icare PIAWE Review and Remediation Program

In 2019, icare reviewed a sample of scheme agent claim files to understand whether PIAWE had been calculated correctly since its implementation in 2012.

Latest updates

How many claims have been reviewed?

As at July, the program has completed a full review of PIAWE calculations and associated weekly payments for 100 Nominal Insurer claims from last year's project and an initial PIAWE review of around 300 claims.

To date, 19 closed claims have been identified to have been underpaid in weekly benefit payments and we will be starting to make contact with these customers, including possibly some employers, by the end of July.

What impact will this have on employer premiums?

Any repayment made against an open or closed claim will not impact prior or future year employer premiums.

For experience-rated employers, an increase or decrease in ongoing weekly benefit payments for open claims may require a premium recalculation at the premium renewal period.

How does the remediation process work?

The remediation process is complex, and we are taking the time to carefully set up the framework and processes to ensure it's done correctly.

Remediation of weekly benefit payments resulting from a miscalculation of PIAWE is a completely new process for the NSW Workers Compensation Scheme and requires setting up a rigorous process for reviewing claim files, recalculating PIAWE and any payments.

How will you be contacting customers?

Initial communication to workers is a critical part of the remediation process.

All communication with customers will initially be made over the phone to thoroughly explain the outcome of the file review and remediation process and also seek consent from the worker to proceed with payment.

Customers will also receive a letter explaining the review outcome and their options for payment.

Overview

In 2019, icare reviewed a sample of scheme agent claim files to understand whether PIAWE had been calculated correctly since its implementation in 2012.

From the sample, we identified errors in initial PIAWE calculations made by scheme agents between 2012 and 2018. 

We are reviewing each of these claim files individually and remediating customer weekly benefit payments if an underpayment is discovered.  

While we’re still in the early stages of the review, probing into the fine details of each claim has found that about five per cent of these historic claims are likely to need underpayments corrected. 

We are now expediting the remediation process to ensure that any payments owed to customers are made as quickly as possible. Any worker impacted will receive a letter detailing the amount owed and payment options. 

More information on icare’s PIAWE Review and Remediation Program can be found in the Frequently Asked Questions below. 

How to contact us

Customers who are concerned they may have been impacted by this issue can visit the SIRA website for more information; or contact SIRA on 13 10 50 or register their details with SIRA for further communication over the coming months. 

Background: Pre-injury Average Weekly Earnings (PIAWE)

Employment and remuneration arrangements for workers in NSW are extremely diverse and can vary between industries and the type and size of an organisation.

To accommodate the complex nature of these agreements, PIAWE methodology was introduced in 2012 as part of legislative changes, to implement through broader benefits reforms. PIAWE came into effect in 2013 as part of the Workers Compensation Legislation Amendment Act 2012.

It was designed to establish a more accurate earnings determination based on all earnings and related benefits in the 52 weeks prior to a worker’s injury. PIAWE has been included in several reviews of the workers compensation scheme over the last few years, and multiple concerns have been raised about the inherent complexity of calculating PIAWE.

The workers compensation scheme in NSW has had a long history of reviews and major legislative changes, including four changes relating to PIAWE between 2012 and 2019, reflecting feedback on PIAWE calculations received from workers, employers and other key stakeholders.

In 2019, significant improvements to, and simplification of PIAWE calculations were introduced. These originated from a major review of the workers compensation scheme in 2016 since icare’s establishment in 2015.

Program updates 

July 2020

  • An initial review of 299 claims completed.
  • Initial contact commenced with 19 customers to explain review findings, the process to remediate any underpayment of weekly benefits and seek consent to make payment.

June 2020

  • Review of 1,000 claim files for mostly claims with 2016 and prior accident years continues.
  • Engagement with TMF Government Agencies initiated to better understand their processes for calculating PIAWE.

May 2020

  • Review of 100 GIO claim files concludes.
  • Commence Review and Remediation Phase One - review of 1,000 claim files. 
  • Expected duration of Review and Remediation Phase One is three months.
  • TMF Risk Discovery Review completed.

April 2020 

  • Review of 100 GIO claim files continues.

March 2020

  • Engagement with Nominal Insurer scheme agents, GIO, EML and Allianz began.
  • GIO engaged to undertake the recalculation of PIAWE identified in the 2019 Review as having an incorrect initial PIAWE calculation.
  • GIO review of 100 claim files commenced to determine whether workers’ payments were correct, a quality assurance framework, peer review process, and best practice approach to PIAWE calculation, file review and remediation.

February 2020

  • icare notified SIRA of PIAWE Risk Discovery Review.
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