Workers compensation monthly report
System overview
Key workers compensation system statistics for the 12 months ending April 2019
$257 billion of reported wages are safeguarded by the workers compensation scheme
$3.6 billion in premiums were collected, representing 1.4% of reported NSW wages1
$2.9 billion was paid out as costs for workers claims
102,933 claims were reported to SIRA
76,819 workers received weekly benefit payments
1For the 2017/18 financial year
Effectiveness
System effectiveness in protecting workers and getting workers back to work and wellbeing
Reportable claims
7,713 were reported in April 2019
10,076 were reported in March 2019
7,438 were reported in April 2018
Claim types
Of the 7,713 reportable claims in April 2019, 92.9% (7,167) were related to physical injuries and 7.1% (546) were related to psychological injuries.
Claims by body locations
Head: 9.1%
Neck: 2.2%
Upper limbs: 34.0%
Trunk: 19.2%
Lower limbs: 20.3%
Also:
Psychological: 7.1%
Multiple locations: 3.1%
To be confirmed: 3.9%
Systemic locations: 1.1%
Effectiveness
Workers’ claims journey results at April 2019
Monthly average over the last 12 months
11,314 reported incidentsA^
8,578 reportable claims ^
3,406 lost timeT^
A Records submitted includes all records received from insurers across NSW. This data excludes administration errors.
T Lost time is based on workers receiving weekly benefits.
^ Figure is based on a 12 month average.
Return to work
59.3%at 4 weeks*
76.4% at 13 weeks*
84.0% at 26-weeks*
Note: SIRA identified data quality issues with the accuracy and completeness of return to work data submitted by the Nominal Insurer (NI). The data appears to indicate a significant deterioration in the NI’s RTW performance. SIRA instructed the NI to improve the quality of the data. To address the data quality and potential performance concerns with the NI, SIRA carried out a data quality audit in December 2018 and commenced a Compliance and Performance Review in February 2019.
* Based on a rolling 12 month cohort, for further details see the Explanatory Note.
Efficiency & viability
Efficient system delivery, sustainability, and viability of the system for generations to come
Total claim payments made by insurers
In April 2019, the Nominal insurer made payments of over $167 million, Government self-insurers (TMF) of over $57 million, self-insurers of nearly $15 million and specialised insurers of over $13 million.
Claim payment types
The breakdown of claim payment types in April 2019 is as follows:
- Weekly payments: 39.8%
- Medical payments: 27.0%
- Common law (WID): 16.1%
- Rehabilitation payments: 4.6%
- Lump sum (S66 & S67) payments: 5.7%
- Death payments: 0.5%
- Investigation payments: 2.3%
- Other payments: 1.9%
- Legal payments: 1.8%
- Commutations: 0.2%
Total claim payments made by insurers
In April 2019 $252 million dollars payed in claim payments.
In March 2019 $253 million dollars payed in claim payments.
Down 0.4% based on data provided by insurers at the end of April 2019. Please note this may increase should late running reports of payments be supplied by insurers after the April data submission.
Benefits paid to and for workers as a percentage of total claims expenditure
Of the total expenditure across the system in 2017/18, 45% was made on payments to claimants and 24% was spent to make payments for the claimants. Insurer expenses across the system was 31% of the total expenditure.
Note: The benefits paid to and for workers is calculated annually. Details of definitions can be found in the methodology and data section. Data sourced from the information insurers provide to SIRA as at the financial year 2017/18.
Customer experience & equity
Customers’ experience with the system is positive and equitable
Enquiries and complaints
SIRA received 2,096 enquiries in April 2019. There were 528 complaints received in the same period.
Note: Complaint data (which may include the name of an insurer) is derived from verbatim reports from customers. While SIRA does some data cleansing, the reporting is verbatim from customers and might occasionally reference an incorrect insurer and/or insurer type.
Disputes lodged
In April 2019, the dispute rate was 0.6%, with 87,432 active claims and 533 disputes lodged.
Note: Including data from the Workers Compensation Commission.
Workers perceptions of equity across the workers compensation system
Jurisdiction | Distributive JusticeAverage (mean) on a 5 point scale | Procedural Justice Average (mean) on a 5 point scale | Informational Justice Average (mean) on a 5 point scale | Interpersonal Justice Average (mean) on a 5 point scale |
|---|---|---|---|---|
New South Wales | 3.9 | 3.8 | 3.7 | 4.3 |
Australian Total | 3.9 | 3.8 | 3.7 | 4.3 |
Definitions of dimensions used to measure customers perception of equity and perceived justice:
- Distributive justice, relates to the fairness of their compensation.
- Informational justice, is about receiving accurate and timely information about the rationale for decisions.
- Interpersonal justice, relates to whether workers were treated with respect and sensitivity.
- Procedural justice, about the fairness of the procedures used to determine the outcomes.
Source: Safe Work Australia 2018 Return to Work Survey.
Affordability
Insurance affordability
Insurance affordability
This is the affordability of insurance is 1.4%, as a percentage of NSW wages for 2017/18.
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Nominal insurer | 74% | 67% | 66% | 64% | 85% | 0.1% | 53% | 73% | 83% |
Government self-insurer (TMF) | 13% | 16% | 23% | 21% | 99% | 0.0% | 74% | 84% | 88% |
Specialised Insurers | 6% | 8% | 5% | 7% | 97% | 0.1% | 73% | 83% | 86% |
Self insurers | 7% | 9% | 6% | 8% | 97% | 0.1% | 65% | 76% | 82% |
NSW workers compensation insurer scorecard
Information about the performance of insurers operating within the workers compensation system
Note: Insurers reported this data to SIRA. Data is as at April 2019.
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While reasonable care has been taken in preparing this document, the State Insurance Regulatory Authority (SIRA) makes no warranties of any kind about its accuracy, currency or suitability for any particular purpose. SIRA disclaims liability for any kind of loss or damages arising from, or in connection with, the use of any information in this document.
SIRA identified data quality issues with the accuracy and completeness of return to work data submitted by the Nominal Insurer (NI). The data appears to indicate a significant deterioration in the NI’s RTW performance. SIRA instructed the NI to improve the quality of the data. To address the data quality and potential performance concerns with the NI, SIRA carried out a data quality audit in December 2018 and commenced a Compliance and Performance Review in February 2019.
Additional scheme performance measures
Information about the performance of insurers operating within the workers compensation system
Cost to the scheme for weekly benefits paid per month
In April 2019, the total amount of weekly benefit payments paid by insurer type was:
$67 million by the Nominal insurer
$25 million by the Government self-insurer (TMF)
$4 million by specialised insurers
$4 million by self-insurers
Note: to ensure consistency across the time series the data excludes Section 39 claimants that exited the system up to June 2018.
Number of workers receiving weekly benefits per month
In April 2019, the number of workers receiving weekly benefits by insurer type was:
17,402 by the Nominal insurer
6,833 by the Government self-insurer (TMF)
1,216 by specialised insurers
1,633 by self insurers
Note: The data is a distinct number of workers receiving weekly benefits and to ensure consistency across the time series, the data excludes Section 39 claimants that exited the that exited the system up to June 2018.
RTW including medical only claimants rate
In April 2019, the 4 week RTW rate was:
74% for the Nominal insurer
82% for the Government self-insurer (TMF)
84% for specialised insurers
86% for self insurers
77% for the system average
In April 2019, the 13 week RTW rate was:
85% for the Nominal insurer
89% for the Government self-insurer (TMF)
89% for specialised insurers
89% for self insurers
86% for the system average
In April 2019, the 26 week RTW rate was:
90% for the Nominal insurer
89% for the Government self-insurer (TMF)
90% for specialised insurers
91% for self insurers
90% for the system average
Average duration of weekly benefits paid in the first 6 months
In September 2018, the average was:
29 days for the Nominal insurer
27 days for the Government self-insurer (TMF)
18 days for specialised insurers
15 days for self insurers
Note: This measure uses work hours lost and injury quarter to calculate average days, it is reported to September 2018 to allow for claim data development.
Reportable claims development
Total reportable claims by financial year at 10 development periods
70,260 in 2015/16
69,264 in 2016/17
71,083 in 2017/18
78,744 in 2018/19
Claim payments development
Total claim payments by financial year at 10 development periods
$351 million in 2015/16
$395 million in 2016/17
$425 million in 2017/18
$437 million in 2018/19
Download the report (PDF, 408 KB) and the methodology and summary data tables (Excel worksheet, 231 KB) used to support this report. If you have trouble accessing content within these reports, please send an email to [email protected] or call us on 13 74 72.
Website www.sira.nsw.gov.au | Catalogue no. SIRA09062 | © State Insurance Regulatory Authority 09/2019