Nominal Insurer Claims Model 2023

icare’s Nominal Insurer Claims Model is a framework established to meet the needs of injured workers and employers within NSW.

icare's Claims Service Providers operate within the model and offer consistent claims services that deliver fair and equitable outcomes for both injured workers and employers in line with the Claims Management Decision Framework.

Learn more about our Claims Model

Claims Service Providers

Allianz, DXC, EML, Gallagher Bassett, GIO and QBE manage claims for the Nominal Insurer scheme that provides workers compensation Insurance to more than 329,000 public and private sector employers in NSW and their 3.2 million employees.

   

In addition to the services eligible employers receive for the price of their premium, they may negotiate value-added services directly with their chosen Claims Service Provider.

In some instances, value-added services may involve an additional fee that is not included in the price of their premium.

As part of the new claims management model, icare has signed a memorandum of understanding (MOU) with global third party administrator (TPA) Sedgwick, placing the company on standby to offer claims management services until the end of 2025.

Contact a Claims Service Provider

Choice of Claims Service Provider

As part of our Claims Model we will continue to provide larger employers with choice of Claims Service Providers.

icare's Claims Service Providers offer eligible employers consistent claims services that deliver fair and equitable outcomes for both injured workers and employers.

Claims Service Providers under ‘Employer Choice'

Currently six Claims Service Providers are available to be selected for Employer Choice; Allianz, DXC, EML, Gallagher Bassett, GIO and QBE.

Offering a greater degree of choice for large employers and other improvements to the claims model will drive competition and improved service quality with a focus on the customer by simplifying the claims process and creating increased transparency and effectiveness.

Employer Eligibility for choice of Claims Service Provider

Currently eligible employers:

  • Have an Average Performance Premium (APP) that exceeds $500,000; or
  • Are a part of a group with a Group Average Performance Premium (GAPP) that exceeds $500,000.

We're offering choice to more employers from 30 June 2024 who:

  • Have an Average Performance Premium (APP) that exceeds $200,000; or
  • Are a part of a group with a Group Average Performance Premium (GAPP) that exceeds $200,000.

How to nominate a Claims Service Provider

As an eligible employer, you can select a Claims Service Provider via our customer self-service functionality up to 14 days before your policy renews or by contacting your Underwriter.

Once icare accepts the nomination, icare will contact you to confirm your transfer.

Any claims lodged prior to your transfer to a new Claims Service Provider will remain with the existing provider for a period after the transfer. icare will work with you over the following 12 months to consolidate your existing open and closed claims with your new CSP on an agreed schedule.

icare's claims management platform

All Claims Service Providers manage new claims on icare's claims management platform.

In time, it is an objective to migrate all historical claims data onto icare’s claims management platform.

Until then, historical claims will continue to be managed by the existing Claims Service Provider.

    Frequently asked questions

  • Can I transfer twice in a 12-month period?
    No. Eligible employers will remain with their selected claims service provider for the next 12-month term of their policy and cannot transfer again until the transfer opportunity arises at their following policy renewal date.
  • Will claims service providers operate under the same policy and premium model?

    Yes.

  • Do all policies under a group policy need to be included with the same Claims Service Provider?

    Yes. As is standard practice in NSW, all policies within a group must be managed by the same claims services provider.

  • What happens if one of the policies under a group is divested?

    If a policy is no longer part of your group, and joins another group, the policy will transfer to the Claims Service Provider presently managing that new group.

    If the policy is no longer a grouped policy member it will be removed from the group however remain with the existing assigned Claims Service Provider.

  • What employer reporting does icare provide?

    icare provides a monthly Cost of Claims report that consolidates an employer's workers insurance claims in one place, regardless of which agent is managing them.

    If you would like to receive the monthly Cost of Claims report or have any questions regarding reporting, please email WIreporting@icare.nsw.gov.au.

    All claims lodged on icare's claims platform, regardless of Claims Service Provider, will now carry the icare insurer identifier (701). Given your claims may be managed by more than one Claims Service Provider, to identify the Claims Service Provider managing the claim in your monthly Cost of Claims report, please refer to the 'managing_entity_name' (column CY).

    An employer may choose to use cost centres to track their claims, the Cost of Claims report includes cost centres for claims lodged on icare's platform, where the cost centre has been advised to the claims service provider. You can include your cost centre when lodging a claim via the authenticated claims portal or update a cost centre on a claim by directly notifying your case manager at the time of lodgement or shortly afterwards. We are currently working on a solution to update cost centres in the Cost of Claims report for existing claims not on icare’s platform.

    For any other reports that you currently receive from your Claims Service Provider, please engage your new Claims Service Provider prior to transferring to arrange these.

 Claims Service Provider contact information

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