ccording to its chief executive, getting rid of adversarial relationships that undermine an injured worker’s ability to return to work from the workcover system remains a “big challenge” for the NSW workers’ comp regulator.
The State Insurance Regulatory Authority (SIRA) is focusing on influencing behaviour and culture in the workers’ comp “ecosystem” instead of on compliance and legislation alone, with the latter being “necessary but not sufficient” to achieve more desirable results, according to Carmel Donnelly.
Speaking at the recent 19th annual National Workers’ Compensation Summit in Sydney , she says a “challenging and confronting fact” in injury management is that “people who access injury compensation schemes may in fact have worse outcomes than if they haven’t been entitled to compensation”.
However, perceived injustice in the system can cause setbacks in injured workers’ return to work and lead to further adverse outcomes like long-term disability, especially among those with psychological injuries, she says.
According to Donnelly, it has been “rightly called out” by parliamentary committees overseeing SIRA’s work that it needs to work “more constructively” towards appropriate return-to-work measures.
“Our conclusion is it needs to be multi-layered,” she says.
“Can we as a regulator more strongly encourage the behaviours from employers, from insurers, from health service and other providers that will increase good return to work and social outcomes?”
Donnelly also says SIRA is moving its insurance licensing and supervision model from minimum compliance to performance-based, with self-insurers being used as a “test bed” and receiving intensive feedback on how SIRA rates their performance.
If an insurer makes the “top tier” their performance exceeds expectations and they’ve earned autonomy, while low or bottom-tier insurers have deficits in their performance and require oversight, and are at risk of being suspended or exited, she says.
SIRA has launched an initiative to maintain claims administration in one place, and increased the number of audits and enforcement actions in workers’ compensation, which reflects the regulator “maturing into a model in which we’re consistent and fair but people can expect there will be enforcement action”, Donnelly says.
She says it is also adopting lessons from NSW’s compulsory third party assist model, which has been reformed to ensure the regulator proactively reaches out to claimants to ensure things are running smoothly with their claims.
The regulator is also working with its board on premiums and guidelines to ensure some of the “volatility” and hard-to-understand changes in NSW premiums are being addressed, and delivering new digital tools and “plain English” guidance for workers and employers so they know their roles and obligations when a workplace injury occurs.
“Thankfully there is a lot more we can do rather than just rely on legislation,” Donnelly says.
SIRA’s role is to work with its partners, employers, providers and other workers’ compensation jurisdictions to determine what more it can do to improve outcomes, she says.