SIRA shares plan to address poor return-to-work performance

The State Insurance Regulatory Authority (SIRA) of New South Wales (NSW) plans to improve return-to-work performance in the NSW workers' compensation scheme as return-to-work rates, a key measure for the scheme, have plummeted since 2015.

In 2015, nearly nine in 10 injured workers were back at work within 13 weeks. But now, SIRA found that fewer than eight in 10 injured workers have returned to work in 13 weeks.

Therefore, SIRA aims to address poor back-to-work performance in the NSW workers' compensation scheme by:

• Requiring all workers' compensation insurers to resubmit their business plans with detail on how they will improve 4-week return-to-work performance. Resubmitted business plans are due to SIRA by February 28, 2022;
• Reviewing all insurers' return-to-work practices in the first half of 2022, which will include assessing insurers' injury management program, file reviews, interviews with customers and claims staff, and a review of the systems and controls in place to identify workers at risk of not returning to work;
• Introducing a return-to-work and early intervention Standard of Practice articulating SIRA's expectations regarding return-to-work and providing a checklist to identify the risk factors for delayed recovery. The regulator is publicly consulting on the standard until February 28, 2022;
• Publishing the return-to-work performance of all insurers in 2022 in line with SIRA's commitment to improving transparency in the workers' compensation scheme and holding insurers accountable for their performance;
• Establishing a dedicated return-to-work inspectorate, which will seek to improve workers' recovery and return-to-work outcomes through education initiatives and, when necessary, enforcement action targeted at employers;
• Funding a two-year research fellowship at the Black Dog Institute to focus on return to work for people with a psychological injury, helping SIRA understand barriers to recovery and workplaces manage successful return to work for people with a psychological injury;
• Expanding the scope of its review into the compliance and performance of Treasury Managed Fund (TMF) government agencies to audit return-to-work performance to support the public sector to implement improvements where they are needed and ensure it has best practice systems in place;
• Using predictive modelling to identify and target employers with workers that may be at higher risk of delayed return to work. It will also seek to support and educate employers through outbound calls, site visits, and providing information to improve workers' return-to-work outcomes;
• Trialling its successful CTP Assist program in the workers' compensation scheme for 12 months. As part of the program, it will make outbound calls to workers at risk of delayed recovery as early as possible in the claims process, equipping workers with the information they need to improve their understanding of the health benefits of good work and drive their recovery; and
• Partnering with the Australian Rehabilitation Providers Association (ARPA) to further explore the benefits of workplace rehabilitation providers on positive return-to-work outcomes.

Read more: SIRA announces fee changes to NSW workers' compensation scheme

Commenting SIRA's priority action plan to address factors contributing to poor performance, chief executive Adam Dent highlighted the scheme's aim.

“The core role of the workers' compensation scheme is to help people recover and return to work,” Dent said. “We know that staying at work or early return to work after an injury leads to the best possible health and social outcomes. Delayed return to work has serious implications for injured people as the evidence shows that the longer a person is away from work, the less likely they are ever to return.”

Aside from poorer outcomes for workers, Dent explained that delayed return-to-work significantly impacts the financial performance of the scheme.

“While the deterioration is more pronounced with some insurers, it is [a] pattern that is evident across the system as well as in some other jurisdictions,” he added. “SIRA is committed to undertaking 10 actions aimed at reversing the trend of poor return-to-work performance and pushing insurers and employers to do better. We're targeting a range of measures that promote compliance with the practices that we know underpin positive return to work outcomes.”

This month, SIRA also announced that it will remove the loadings from surgical procedure fees in the NSW workers' compensation scheme beginning July 01, 2022, to bring surgical procedure fees in line with Australian Medical Association (AMA) rates and fees paid in the compulsory third-party (CTP) insurance scheme while remaining among the highest of all Australian jurisdictions.

However, the regulator clarified that loadings on surgical consultation will remain in response to surgeons' feedback giving the go signal for additional administrative processes associated with the NSW workers’ compensation scheme.