What is being announced?
Insurance and Care NSW (icare) has announced Allianz, EML, QBE and GIO have been appointed to provide claims management services for the Insurance for NSW Treasury Managed Fund (TMF) workers compensation portfolio. These appointments are subject to contract execution.
When will the contracts commence?
The new contracts, supporting 202 NSW Government Agencies and their 389,000 workers and 82,000 volunteers, will commence on 1 January 2020 for Allianz, EML and QBE. GIO will commence following the implementation of the icare technology platform.
Why is this happening?
Current contracts with EML, Allianz and QBE expire at the end of 2019.
What process was followed to select these providers?
The new contracts have been awarded following a robust and competitive RFP (Request for Proposal) process that commenced in May 2019. The TMF RFP strategy was approved by Procurement NSW and the process was overseen by an external Probity Officer and independently facilitated. Approval was also required by icare’s Board.
What does 'subject to contract execution' mean?
These providers have been appointed to provide claims management services for the TMF; final contracts will be executed shortly.
Are there different contract terms for different claims managers?
icare has aimed for consistent contracts to be executed to appoint the claims managers. There is some variation in specific details due to the different claims portfolios and the negotiation process undertaken with each of the providers.
How have NSW Government Agencies been involved?
In preparation for the RFP, icare identified the needs of NSW Government Agencies through surveys and other feedback mechanisms. We have listened to their needs and these were woven into the RPF objectives and criteria. Representatives of NSW Government Agencies were involved in the evaluation process for this RFP.
Why have these particular providers been appointed?
icare is confident these organisations have the best capability to provide claims management services for the TMF. Their RFP responses most closely fulfilled the criteria of improving workers compensation services, having the ability to deliver the principles of the icare service model, establishing a future workers compensation operating model that will meet future needs of NSW Government Agencies and injured workers, and ensuring the TMF is a financially stable, sustainable scheme.
What are the principles of the icare service model?
The principles of the icare service model are:
- Allocating resources according to need
- Straight-through processing where possible
- Empathetic customer service to empower customers
- Service providers (partners) who are an extension of agencies and icare
- A focus on return to work and life for injured workers
- Empowered customers.
What has changed if these are the same providers as previously?
The change in contracts brings the opportunity to improve icare’s claims management processes and service for NSW Government Agencies and injured workers. The current providers operate on three different service models. The new contracts require all claims managers to deliver a consistent service model and operating model.
While the claims managers commencing on 1 January 2020 are also the incumbent providers, the addition of GIO broadens the mix of providers available. This appointment paves the way for the eventual introduction of choice of provider for NSW Government Agencies, which will become available once icare’s technology platform is available.
How has pricing been determined?
Competitive pricing submissions were obtained from respondents as part of the RFP process and subject to subsequent negotiation under probity.
How will the claims management providers be measured under the new contracts?
Strong performance measures are included in the new contracts to enable better Return to Work outcomes and there is a direct link between improved performance and remuneration.
What are the claims managers' KPIs for performance incentives?
The performance metrics for the new contracts have been designed to incentivise claims manager activity and behaviour, to achieve a good balance between favourable customer experience and strong Return to Work (RTW) outcomes for injured workers. There are also a number of governance and compliance metrics, which combined with the Customer and RTW metrics, have a stronger link to the Remuneration framework.
icare has mentioned it is introducing a new single technology platform. When will this happen?
icare anticipates its technology platform will be available for non-exempt claims in 2020. This will be built by adapting the existing system used by icare’s Nominal Insurer scheme.
The icare technology platform will be available for exempt claims for emergency services workers compensation at a later stage, once further technology build has been undertaken to accommodate the different legislative requirements for exempt workers’ claims.
Will it be mandatory for claims managers to use icare's new technology platform?
Once icare’s claims technology platform is available, it will be mandatory for claims managers to use it.
Why are these changes being introduced?
icare’s objective is to improve the customer experience while ensuring the financial sustainability of the TMF scheme. We support fairer, more empathetic treatment for injured workers, and aim to make the service faster and more efficient while ensuring claims at risk of prolonged time loss and with more complex circumstances receive the support they need.
Will the claims managers use dual systems until icare's system is ready?
Our intention is that all claims managed by a particular claims manager will be migrated to icare’s system at the same time. This does not necessarily mean all claims or all claims managers will migrate simultaneously. We expect that once claims are migrated to icare’s claims technology platform, claims managers will not need to use their legacy systems for day-to-day claims management.
icare's Claims Technology Platform
What other changes will take place in the future?
Further details will be provided about how to preference for a change in claims manager at the time icare’s claims technology platform is available.
How will NSW Government Agencies be able to enact choice of claims manager?
NSW Government Agencies have told us they want more flexibility. This will be addressed during 2020 and 2021; once icare has complete confidence the icare technology platform is fully operational to support TMF customers, NSW Government Agencies will have the opportunity to enact choice of claims manager.
Any movement of existing claims between providers and rebalancing of portfolios resulting from choice of provider will be undertaken once the system is operational, to ensure smooth transition of claims, minimal disruption and risk, and continuity of service to injured workers and NSW Government Agencies and their employees and volunteers.
Later changes will include the introduction of an evolved operating model so NSW Government Agencies can have more involvement in the claims management process.
Future choice of claims manager
What are Insurance for NSW and the TMF?
icare’s Insurance for NSW is the largest public sector-managed fund scheme in Australia.
Via the Treasury Managed Fund (TMF), Insurance for NSW provides asset and liability protection, including workers compensation insurance, for 202 NSW public sector Agencies and their 329,000 workers and 82,000 volunteers.
More details about the TMF are included in icare’s annual report 2018-19, due to be published shortly and on the icare website.
Who has icare communicated this information to?
icare is communicating this information to the market including claims managers, NSW Government Agencies and other interested parties.
More information will be available on the NSW Government eTendering website over the coming weeks.
How can I find out more information?
If you have other questions regarding Insurance for NSW, the TMF and the appointment of claims management providers, please email InsuranceforNSW@icare.nsw.gov.au.