  Claim payments for April 2019 were, Weekly $68,100,000, Medical $54,700,000, and total payments of $170,600,000;  Claim payments for May 2019 were, Weekly $74,900,000, Medical $59,100,000, and total payments of $189,700,000;  Claim payments for June 2019 were, Weekly $68,800,000, Medical $51,200,000, and total payments of $168,800,000;  Claim payments for July 2019 were, Weekly $81,700,000, Medical $73,000,000, and total payments of $213,400,000;  Claim payments for August 2019 were, Weekly $75,100,000, Medical $59,600,000, and total payments of $185,700,000.

Data shows from 1 Jan 18 – 31 Aug 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 $50,900,000 $151,000,000
    July 2018 $61,200,000 $64,500,000 $190,300,000
    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 $54,400,000 $172,900,000
    November 2018 $66,400,000 $53,800,000 $186,300,000
    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 $170,600,000
    May 2019 $74,900,000 $59,100,000 $189,700,000
    June 2019 $68,800,000 $51,200,000 $168,800,000
    July 2019 $81,700,000 $73,000,000 $213,400,000
     August 2019 $75,100,000 $59,000,000 $185,700,000

Service Levels (EML): 85% of inbound calls answered within 60 seconds

There has been an improvement in EML service levels from January 2018 to September 2019. Over this period the percentage of calls answered within 60 seconds (defined as Grade of Service) has risen from a low of 18.75 per cent in February 2018 to a high at August 2019 of 86 per cent. In addition, call wait times have dropped from an average of over five minutes at the start of 2018 to a relatively consistent average under one minute.

We have also recently introduced changes to call routing which is helping to improve service to our customers. The changes allow customers’ calls to more accurately reach their dedicated Case Manager or someone within their team. This means customers are able to talk to someone who can answer their claim queries on the spot, with a reduction in 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. In January 2018, 29% of calls met target, average call wait time of 317 seconds; February 2018, 19% of calls met target, average call wait time of 467 seconds; March 2018, 59% of calls met target, average call wait time of 148 seconds; April 2018, 83% of calls met target, average call wait time of 32 seconds; May 2018, 76% of calls met target, average call wait time of 46 seconds; June 2018, 64% of calls met target, average call wait time of 70 seconds; July 2018, 70% of calls met target, average call wait time of 63 seconds; August 2018, 80% of calls met target, average call wait time of 36 seconds; September 2018, 75% of calls met target, average call wait time of 48 seconds; October 2018, 81% of calls met target, average call wait time of 36 seconds; November 2018, 79% of calls met target, average call wait time of 36 seconds; December 2018, 75% of calls met target, average call wait time of 45 seconds; January 2019, 70% of calls met target, average call wait time of 54 seconds; February 2019, 64% of calls met target, average call wait time of 65 seconds; March 2019, 68% of calls met target, average call wait time of 67 seconds; April 2019, 76% of calls met target, average call wait time of 53 seconds; May 2019, 83% of calls met target, average call wait time of 34 seconds; June 2019, 85% of calls met target, average call wait time of 31 seconds; July 2019, 85% of calls met target, average call wait time of 31 seconds; August 2019, 86% of calls met target, and the average call wait time was 30 seconds; September 2019, 85% of calls met target, and the average call wait time was 31 seconds.

Data shows from 1 Jan 18 – 30 Sept 19.

  • View data for the support centre calls graph
    Months Call 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 

Net Promoter Score: +9 for Workers Insurance

The Net Promoter Score (NPS) has remained strong for injured workers over 2018 and the first half of 2019, with a score consistently above +20. For employers, the NPS score has declined from May 2018.

The NPS score for employers improved over recent months with additional actions including remediation of outstanding wages and a backlog reduction resulting in faster response times. We've established several initiatives to ensure the needs of our employer customers are being met. This includes the introduction of the Authorised Provider model, which is designed to 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. We also have a program of continuous improvement to the new claims management as outlined above.

This graph shows the Net Promoter Scores for Workers Insurance, Employers and Injured workers. For January 2018, Workers Insurance scored 19, Employers -6, and Injured Workers 24. For February 2018, Workers Insurance scored 19, Employers -11, and Injured Workers 24. For March 2018, Workers Insurance scored 17, Employers -9, and Injured Workers 25. For April 2018, Workers Insurance scored 14, Employers -14, and Injured Workers 23. For May 2018, Workers Insurance scored 14, Employers -13, and Injured Workers 24. For June 2018, Workers Insurance scored 14, Employers -18, and Injured Workers 23. For July 2018, Workers Insurance scored 16, Employers -16, and Injured Workers 25. For August 2018, Workers Insurance scored 16, Employers -16, and Injured Workers 26. For September 2018, Workers Insurance scored 18, Employers -19, and Injured Workers 28. For October 2018, Workers Insurance scored 19, Employers -18, and Injured Workers 26. For November 2018, Workers Insurance scored 22, Employers -25, and Injured Workers 27. For December 2018, Workers Insurance scored 21, Employers -25, and Injured Workers 26. For January 2019, Workers Insurance scored 19, Employers -26, and Injured Workers 24. For February 2019, Workers Insurance scored 21, Employers -22, and Injured Workers 25. For March 2019, Workers Insurance scored 21, Employers -20, and Injured Workers 26. For April 2019, Workers Insurance scored 18, Employers -27, and Injured Workers 25. For May 2019, Workers Insurance scored 6, Employers -31, and Injured Workers 20. For June 2019, Workers Insurance scored 6, Employers -30, and Injured Workers 20. For July 2019, Workers Insurance scored 5, Employers -26, and Injured Workers 20. For August 2019, Workers Insurance scored 8, Employers -20, and Injured Workers 21. For September 2019Workers Insurance scored 9, Employers -17, and Injured Workers 20.

Data shows from 1 Jan 18 – 30 Sept 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

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.