New workers insurance claims service model

From January 2018, icare workers insurance will have a new workers insurance claims service model which will improve the claims experience of injured workers and employers.

Key improvement to claims

  1. EML will be icare's appointed claims service provider
    From 1 January 2018, EML will be the appointed claims service provider for icare for claims management under the icare workers insurance scheme.
  2. Report an injury through an online form
    From 1 January 2018, employers, injured workers and third party representatives will have the option to report an incident or injury through a new online form (in addition to existing methods of phone, email and post). This form will be accessible via the icare and EML websites.
  3. Upload a document to an existing claim online
    Update an existing injury notification or existing claim by uploading supporting documents online.
  4. Asking relevant questions up front to expedite access to support
    We want to deliver the best return to work outcomes for injured workers and employers. The questions asked in the online form will give us a better understanding of the injured worker’s injury by asking relevant questions at the time of notification.

Key dates

Date What's new
 31 Dec 2017 CGU and QBE will exit the icare workers insurance scheme

CGU and QBE existing claims (claims notified up to and including 31 December that are ongoing) will transfer to GIO for continued management
1 Jan 2018 

New workers insurance claims model for icare goes live 

EML is the scheme agent and service management for all new icare workers insurance claims

GIO and Allianz will continue to manage existing claims from 1 January 2018

Online injury notification form goes live

EML is the claims service provider for icare workers insurance claims

What these changes mean for you

How to notify us of an injury

Video Transcript
Timing Dialogue 
00:00:02 From January 1, 2018 lodging a new notification of an injury in New South Wales will be a whole lot easier.
00:00:12 To begin - simply select if you are an employer, a worker or their representative. Your experience will be tailored based on your selection, and you will be prompted throughout.
00:00:26 Simply
  • Fill in the claim details about the injury, by following the prompts on screen.There are hints and tips to help you through the process
  • Send through documentation or any receipts
Hit submit to complete your lodgement and you’ll will receive a notification number instantly. We will contact with both the employer and injured worker to make sure you get the right level of support
00:00:50 Remember if you need assistance, we’re here to help. Call us on 13 77 22 or email icare and EML are working together to ensure the New South Wales workers insurance scheme is at the forefront of customer-centric and sustainable service delivery for our customers.

    More about the new claims model

  • Why are we changing to a new model?
    Two years’ worth of research and feedback on the current scheme has confirmed the need for change. Employers told us they wanted better communication, a better claims process, lower premiums, an improved policy renewal process and improved customer service. Workers also wanted improvements in communications, claims processing and a more empathetic approach to rehab and recovery.
  • New claims model ready for launch

    On 1 January 2018, new claims will be managed in our re-designed claims model with EML as our appointed claims service provider for new claims. We are embarking on a unique relationship where we will bring together the best of the strategic focus, oversight and direction of icare with the operational excellence of EML.

    The new service model is designed, built and ready for launch on January 1 2018. As well as our systems being ready, we will have the right people in place to deliver a great customer experience. Recruitment and on-boarding of new specialised teams is underway and dedicated teams of specialist case managers, triage specialists and administrators will be in place in Newcastle, Parramatta and the Sydney CBD when the model goes live on 1 January. Although many of our team members already have experience in the workers compensation industry, they are undergoing training in the new model and our expectations for the customer focused service they will deliver.

    icare and EML are currently in ‘dress rehearsal’ mode where the case managers are testing and refining the systems and processes to ensure customer service levels are maintained through every aspect of the model. This testing commenced in October and will continue up until go live in January.

  • What is different?
    At the heart of the model is a new portal that will allow quick and effective notification of an injury that leads to the triage of each claim and ensures the right level of case management and support is assigned. Employers, workers and third parties will still have the choice to notify us directly through the portal or alternatively they can contact us by email, or phone and speak to our teams for further assistance.
  • What will it deliver?

    By asking a number of new questions, we will be able to quickly triage the claim into an appropriate segment of the model.

    If the claim is low risk, for instance a medical only claim, we can reduce the intervention levels required and deliver a faster resolution. More complex claims can be quickly assigned to highly-trained and experienced specialist case managers. We want to deliver the best return to work outcomes for injured workers and employers appropriate to the complexity of the claim and the new model will make that a much more transparent and equitable process for all involved.

  • What happens to existing claims?

    Any existing claims will continue to be managed by your current claims service provider.

    Your scheme agent may have changed recently. If that is the case, you will have already been notified of this change.

    This could mean you can have claims with two different scheme agents until existing claims are settled. icare and the scheme agents will work with you or your broker directly to resolve any issues this may cause.

    For simple claims, our claims advisors will have detailed information on the case history and will be available to handle any queries and. For more complex claims, there will be a dedicated case manager assigned to the claim.

  • What support is available?

    We understand that for many small to medium employers, notifying us of an injury is something done infrequently, if at all.

    We’ve made the online form easy to use, the questions simpler and more intuitive, with some helpful tips through the process. You’ll be able to call the claims support centre for any assistance required throughout the entire process.

  • What information will I need to provide online?

    The new online form will ask a set of mandatory questions which will be enough to notify us that an injury has occurred.

    If more information is known and available to the person notifying us, it can be provided immediately online. Documents can also be uploaded at this time.

    If more time is needed to gather information, you can submit responses to those mandatory questions, and opt to speak to someone later.

  • Who can report an injury?

    Some injured workers will have another person, like a family member, doctor, or lawyer notify us through EML on their behalf. This is known as a third party.

    The third party will have the ability to notify us of an injury, and provide contact details for themselves, the injured person, and the employer to ensure that communication between all parties commences.

  • What happens once you've notified us of an injury?

    Irrespective of who lodges the notification, both the employer and injured worker will receive a confirmation that you have notified us of an injury.

    We will then assess the details you provide and assign the case to the appropriate level of care in our model. Employers and injured workers will receive a call from us to discuss/confirm details of the claim and next steps. If the claim is low risk, for instance a medical only claim, we can reduce the intervention levels required and deliver a faster resolution.

    More complex claims can be quickly assigned to highly-trained and experienced specialist case managers to support the injured worker and work with the employer to help to achieve sustainable return to work outcomes.