2021 Statutory Review of Motor Accident Injuries Act 2017 - Progress update on recommendations

Clayton Utz 1

The legislature considers amending the Act to require the Minister to review the Act (and the regulations and guidelines under the Act), on terms similar to the current section 11.13(1), as soon as practicable after the period of 8 years from commencement of the Act and every 5 years thereafter.

Complete:

Section 11.13 of the Motor Accident Injuries Act 2017 has been amended to require review of the Act every 5 years. This legislative change was made via the Motor Accident Injuries Amendment Act 2022 which passed through Parliament on 18 November 2022.

Clayton Utz 2

SIRA consider developing, implementing and reporting on measures of insurers’ procedures to comply, and actual compliance, with overarching obligations relating to statutory benefits claims including under clauses 4.5, 4.48 and 4.76-77 of the Guidelines, and Division 6.2 of the Act.

Complete:

The forward Insurance Claims and Conduct Assurance Program (ICCAP) schedule will include compliance activity related to the clauses identified in this recommendation, which will be addressed over the next 18 months.

The ICCAP schedule, which is released to insurers and published on SIRA’s website, contains the ICCAP activities of the next 12 months.

Clayton Utz 3

SIRA consider:

(a) amending Schedule 3A of the Guidelines to add an obligation requiring the insurer to report to SIRA on the outcomes of the processes and structures detailed in the insurer’s business plan in accordance with clauses 3.16, 3.17 and 3.18 of Schedule 3A of the Guidelines; and

(b) if SIRA has concerns about risk culture and requires insurers to make changes or undertake remedial actions to address those concerns, publishing SIRA’s concerns and requirements for insurers.

Complete:

Amendments were made to the Motor Accident Guidelines Version 9, published on 25 November 2022. New clauses 3.15 and 3.20 state insurers must report on culture requirements to SIRA.

SIRA has implemented a Regulatory Publishing Policy which would be utilised should SIRA have concerns about risk culture and require insurers to make changes or undertake remedial actions to address those concerns. Publication would occur through SIRA’s quarterly regulatory bulletin which currently includes all insurer performance concerns and remediation plans.

Clayton Utz 4

The legislature consider amending the Act to authorise SIRA to issue Guidelines with respect to the qualifications, education and training, performance assessment, case-loads, and remuneration of insurer personnel involved in decision-making in relation to claims by injured persons.

SIRA should use that power to issue Guidelines including minimum qualification, education, experience and training requirements, restrictions on the criteria for performance assessment and remuneration of such personnel, and standards in respect of case-loads.

Not complete:

Would require amendment to the Motor Accident Guidelines. SIRA will undertake policy analysis to consider appropriate options for inclusion in the Motor Accident Guidelines version 10.

Clayton Utz 5

The legislature considers amending the Act to authorise SIRA to provide in the Guidelines for:

(a) types of treatment and care that are taken to be reasonable and necessary in the circumstances for the purposes of section 3.24(2) of the Act; and
(b) treatment and care costs, incurred in defined circumstances, that are taken to be reasonable for the purposes of section 3.24(1)(a) of the Act.

SIRA should use that power to issue Guidelines specifying relevant types of treatment and care, and relevant treatment and care costs incurred in defined circumstances.

In progress:

Legislative change was made via the Motor Accident Injuries Amendment Act 2022 which passed through Parliament on 18 November 2022.

SIRA is currently considering the form and content of the Guidelines on treatment and care.

Clayton Utz 6

The legislature consider amending the Act to provide that treatment or care recommended in writing by a treating practitioner is, subject to evidence to the contrary:
(a) presumed to be reasonable and necessary in the circumstances; and
(b) if certified by the treating practitioner, presumed to relates to the injury resulting from the motor accident concerned.
The amendment should provide for SIRA to specify in the Guidelines circumstances in which one or both of the presumptions do not apply.

Not complete:

Would require legislative amendment.

Clayton Utz 7

The legislature consider amending the Act, in relation to determining whether any treatment and care provided to the injured person in accordance with a written recommendation by their treating practitioner is reasonable and necessary in the circumstances or, if certified by the treating practitioner, relates to the injury resulting from the motor accident concerned:
(a) to prohibit insurers from requesting the injured person to undergo a medical or other health related examination;
(b) to allow insurers to request additional information from a treating practitioner; and
(c) to provide that an insurer who wishes the injured person to undergo a medical or other health related examination must lodge a medical dispute with the PIC.
The amendment should provide for SIRA to specify in the Guidelines circumstances in which the restriction in (a) does not apply.

Not complete:

Would require legislative amendment.

Clayton Utz 8

SIRA consider:
(a) developing a panel of rehabilitation providers and occupational therapists, contracted to SIRA and not insurers, who would have responsibility to provide any:
a (i) rehabilitation assessment;
a (ii) assessment to determine attendant care needs; or
a (iii) assessment to determine functional and vocational capacity; (b) amending the Guidelines to provide that, for the purposes of sub-sections (b) and (c) of section 6.27(1) of the Act, any assessment of these matters otherwise than by a treating practitioner must only be undertaken by a member of the panel (or an employee or contractor of a member of the panel).

In progress:

Legislative change was made via the Motor Accident Injuries Amendment Act 2022 which passed through Parliament on 18 November 2022.

SIRA will consider development of a rehabilitation provider approval framework for consultation, aligned to new guideline-making powers.

Clayton Utz 9

SIRA amend Part 4 of the Guidelines to:

(a) prohibit insurers or any person appointed by insurers from attending a private consultation between an injured person and a treating practitioner occurring in the ordinary course of the injured person's treatment and care that relates to the injury resulting from motor accident concerned; and
(b) require insurers to give written notification to the injured person concerned of any communication (whether written or otherwise) between the relevant insurer and an injured person's treating practitioner, including the matters discussed and the outcome of the communication.

Complete:

Amendments were made to the Motor Accident Guidelines version 9, published on 25 November 2022.

There is a new requirement at clause 4.107 which states that insurers must provide the claimant with copies of all correspondence with the claimant’s treating practitioner or, for unwritten communication with the treating practitioner, provide a written notification to the claimant outlining the matters discussed and the outcome of the communication.

SIRA will not be updating the Guidelines to prohibit the insurer attending a private consultation between an injured person and a treating practitioner. Privacy obligations would prevent an insurer or their representative from attending a private consultation without prior consent. It is open to the injured person to provide informed consent, or alternatively, the insurer would need to schedule a separate case conference.

Clayton Utz 10

SIRA consider taking steps to ensure compliance by insurers with their obligations under clauses 4.76 to 4.90 of the Guidelines relating to recovery plans for injured persons, and to ensure that recovery plans are of a high standard and address not only return to work but also return to other activities.

Complete:

The ICCAP Supervision Plan for Recovery Plans was completed in December 2022.

Clayton Utz 11

SIRA consider:
(a) consulting with relevant medical stakeholders and, if considered necessary, undertaking research to determine the extent to which certain treatment and care is not reasonably available at AMA rates; and
(b) whether it is necessary to amend clause 4.95 of the Guidelines to ensure that insurers pay the reasonable cost of treatment and care above AMA rates in circumstance where equivalent treatment or care is not reasonably available at AMA rates.

Complete:

During 2021, SIRA undertook broad-based analysis of surgical fees in the Workers Compensation and CTP Schemes, including consultation with medical and surgical stakeholders. It was determined that treatment and care at Australian Medical Association rates is reasonably available.

SIRA continues to monitor access to treatment and fees and any issues that may be raised by the Industry Advisory Committee that has been established to guide SIRA’s value-based care program.

Clayton Utz 12

SIRA consider undertaking research to determine precisely the barriers to participation in the Scheme by providers of treatment and care, and the measures that could be taken to remove or reduce those barriers, in order to enable injured persons to have the provider of their choice.

In progress:

SIRA has undertaken an in-depth survey with ten CTP providers to identify barriers and opportunities to improve health care provider experience in the Scheme.

SIRA is now considering the insights, which will be incorporated into the future work program.

Clayton Utz 13

SIRA should amend clause 4.99 of the Guidelines to clarify that the insurer is required to issue its decision in relation to treatment or care within 10 days of receipt of the claimant’s request, whether the request is for pre-approval to pay statutory benefits for the treatment or care or for the payment of statutory benefits for treatment or care that has already been provided.

Complete:

Implemented in the Motor Accident Guidelines version 8, published on 29 October 2021.

Clayton Utz 14

SIRA should undertake a review of the weekly payments framework, to assess what steps can be taken to enable a greater proportion of earners to receive their full entitlement sooner and to minimise disputes. The review should consider, among any other matters considered relevant, whether:

(a) the provisions for determining the appropriate amount of weekly payments for earners can be simplified, including consideration of whether weekly payments should be made on the basis of a set statutory rate, or rates dependent on the nature of the injured person's pre-accident employment or pre-accident training, skills and experience;
(b) the provisions for calculating weekly payments in the post-second entitlement period remain appropriate;
(c) the Act or Guidelines should be amended to enable faster and better access to relevant information by insurers for the purpose of calculating the required amount of weekly benefits; and
(d) guidance is required as to how disputes in relation to weekly benefits should proceed in the PIC, having regard to the provisions currently in clauses 1(a) and 2(d) of Schedule 2 to the Act.

In progress:

The Motor Accidents and Workers Compensation Legislation Amendment Act 2021, which received assent on 16 June 2022, made changes to the weekly payments framework to better enable injured people to have their benefits assessed and calculated.

SIRA is undertaking a review and monitoring the weekly payments framework, including identification of administrative options to support timely and accurate entitlement to weekly payments.

The recent legislative amendments to the weekly payment provisions which commenced from 1 April 2023 will impact entitlements and insurer decisions and will be factored into the review.

The ICCAP activity has also been completed, which will be an input to ongoing review of the weekly payments framework.

Clayton Utz 15

The legislature consider amending the Act to make weekly payments of statutory benefits payable in respect of the period before the claim is made even if the claim is made more than 28 days after the date of the motor accident if the claimant provides a full and satisfactory explanation for the delay.

Complete:

Legislative changes have been made through the Motor Accident Injuries Amendment Act 2022 which passed through Parliament on 18 November 2022.

Section 6.13(2) of the Motor Accident Injuries Act 2017 now provides regulation-making power to specify circumstances when statutory benefit may be made in respect of any period before the claim is made where the claim is made 28 days after the motor accident.

The amending Regulation was published and commenced with effect from 1 April 2023.

Clayton Utz 16

SIRA should amend the Guidelines to clarify that the relevant insurer must begin weekly payments of statutory benefits immediately after determining that a claimant is an earner entitled to weekly payments under section 3.6(1), including by making interim payments if the full entitlement has not yet been determined.

Complete:

This recommendation has been addressed through changes to clauses 4.47-4.49 of the Motor Accident Guidelines version 9.

Clayton Utz 17

SIRA should undertake a review of the lodgement of damages claims under Part 4 of the Act which should:
(a) proceed on the basis that section 6.14 of the Act should be amended to remove the requirement for person’s with whole person impairment 10% or less to wait 20 months before lodgement and section 6.23(1) of the Act should be amended to remove the 2-year prohibition on settling claims for damages; and
(b) consider, among any other options considered appropriate for consultation, amendments to the Act would have the following effect:
(i) an injured person with non-minor injuries wishing to claim damages for past economic loss only (i.e. not seeking to claim damages for future economic loss or for non-economic loss) could do so at any time;
(ii) insurers be required to assist injured persons who are unlikely to have been wholly at fault and unlikely to have whole person impairment greater than 10% to lodge a claim for damages of the above nature upon the injured person’s return to work within the first 12 months after the motor accident concerned; and
(iii) any persons wishing to claim damages for future economic loss or damages for non-economic loss (in addition to damages for past economic loss) could do so only 12 months or more after the motor accident concerned; and
(iv) despite sub-paragraph (iv), if a person assessed within the first 12 months after the motor accident concerned as having a degree of permanent impairment greater than 10% as a result of the accident, then they may claim damages at any time.
(c) consider whether section 6.25 of the Act should be amended in respect of the timing and content of the claimant’s obligation to give particulars of a damages claim.

Complete:

Legislative changes have been made via the Motor Accident Injuries Amendment Act 2022 which passed through Parliament on 18 November 2022.

Section 6.14 of the Motor Accident Injuries Act 2017 has been amended to remove the requirement to wait 20 months before lodging a damages claim.

Clayton Utz 18

The Minister consider the making of a regulation under section 4.9(2)(a) of the Act to specify a discount rate lower than 5% and which properly qualifies the present value of future economic loss.

Not complete:

Would require regulation amendment.

Clayton Utz 19

The legislature considers amending section 2.25 of the Act to align with Part 2 of Schedule 4 to the Act, to enable Guidelines made under section 2.25 to adopt the mechanism and procedure for profit adjustment in place under the TEPL Guidelines.

Complete:

Legislative changes have been made via the Motor Accident Injuries Amendment Act 2022 which passed through Parliament on 18 November 2022.

Clayton Utz 20

The legislature consider amending clause 2 of Part 2 of Schedule 4 to the Act, to provide expressly that SIRA may exercise a power under clause 2 relating to third-party policies in force during the transition period, either during or after the transition period.

Complete:

The Motor Accidents and Workers Compensation Legislation Amendment Regulation 2020 amended clause 2(4) of Part 2 of Schedule 4 to the Motor Accident Injuries Act 2017.

Clayton Utz 21

SIRA undertake a consultation to report on any barriers in the Scheme to innovation in the setting of premiums and other aspects of the conduct of CTP insurance business, and the extent and manner in which removal of those barriers would affect:

(a) affordability; and
(b) the flexibility and incentive for insurers to innovate in ways that advance the objectives of the Act and encourage safer driving decisions.

Complete:

Following consultation with insurers in November 2022, SIRA completed a sprint to review and produce an overarching innovation portfolio framework and identify a number of tactical initiatives to be implemented in the short term.

The outputs of the sprint include a value map for the schemes governed by SIRA with clear value levers identified, key recommendations (including quick wins) and a roadmap for achieving SIRA's ambition to be an innovative regulator and drive innovation in the schemes that we govern.

The SIRA innovation framework will now be embedded, and a change management approach will be taken, including communications to key stakeholders, considerations on SIRA capability and operational model as well as applications for quick wins: the review of Transitional Excess Profits and Losses (TEPL) innovation framework, the review of SIRA research function and applying it to the medico legal review and the workers compensation scheme re-design review. Through this forum SIRA will continue to engage and consult on the innovation framework.

Clayton Utz 22

The legislature consider amending section 6.2(2) of the Act to amend the minimum requirement for a satisfactory explanation for failure to comply with a duty to: a reasonable person in the position of the claimant would have been justified failing to comply with the duty.

Not complete:

Would require legislative amendment.

Clayton Utz 23

The legislature considers amending section 7.9 of the Act to provide that Division 7.3 of the Act (Internal review) does not apply to a decision relating to the degree of permanent impairment of an injured person that has resulted from the injury caused by the motor accident (including whether the degree of permanent impairment is greater than a particular percentage)

Complete:

Legislative changes have been made via the Motor Accident Injuries Amendment Act 2022 which passed through Parliament on 18 November 2022.

Changes to section 7.19 of the Motor Accident Injuries Act 2017 remove the requirement for an internal review to a medical dispute about the degree of permanent impairment.

Clayton Utz 24

The legislature consider amending each of sections 7.11(3), 7.19(3) and 7.41(3) of the Act to provide that, in addition to the regulations already permitted by those sections, the regulations may prescribe circumstances in which section 7.11, 7.19 or 7.41 (as the case may be) does not apply (thus having the effect that, in the prescribed circumstances, a claimant may proceed directly from the insurer's initial decision on a matter to dispute resolution under Division 7.4, Division 7.5 or Sub-division 4 of Division).

Not complete:

Would require legislative amendment.

Clayton Utz 25

The Minister consider the making of regulations under sections 7.11(3), 7.19(3) and 7.41(3) of the Act, as amended in accordance with Recommendation 24, to prescribe the circumstance where the claimant and relevant insurer are in a dispute of a category that has already been the subject of an internal review in relation to the claim.

Not complete:

Would require legislative and regulation amendment.

Clayton Utz 26

The legislature consider amending the Act to provide that the Guidelines may prescribe maximum acceptable overturn rates in relation to a licensed insurer's statutory benefits decisions that are the subject of merit review, medical assessment and miscellaneous claims assessment under the Act on referral by the claimant.

Not complete:

Would require legislative amendment.

Clayton Utz 27

SIRA should issue Guidelines setting maximum acceptable overturn rates in relation to statutory benefits decisions that are the subject of merit review, medical assessment and miscellaneous claims assessment under the Act on referral by the claimant.

Not complete:

Would require legislative amendment.

Clayton Utz 28

The legislature consider amending Subdivision 3 of Division 7.6 of the Act to adopt a simpler approach to the drafting of the provisions governing miscellaneous claims assessment, in particular having regard to the current section 7.42(2). The drafting of the Act should not be more complex than needed to give effect to the scheme design

Not complete:

Would require legislative amendment.

Clayton Utz 29

SIRA should undertake a consultation to determine changes to the Scheme that directly facilitate and incentivise the use of joint medico-legal assessments in relation to claims for damages, as well as a program of data collection to assess the efficacy of the changes.

Complete:

Consultation on the Motor Accident Guidelines version 9 concluded in September 2022, and changes have been made to Part 8 of the Motor Accident Guidelines version 9, with a new requirement that the parties shall use their best endeavours to agree to a joint medical assessment.

SIRA has published a Guidance to Joint Medical or Other Health-Related Assessments in the CTP Scheme to assist insurers and legal representatives in meeting the new Part 8 requirement. The Guidance sets out a process that parties may follow to reach agreement to a joint assessment and incorporates supporting material, including a template joint letter of instruction and flowchart. The Guidance was developed through consultation with key stakeholders including insurers, legal representatives and health practitioners working in the Scheme.

SIRA will continue to monitor the impact of the Guidance material. SIRA actively monitors available data to monitor the rate of joint medico-legal assessments across the Scheme. SIRA will continue to engage with insurers and legal providers to ensure the parties use their best endeavours in line with their expectations under the Guidelines.

Clayton Utz 30

SIRA should develop and consult on recommended changes to the provisions of the Act and Regulations that govern the provision of legal support in the Scheme.

In progress:

SIRA has expanded the services of CTP Assist in response to the Legal Supports Review and will consult stakeholders from August 2023.

Clayton Utz 31

SIRA should amend the Guidelines to require the relevant insurer for a claim to include contact details for the Independent Review Office and a description of the service provided by the Independent Review Office in respect of complaints about insurers in:
(a) the written notice to the claimant under section 6.19(1) of the Act; and
(b) each written notice to the claimant of a decision;
(i) to decline to pay a statutory benefit that was claimed, or to cease paying statutory benefits (including on the basis of minor injury or fault);
(ii) not to approve treatment and care, or not to approve treatment and care in full;
(iii) relating to the amount of weekly payments payable to the claimant, unless the decision to pay an amount equal to an amount that was claimed; and
(iv) as to the degree of permanent impairment of the claimants, if the decision is not consistent with opinion submitted to the insure by or on behalf of the claimant.

Complete:

Implemented in the Motor Accident Guidelines version 8, published on 29 October 2021.

Clayton Utz 32

SIRA should develop and issue a public statement of its policy as to when it may comment publicly on its regulatory activities. SIRA’s policy should include, among any other elements considered appropriate, its position on publication of the following, subject to circumstances in which it is against the public interest to do so:
(a) regulatory notices and letters of censure;
(b) civil penalties and other formal regulatory action, together with an outline of reasons for their imposition;(c) an outline of any recommendation plan opened in relation to a regulatory notice; and
(d) the outcomes of any remediation plan opened in relation to a regulatory notice; and
(e) the outcome of any referral by the Independent Review Office to SIRA of a significant matter.
The policy should also address the circumstances in which SIRA may comment publicly, or will not comment publicly, on investigations.

Complete:

SIRA released its Regulatory Publishing Policy on 17 June 2022.

Clayton Utz 33

SIRA should develop and issue a public statement of its policy for the publication of information about assessment of insurer profit under the TEPL Guidelines and section 2.25 of the Act (including information about insurer profit and SIRA’s decision-making), as well as information about the application of Clause 8 (‘Innovation Support’) of the TEPL Guidelines

Complete:

SIRA released its Regulatory Publishing Policy on 17 June 2022.

Clayton Utz 34

The Minister consider the making of an amendment to the regulations to remove ‘adjustment disorder’ from the definition of ‘minor injury’.

Not complete:

Would require regulation amendment.

Clayton Utz 35

SIRA should amend clause 5.4 of the Guidelines for clarity, so that the clause reads: Insurers should not require injured persons to undergo diagnostic imaging for the purpose of the insurer determining whether the injury related to the claim is a minor injury.

Complete:

Amendments were made to the Motor Accident Guidelines version 9, published on 25 November 2022.

Changes to clause 5.4 clarifies that insurers should not require injured persons to undergo diagnostic imaging for the purposes of determining whether the injury related to the claim is a minor injury.

Clayton Utz 36

The legislature consider amending the Act to provide that all injured persons may claim damages if the injuries caused by the motor accident result in a degree of permanent impairment greater than 10%.

Not complete:

Would require legislative amendment.

Clayton Utz 37

The legislature considers amending sections 3.11 and 3.28 in Part 3 of the Act to extend to 52 weeks the current 26-period of statutory benefits for persons with minor injuries only.

Complete:

Legislative changes have been made via the Motor Accident Injuries Amendment Act 2022 which passed through Parliament on 18 November 2022.

Changes to sections 3.11 and 3.28 of the Motor Accident Injuries Act 2017 took effect from 01 April 2023 and the Motor Accident Guidelines version 9.1 was published with effect from 01 April 2023 to support the legislative amendments.

Clayton Utz 38

SIRA should undertake a consultation to identify an alternative term for 'minor injury', with a view to proposing that the term be changed.

Complete:

Legislative changes have been made via the Motor Accident Injuries Amendment Act 2022 which passed through Parliament on 18 November 2022.

Numerous changes to the legislation and regulation amend the term 'minor injury' to 'threshold injury' and commenced from 1 April 2023. The Motor Accident Guidelines version 9.1 was published with effect from 01 April 2023 to support these legislative amendments.

Clayton Utz 39

The legislature consider amending the Act to provide that, in circumstances where an insurer wishes to reverse its decision – adversely to the claimant – as to whether the injuries caused by the motor accident are minor injuries exclusively for the purposes of Part 3 of the Act (Statutory benefits), and more than 18 months have passed since the motor accident concerned, the insurer must refer the matter to the Commission for medical assessment and must not cease paying statutory benefits (unless otherwise permitted to do so under the provisions of the Act) until such time as a medical assessor issues a certificate as to the matter, to the effect that the claimant's injuries are minor injuries exclusively.

Not complete:

Would require legislative amendment.

Clayton Utz 40

The legislature consider amending Part 3 of the Act to:
(a) extend to 52 weeks the period for which statutory benefits are available to injured persons who are wholly or mostly at fault; or(b) remove altogether the restrictions on the entitlement to statutory benefits of injured persons who are wholly or mostly at fault.

Complete:

Legislative changes have been made via the Motor Accident Injuries Amendment Act 2022 which passed through Parliament on 18 November 2022.

The Motor Accident Guidelines version 9.1 was published with effect from 1 April 2023 to support these legislative amendments.

Clayton Utz 41

The legislature considers amending the Act to allow SIRA to issue Guidelines providing for the payment of statutory benefits for treatment and care after 26 weeks to injured persons who are wholly or mostly at fault, in specified circumstances.

Complete:

Legislative changes have been made via the Motor Accident Injuries Amendment Act 2022 which passed through Parliament on 18 November 2022.

Section 3.28 of the Motor Accident Injuries Act 2017 has been amended with effect from 01 April 2023 and provide that statutory benefits for treatment and care will be available for up to 52 weeks for those at fault. The amendments do not provide entitlements for treatment and care beyond 52 weeks.

Due to the legislative amendments, there will be no further changes required to the Motor Accident Guidelines.

Clayton Utz 42

SIRA should issue Guidelines specifying that, in circumstances of delay caused by non-compliance by the relevant insurer with claim handling provisions, statutory benefits for treatment and care after 26 weeks are payable to injured persons who are wholly or mostly at fault to the extent that the expenses are incurred after 26 weeks due to the insurer's delay

Complete:

This recommendation was dependent on Clayton Utz Recommendation 41.

Legislative amendments were included in the Motor Accident Injuries Amendment Act 2022 which passed through Parliament on 18 November 2022, extending entitlements to statutory benefits from 26 to 52 weeks. As such, no further changes to the Motor Accident Guidelines are required.

Clayton Utz 43

The legislature considers amending the section 3.37 of the Act to provide that statutory benefits are not payable to an injured person after the person has been charged with or convicted of a serious driving offence that caused or contributed to the motor accident.

Not complete:

Would require legislative amendment.

Clayton Utz 44

The Minister consider issuing a public statement, through SIRA, of the outcome of Recommendation 6 made by the Law and Justice Committee in its 2018 review of the Scheme.

Complete:

Published in SIRA’s submission to the Standing Committee on Law and Justice 2020 Review of the CTP and Lifetime Care and Support Schemes, see Appendix 1.

Clayton Utz 45

SIRA consider developing a panel of trauma support specialists with training and expertise in both trauma counselling and the Scheme. In the event of a death or catastrophic injury resulting from a motor accident, a trauma counsellor would be made available to assist family members of the deceased or injured person to take necessary steps in the period following the event to care for their psychological wellbeing as well as to assist in their early engagement with the relevant insurer.

Complete:

Legislative changes have been made via the Motor Accident Injuries Amendment Act 2022 which passed through Parliament on 18 November 2022.

Changes to section 10.12 and a new section 11.1A of the Motor Accident Injuries Act 2017 enables SIRA to establish a trauma support service which may be funded by the Motor Accidents Operational Fund.

SIRA has engaged a provider to deliver SIRA’s new Trauma Support Service for family members of people killed in a motor vehicle collision in NSW which has commenced operation from June 2023.

Clayton Utz 46

The legislature considers amending section 1.6 of the Act (Meaning of 'minor injury') to provide that a psychological or psychiatric injury resulting from the death or catastrophic injury of a family member is not a 'minor injury' for the purposes of the Act.

Not complete:

Would require legislative amendment.

Clayton Utz 47

The legislature consider amending Division 9.4 of the Act to provide that, in addition to existing provisions requiring the Nominal Defendant to discharge the obligations of a person insured under a third-party policy issued by an insolvent insurer, the Nominal Defendant is to discharge the obligations of the insolvent insurer:
(a) under Part 3 of the Act; and
(b) under any agreement entered into with the Lifetime Care and Support Authority under section 3.45(2) of the Act.

Complete:

Legislative amendment is not required. SIRA will engage with insurers and the Lifetime Care and Support Authority to ensure adherence to the legislative requirements entered under 3.45(2) of the Act.

Clayton Utz 48

The legislature consider amending section 9.10 of the Act to:
(a) remove the limitation on the section, so that it does not only apply "instead of suspending the insurer's licence";
(b) provide that the licensed insurer concerned must be given an opportunity to make written submissions to SIRA with respect to the alleged contravention; and
(c) remove the requirement on SIRA to refer the matter to a special committee for advice

Complete:

Legislative changes have been made via the Motor Accident Injuries Amendment Act 2022 which passed through Parliament on 18 November 2022.

Clayton Utz 49

The legislature consider amending the Act to insert a new object of the Act under section 1.3(2) in Division 1.1 as follows:
(i) to promote the prevention of motor accidents and safety in use of motor vehicles

Not complete:

Would require legislative amendment.

Deloitte 1

We recommend the ongoing use of independent claim file reviews as this provides the most effective means of assessing this objective. Some key areas we recommend that the independent claim file review cover includes declined claims for treatment and care benefits, claims that go through the dispute resolution process, and claims that are ‘cash settled’. While the claims portfolio appears to have been fairly represented through existing independent claim file reviews, a deeper focus on reviewing claims in these key areas will provide the greatest insight for further improvement to the Scheme. We are of the position that SIRA is best placed to decide if SIRA engages an external independent body or if SIRA, as an independent authority, undertakes a review.

Complete:

SIRA has established an ongoing program of thematic reviews called the Insurer Conduct & Claims Assurance program (ICCAP). The schedule for ICCAP activities is published on SIRA’s website.

ICCAP activity commenced in June 2022. ICCAP’s completed to date include:

• Treatment   and care decisions (including internal review) and re-audit.
• Recovery   planning.
• Weekly   payments.

Deloitte 2

Suggestion: From a health outcomes point of view, recovery plans can be beneficial to the claimant. Further, given that there are reported inconsistent processes for the implementation of recovery plans across the Scheme, we suggest a review is conducted to understand best practice recovery plan processes and documentation and share this with all key stakeholders. This suggestion is aligned and in complement to Recommendation 10 of Clayton Utz’s analysis.

Complete:

SIRA conducted an ICCAP on Recovery Planning which was completed in December 2022.

A capability session has also been delivered by SIRA in partnership with Monash University to insurers on ‘Best Practice Recovery Planning.’ Further sessions have been delivered by SIRA to build capability on evidence-based risk planning.

Deloitte 3

Collect data separately for declinatures of weekly benefits and treatment and care benefits to monitor the declinature rates for these benefits for not at-fault nonminor claimants, after being on benefits for 26 weeks.

Complete:

This recommendation is no longer applicable due to legislative changes made via the Motor Accident Injuries Amendment Act 2022 which passed through Parliament on 18 November 2022.

Those with a threshold injury will have extended entitlements to benefits and the liability timeframes have also changed.

Deloitte 4

Suggestion: Make available the data to measure this KPI. Further, we suggest monitoring the extent to which actual treatment and care provided to injured persons differs from medical advice, and the extent to which medical advice differs where multiple opinions are sought. This may be an area which can be included as part of claim file

Complete:

SIRA considered this measure to be included in the CTP Scheme Performance Framework, however, the data is not currently available and is not something that insurers can easily provide.

SIRA continues to monitor insurer decision making in line with the decision-making framework and requirements in the Motor Accident Guidelines. SIRA’s oversight is limited to its scope of operations in conjunction with the obligation on the insurer to make appropriate decisions, and role of the Personal Injury Commission (PIC) regarding the review of disputes.

Deloitte 5

Suggestion: While complaints emanate from a small proportion of claims, we suggest more detailed monitoring and analysis of the underlying drivers of complaints to understand the extent and situations in which injured persons have not viewed their treatment and care was appropriate.

Complete:

Independent Review Office (IRO) complaints data is analysed by SIRA and presented to insurers at their Quarterly Performance Meeting.

SIRA will also continue to monitor and publish data on complaints. The Memorandum of Understanding between the IRO and SIRA includes an agreement that the IRO refer significant matters to SIRA.

Deloitte 6

Suggestion: in the 'CTP Insurer Claims Experience and Customer Feedback Comparison', we suggest that complaint volumes are expressed as a percentage of lodged claims rather than on all Green Slips. This would provide a more meaningful statistic since most complaints are in respect of lodged claims.

Complete:

Revised for June 2022 CTP Insurer Claims Experience and Customer Feedback Comparison Report to include complaint volumes expressed as a percentage of active claims.

Deloitte 7

NPS and CES scores indicate that CTP Assist has been an effective mechanism. Some stakeholder submissions and discussions indicated some areas for improvement in CTP Assist, including the accuracy of information provided, primarily related to more complex matters. We recommend a review of whether a complex claims case team with expertise in supporting matters such as weekly benefit calculations, would further enhance the capability of CTP Assist, in order to help injured persons better navigate the NSW CTP Scheme and understand their benefit entitlements. This recommendation is in complement to Recommendation 45 of Clayton Utz’s analysis.

Complete:

SIRA announced and implemented the expansion of CTP Assist in January 2022. It now delivers increased outbound calls to people from non-English speaking backgrounds and self-employed.

SIRA established a specialist team in June 2023. This team assists the families of those impacted by a fatality due to a motor crash by contacting them and providing support with the CTP claims process. A specialist support role sits within that team to provide intensive support to family members.

A further evaluation will determine any additional changes to the services.

Deloitte 8

We recommend, in-line with an option suggested by Taylor Fry in their Review of Legal Support, for CTP Assist to have an expanded role and be more proactively promoted as the first point of call for injured people. This is to ensure that more claimants are aware of all their benefits, including regarding disputes, and can navigate their claims journey more effectively.

Complete:

SIRA announced and implemented the expansion of CTP Assist in January 2022. It now delivers increased outbound calls to people from non-English speaking backgrounds and self-employed. A further evaluation will determine any further changes to the services.

SIRA will undertake a program of work to improve awareness and navigation of the CTP Scheme.

Deloitte 9

Suggestion: We understand SIRA is currently working to develop RTW definitions and measures which may be aligned across the CTP and Workers’ Compensation schemes. This will allow more effective measurement and monitoring of RTW rates to produce insights that may inform improvements which provide better outcomes for injured persons. Deloitte are supportive of this work.

Complete:

Recovery through work performance data was included in the June 2022 CTP Insurer Claims Experience and Customer Feedback Report and continues to be made publicly available each quarter.

Deloitte 10

Suggestion: We suggest that as part of the development of RTW measures, that stay at work measures for 4, 13, 26 and 52 weeks are included as part of that process.

Complete:

Recovery through work performance data, includes stay at work, return to work and working rate.

Deloitte 11

Suggestion: We suggest that as part of SIRA's development of RTW measures, that return to pre-accident activities capacity is measured, including everyday activities but also activities that the injured had usually partaken in and enjoyed pre-accident (or continue to produce this report annually).

Complete:

SIRA measures return to activity through its Customer Outcomes Survey being established in FY 23/24.

Deloitte 12

Recommendation: We recommend analyses of the profile of declined claims, particularly those that lodged a late claim to understand whether these are vulnerable customers that need assistance, or due to another underlying reason, which will assist in assessing whether the current measures are sufficient for ensuring injured road users understand how to access the system and their entitlements.

Some stakeholders submitted they had observed poor literacy and an inability to use email in some claimants. Some stakeholders submitted that some claimants have difficulty completing claim forms in the first month after the injury due to the physical and psychological effects of pain and pain medication, which may be exacerbated by more complex aspects such as calculations of weekly income earnings.

Complete:

This analysis has been completed as part of the Data and Monitoring Analytics Program. The analysis shows that these rejections are very rare with only 48 (0.1% of claims up to July 2022) being rejected for late lodgement.

Regarding late claims, an amendment was introduced through the Motor Accidents Injuries Amendment (Claims for Statutory Benefits) Regulation 2023, which permits payment of weekly benefits in certain circumstances where a claim is lodged within 3 months, but not within 28 days after the motor accident.

SIRA will continue to monitor this. SIRA will undertake a program of work to improve awareness and navigation of the CTP Scheme.

Deloitte 13

Suggestion: We suggest that SIRA updates the animation series to include information on the PIC to assist potential claimants navigate this element of the Scheme.

In progress:

A review of SIRAs animation series has been undertaken with work currently progressing to revise and refresh information available to claimants to assist them to navigate the scheme.

Deloitte 14

Recommendation: We recommend the collection of data on the timing of the first and second liability decision separately, to monitor compliance with both the first and second liability decision as per 6.19 of the Act.

Complete:

SIRA currently monitors Insurer compliance to the first and second liability decision timeframes.

Deloitte 15

Recommendation: The metrics and analysis reveal benefits are generally being paid consistent with legislative requirements, which provides for more benefits to be paid to more severely injured claimants.

The metrics consider claimants that are on benefits. We recommend monitoring of the proportion of claimants that have not recovered or been able to return to work (not just those on benefits) from their injury and have not been paid benefits within each of the categories considered. We would expect this proportion to be small, except perhaps for minor and at-fault / mostly at-fault claims where benefits entitlements are limited, however it is for this proportion of claims that are potentially not receiving ongoing financial support that may be in need.

Whilst our analysis does not consider the appropriateness of the duration of benefit payments in regard to the legislations, we support Recommendation 37 and Recommendation 40 of Clayton Utz’s analysis which recommends changes to persons with minor injuries and those that were wholly or mostly at-fault.

Complete:

SIRA already publishes quarterly Scheme monitoring reports and the CTP Insurer Claims Experience and Customer Feedback report.

SIRA has data available to monitor claims which don’t return to work and don’t receive treatment and care. These are included regardless of liability status.

Deloitte 16

Recommendation: Given 41% of insurer decisions are overturned, we recommend an independent claim file review consider whether claimants were provided adequate ongoing financial support for their particular needs and circumstances, focussing on claims that were not disputed at the DRS, however displayed similar characteristics to those that were overturned in favour of the claimant at the DRS to further glean insights into the appropriateness of insurer internal reviews.

We are in support of Recommendation 26 and 27 of Clayton Utz’s analysis which recommends the setting of maximum acceptable overturn rates in relation to statutory benefits decisions that are the subject of merit review, medical assessment and miscellaneous claims assessment under the Act on referral by the claimant

Complete:

SIRA prepared a Response to Independent Report on Internal Review. Part of that response was to conduct a review of the insurers process in relation to Internal Reviews. This was conducted as part of the Treatment and Care ICCAP activity. Insurers were required to remediate and re-audited on their ability to be compliant with requirements. All insurers have now been assessed as compliant and remediation activities closed.

SIRA has also established monitoring of overturn rates of insurers. SIRA utilises this data to determine individual insurer regulatory activity based on risk.

Overturn rates have now improved, and the Personal Injury Commission (rather than the Dispute Resolution Services) provide an important review of insurer decisions when raised as a dispute. The framework of internal review and an independent review body establishes the opportunity for quick resolution and trust in decision making.

Deloitte 17

Suggestion: Consistent with the ICA submission, we suggest monitoring of:

* the detection rate of non-compliance with registration and insurance requirements

* the annual number of breaches of the requirements for registration and insurance detected and actioned by NSW Police.

These measures will provide insights into both detection and compliance behaviour and may offer additional value when considered in concert with measures relating to affordability (such as utilisation of short-term registration).

In progress:

SIRA already publishes quarterly scheme monitoring reports and the CTP Insurer Claims Experience and Customer Feedback report.

SIRA currently monitors the Nominal Defendant scheme and will explore the possibility of accessing these data points with NSW Police.

Deloitte 18

Suggestion: Consistent with the ICA submission, we suggest monitoring of:

* the utilisation of the nominal defendant Scheme

* measure of the number of claims received under the uninsured nominal defendant provision (to be used with the previous suggestion in objective (c)).

Complete:

SIRA collects this data, and it will be monitored and published in future annual CTP Scheme Performance reporting.

Deloitte 19

Recommendation: CTP insurance is a product that provides benefits to society though sold for profit, and the ideal outcome is that all participants act with integrity to assist balancing those objectives. There is at least a perception through some stakeholder discussions and feedback amongst claimant representatives that the balance of power lies with the insurers on disputed matters. It is recommended that insurers continue to develop cultures where policyholders are treated fairly and compassionately.

Complete:

As at November 2021 adherence to SIRA’s Customer Conduct Principles is a licence condition for all insurers. 
SIRA is working with APRA to better understand insurers risk culture. This will inform any further response.

Deloitte 20

Recommendation: Given the relatively higher level of affordability of NSW CTP premiums, there is the potential that some premium increases may be absorbed by policyholders whilst still meeting the affordability objective. We recommend any review of premiums balances the Scheme objectives, including affordability, to encourage early and appropriate treatment and care, financial support for injured persons, to achieve optimum recovery of persons from injuries sustained in motor accidents, and to maximise their return to work or other activities.

Complete:

Any changes to premiums are assessed against the objectives of the Scheme.

Deloitte 21

Recommendation: Conduct another review into the reasons for lower claims frequency in the Scheme compared to the original Schedule 1E parameters. For example, whether there is different experience observed in data from hospitals across different geographical locations, which may help create a link to claim reporting patterns for vulnerable people such as those who require an interpreter or other assistance. Further we recommend that SIRA make it a requirement that insurers accurately record for each claim the ‘Interpreter Required’ field, which may be used to support this analysis. We recommend that SIRA maintains its discretion to trigger the TEPL mechanism, with due reference to advice from the scheme Actuary and Premium Committee. We are supportive of comments made by SIRA’s chief executive at the Law and Justice Committee hearings that activation of the TEPL mechanism will be conducted at interim annual reviews once desired confidence levels are achieved.

Complete:

This analysis has been completed as part of SIRA’s ongoing Data and Monitoring Analytics Program.

The long-term casualty frequency has trended consistently downwards. The analysis showed the 2020 and 2021 accident years followed the long-term trend; however, both were impacted by Covid-19 lockdowns. Post-Covid accident quarters, outside of lockdowns, showed casualty frequencies similar to the last pre-Covid experience, indicating the casualty frequency may have plateaued.

A more significant reduction in claim counts was observed (admitted hospital patients) in 2020 and 2021 accident years, compared to 2018 and 2019 accident years. However, many low-severity injured people making a CTP claim do not require hospitalisation and these were the specific profiles of injuries (whiplash-only, soft-tissue) driving the trend during Covid lockdowns. The gap can be expected to close again as casualty frequency and low-severity propensity to claim rebound to pre-Covid levels. Most of the propensity to claim trends were consistent for regions, fault status and road user groups.

Prospective parameter setting for Schedule 1E is likely to be better influenced by 2018 and 2019 claims experience given (outside of lockdowns) casualty and propensity for 2020 and 2021 looks reasonably consistent with pre-Covid experience. i.e., in the absence of lockdowns, the claim frequency is likely to be higher than 2020 or 2021 in the near future.

SIRA will continue to monitor.

SIRA is progressing changes to the insurer data reporting system, and the ‘interpreter required’ field will be a mandatory inclusion in the next release.

Deloitte

22

Recommendation: We recommend that SIRA maintains its discretion to trigger the TEPL mechanism, with due reference to advice from the Scheme Actuary and Premium Committee. We are supportive of comments made by SIRA’s chief executive at the Law and Justice Committee hearings that activation of the TEPL mechanism will be conducted at interim annual reviews once desired confidence levels are achieved.

Complete:

SIRA has published the Motor Accidents Guidelines – TEPL. These guidelines set out the process and SIRA will continue to conduct assessments of past accident years on an annual basis. SIRA continues to refine the TEPL process and to capture the learnings from the TEPL process to incorporate into the post transition guidelines.

Deloitte 23

Recommendation: Minor injury assessments are completed until up to around three months after being reported which can result in reclassification of claims. Given also that 55% of internal reviews were referred to the DRS (now PIC) and the operational and legal costs incurred for these claims, we recommend an independent claim file review is conducted to understand the drivers of minor injury claim disputes and the associated cost of these.

Complete:

The legislative changes via the Motor Accident Injuries Amendment Act 2022 which passed through Parliament on 18 November 2022 mean that those with a threshold injury will have extended entitlements to benefits. Liability timeframes have also changed.

Deloitte 24

Recommendation: We recommend that consideration be put forth to simplify both the full and interim premium filing process in the Motor Accident Guidelines. This can encourage competition amongst the market by increasing price competition amongst existing insurers and providing potential new entrants with less administrative burden.

Complete:

This is being addressed through the Digital Premium Regulation (DPR) program, the first phase of which was delivered in March 2022. The program will continue to enhance and simplify the premium filing process in the context of increased granularity and sophistication of insurer pricing.

Deloitte 25

Recommendation: We recommend that SIRA engage with insurers and NSW Police to identify the most efficient way of accessing the information and data pertaining to potentially fraudulent claims, and to the extent it will be released to the claimant. For example, a portal system could be set up for release of all police investigations relating to a matter in which a CTP claim is made, once investigations are completed. This would avoid the need for making multiple Government Information (Public Access) Act 2009 (GIPA) applications which require authorisation by the parties and lead to highly relevant police outcomes, particularly with regard to suspected fraudulent claims, being available to insurers in the early stages of investigating a claim.

Complete:

SIRA continues to liaise with NSW Police with respect to systemic fraud.

SIRA is currently working with industry to strengthen its approach to fraud. This includes engagement across NSW Government, with co-regulators, the Insurance Council of Australia, and insurers.

SIRA is committed to ensuring information related to fraud, or suspected fraud is accessible to insurers where appropriate. SIRA has established an ongoing insurer fraud forum to assist in the information being available to insurers at early stages. Formal provision of information in relation to allegations of fraud are performed through significant matter notification requirements.

There are no plans to expand data sharing.

Deloitte 26

Recommendation: We recommend a thorough investigation into the extent and nature of fraud and potential fraud which will then form the basis of accountabilities, roles and responsibilities in respect of fraud deterrence across all Scheme participants.

Complete:

SIRA developed a Fraud Framework which sets out the approach to utilise and coordinate available resources and key stakeholders to deter, detect and respond to fraud. The framework aligns to SIRA’s Regulatory Framework and approach to being a contemporary regulator that is customer-centric, intelligence-led, and risk-based.

It includes an overview of the legislative framework, including obligations and functions and a view of the potential fraud types within the schemes.

Deloitte 27

Suggestion: Monitor certain key metrics (detective), for example:

* Fraud investigations - Volume of investigations as a percentage of total claim volumes.

* Fraud prosecutions - Volume of prosecutions annually and compared to volume of open

claims.

* Fraud recovery rates - Fraud recovery rates annually expressed as amount recovered in

proportion to premiums.

* Comparison against hospital data - Ratio of CTP claims that eventuate compared to the number of road accident victims that attend hospital. As described above, while this ratio is available at a high-level, the ratio for 2020 appears unusually low and more analysis is necessary.

In progress:

Fraud metrics will be monitored and published in annual CTP Scheme Performance reports.

SIRA has completed an analysis of hospital data to understand the ratio of CTP claims that eventuate from hospital admissions.

SIRA will continue to consider what fraud metrics are appropriate and intend to publish the Fraud Framework. Further information regarding the Fraud Framework is outlined in the progress update for Deloitte Recommendation 28.

Deloitte 28

Suggestion: Implement specific fraud deterrence initiatives (preventative), for example:

* Dissemination of monitoring insights to the public.

* Education around the criminality of exaggeration of injury or losses in insurance claims.

Complete:

The Fraud Framework includes the following initiatives to deter fraud:

• Public   information: SIRA utilises its website, social media, and other communication   resources as a mechanism to communicate to the community SIRA’s focus,   activities and zero tolerance towards fraud. SIRA’s communications explain   the social, financial and vocational effects that a criminal conviction for   fraud can have on the life of an individual.
• Reporting   of prosecutions: In line with its Regulatory Publishing Policy, SIRA   publishes successful fraud prosecutions to ensure transparency, evidence our   accountability and increase public trust within the schemes. Publication and   reporting of prosecution outcomes are a key deterrent for conducting fraud   within the schemes.

SIRA continues to implement activities to align to its Fraud Framework.

Deloitte 29

Suggestion: Monitor reasons for withdrawal of claims, applications for insurer internal reviews, and disputes with the PIC, for indications of fraudulent elements in claims.

In progress:

SIRA has established quarterly insurer fraud forums to gather insights from industry and inform monitoring on indicators of fraud.

Further, insurers are required to notify SIRA of any matters that involve an actual or alleged incidence of serious or systemic fraud as part of their significant matter licence condition obligations.

Deloitte 30

Suggestion: We suggest that monitoring of average caseloads per claimant be formalised into reporting to understand the effect this may have on the resolution of claims. A balance should be targeted and incentivised with caseloads being set in a way that allows the resolution of claims, early and appropriately. This suggestion is viewed in complement to Recommendation 4 in Clayton Utz’s analysis.

In progress:

Being considered under Clayton Utz recommendation 4.

SIRA will consult on the form and content of the Motor Accident Guidelines.

Deloitte 31

Suggestion: We suggest that monitoring is conducted on the number or proportion of applications for additional costs outside what is permitted by the Regulations (16 monetary units which is currently the equivalent of $1,660.16), where it is asserted that the matter involves ‘exceptional circumstances’ under s 8.10(4)(b), to gain insight into the nature of claims where this is most prevalent and therefore whether there are areas to improve in Scheme design and / or operation.

In progress:

Being considered under Clayton Utz Recommendation 30.

Deloitte 32

Suggestion: We suggest the rate of transition to common law claims is monitored which will impact the cost to the Scheme.

Complete:

SIRA monitors ‘transition to common law’ through its 2017 CTP Scheme Quarterly Actuarial monitoring report. This will be monitored and published in annual CTP Scheme Performance report.

Deloitte 33

Recommendation: We recommend a reconsideration of the claimant information collection requirements to better inform claims decisions. This could include more detailed collection of the injured person’s pre-accident employment details or pre-accident training, skills, and experience. This recommendation should be considered with regard to Recommendation 14 from Clayton Utz’s analysis.

In progress:

Being considered under Clayton Utz recommendation 14.

This recommendation will be considered as part of the broader review of the weekly payments framework and potential administrative options in response to Clayton Utz Recommendation 14.

Deloitte 34

Recommendation: We recommend increasing the monitoring of a number of key aspects related to claim disputes including:

* the number of disputes which progress from internal review to PIC in aggregate and for

more granular reasons including WPI assessments, fault status, benefit types, and

other key reasons etc.

* the number of notices issued to claimants where the insurer views the claimant is in

breach of the laws and regulations, and the number of insurer applications to the PIC which allows insurers to recover some legal costs.

* the number and duration of matters in backlog that are currently before the PIC.

In progress:

SIRA already publishes quarterly scheme monitoring reports and the CTP Insurer Claims Experience and Customer Feedback report.

SIRA is considering this data as a part of its engagement with the PIC.

Deloitte 35

Recommendation: We understand the PIC has acknowledged concerns that the PIC portal has been ineffective as a tool to disseminate required information to relevant stakeholders and is aiming to address these issues in the short term. We are supportive of these activities being conducted in the short-term

Complete:

The Commission successfully launched its new portal, Pathway, in the Motor Accidents Division on 19 June 2023. The Commission also issues regular updates through the PIC Newsletters and convenes a stakeholder reference group to hear and address concerns raised by its stakeholders.

Deloitte 36

Recommendation: There are time limits set on claim lodgement, internal review related communications, and a number of other key processes, however, there does not appear to be any time limits on the PIC to resolve disputes. We understand from one submission that under the MACA Scheme there was a requirement for a decision to be made within 15 days of a hearing, and that this requirement has been removed. This extends, not only to decisions pertaining to statutory benefits, but to all certificates issued by the PIC, including medical assessment certificates. It was submitted that it is now frequently the experience of participants in the scheme that a Certificate is often issued three months after the actual date of assessment noted on the Certificate.

In light of the above, we recommend setting KPIs for the PIC including targets for resolution of disputes (potentially set differently allowing for case type or complexity) within a certain time limit and monitor the turnaround time (number of days) for the PIC to make a decision. It is noted that the PIC is not governed by the MAIA Act (2017), however it is an integral part of the Scheme. Thus, this recommendation would be appropriate for the Initial Review of the Rules of the PIC of NSW being undertaken from September 2021 to the first half of 2022

Complete:

The Commission’s Key Performance Indicators, effective 1 July 2022, have been published on the Commission’s website and will be reported each year in its Annual Review commencing in 2023.  The Initial Review of the Commission’s Rules took place in late 2021 – early 2022. It should be noted that the Commission’s Rules are made with respect to practice and procedure to be followed in proceedings before the Commission, and not with respect to its KPI’s.

Deloitte 37

Recommendation: We recommend the following data be collected and monitored to assess cost-effectiveness of the resolution of disputes:

• Cost of insurer internal   reviews – average cost per insurer internal review as a proportion of average   claim cost for claims that are settled via internal review and do not   progress to PIC.
• Settlements with or without   dispute – costs of settlements for claims with a dispute compared to claims   without a dispute.
• Cost of escalation -   average cost per review as a proportion of average claim cost for claims that   escalate to PIC review, considering legal representation.

Complete:

SIRA already publishes quarterly scheme monitoring reports and the CTP Insurer Claims Experience and Customer Feedback report.

SIRA does not collect insurer cost of providing internal reviews, but rather controls insurer expenses through premium collection.

Deloitte 38

Recommendation: We recommend that a review is conducted into the types of claims that are suitable for internal review vs. those that should proceed directly to the PIC. Medical disputes relating to whole person impairment appears to be one example where disputes should proceed directly to the PIC. The decision on the types of claims that may be considered suitable or optional to the claimant should balance the different Scheme objectives.

Complete:

The response to this recommendation has been addressed under Clayton Utz Recommendation 23.

Deloitte 39

Recommendation: Given 43% of IIRs related to weekly benefit amounts are overturned in favour of the claimant, we recommend a review of weekly benefits calculation / processes to reduce the percentage of internal reviews related to the amount of weekly benefits.

In progress:

This recommendation will be considered as part of the broader review of the weekly payments framework and potential administrative options in response to Clayton Utz Recommendation 14.

Deloitte 40

We recommend that SIRA investigate the level of understanding by claimants regarding the scheme and its entitlements, including disputation paths. Taylor Fry’s report ‘Review of Legal Supports’ dated 3 September 2021 recommends a comprehensive survey of claimants would be suitable to achieve this.

Complete:

SIRA’s annual Customer Experience Research Program provides insights into customer experience within the CTP Scheme. This will be expanded in 2023 to gather further information on their understanding of entitlements and experience through the disputation pathways.

Deloitte 41

Suggestion: We suggest an exercise to improve the quality, accuracy, and completeness of the UCD is performed to ensure accurate comparisons between insurers and reduce data errors that are not due to insurer errors. Input from insurers will help align data categories between insurers and reduce administrative burden in the future.

Complete:

Delivered through the CTP Data Assurance Program and education. Data inaccuracies will be resolved within data correction timeframes which are now published in the Motor Accident Guidelines section 3.35. This is supported by real time monthly data exception reporting that is provided to insurers.

Deloitte 42

Suggestion: We suggest that SIRA, with stakeholder input, develop a suite of KPIs that will help facilitate the effective management of the Scheme.

Complete:

SIRA already publishes quarterly Scheme monitoring reports and the CTP Insurer Claims Experience and Customer Feedback report.

The revised metrics have been endorsed and the framework has been presented to insurers and legal stakeholders as part of SIRA’s engagement activity.

Deloitte 43

Suggestion: We suggest that SIRA updates the Qlik manual to ensure all conditions and exclusions across each metric are documented and clearly understood. We note that in performing our work, we observed that the majority of metrics on Qlik were appropriately documented.

Complete:

This was incorporated into the Regulatory Information and Analytics Improvement Program at the end of 2022.

Governance tools are being finalised to support business users, including a data dictionary and measures definitions.

Deloitte 44

Suggestion: We suggest that reconciles and are able to appropriately explain differences from Qlik to other work performed, such as from the Scheme Actuary. This will ensure that the analysis performed by SIRA and other parties do not generate conflicting insights and recommendations.

Complete:

This was incorporated into the Regulatory Information and Analytics Improvement Program at the end of 2022.

Reconciliation between reports is undertaken on a case-by-case basis. Governance tools are being finalised to support business users, including a data dictionary and measures definitions. Where definitions are varied from measure definitions are varied, there should be an explanation with the report.