As a result of the information requirements and complex process used to determine these workers compensation payments, there have been deficiencies in some of the compensation determinations over this seven-year period between 2012 and 2019. As a result, some workers may not have been paid their correct weekly payments by their insurer.
The issue relates to the complexity of the pre-injury average weekly earnings (PIAWE) determination under legislation passed in 2012. In September 2019 the NSW Government published amendments to the PIAWE regulations that were intended to reduce the complexity of these determinations.
icare discovered discrepancies in the determination of PIAWE by insurers in 2019 and a remediation program is underway to ensure injured workers are paid their correct entitlements. Many of the errors found relate to injuries prior to the establishment of icare in 2015 when it took over workers insurance from its predecessor WorkCover NSW.
icare will not recover any overpayments and is remediating underpayments as files from the seven-year period are reviewed.
At this stage the remediation program covers workers compensation payments for private sector employees in NSW (under the Nominal Insurer). Workers compensation payments for NSW Government employees (under the Treasury Managed Fund) and payments by Specialised Insurers and Self Insurers are being handled separately.
icare has specialist resources in place and has set up quality assurance checks to assess any payments in question. Any worker who was paid weekly benefits for injuries notified between 1 October 2012 and 20 October 2019 can check on the PIAWE assessment page if they are eligible for their payments to be assessed.
icare is also encouraging employers to assist current or former employees if they request information on their pre-injury earnings over this seven-year period.
Through the remediation program for payments under the Nominal Insurer, icare has discovered two main reasons as to why insurers were not paying the correct entitlements – firstly, the sheer volume of data and information that was required for PIAWE under legislation, and secondly the complexity of the PIAWE calculation.
As a result, employers found it difficult to provide insurers with the required data and information to determine PIAWE, and insurers were only able to pay an injured workers' weekly payment based on the information provided to them by employers.
In addition, under the legislation insurers must assess and commence provisional weekly payments within seven days of being notified of the injury. Because of this short timeframe, initial payments were often based on incomplete information and in many cases were later recalculated and payments adjusted.