Two Australian employers can buy the same accident and health policy, for similar workforces, and end up with completely different claims experiences. According to David Pickering (pictured), group executive of EML Solutions, part of personal injury claims manager EML Group, that gap has little to do with the wording and everything to do with what employers actually do when someone gets sick or hurt.
The pressure on the product is growing fast. Across EML's largest accident and health portfolio, reported physical claims rose from 47 in FY21 to 288 in FY26 to date - a 513% increase - while psychological claims grew more than 400% over the same period, according to portfolio data supplied by Pickering's team.
Against that backdrop, Pickering said outcomes are diverging for reasons that sit entirely outside the policy.
"In practice, two organisations can have the same policy and similar workforce profiles but depending on the systems and support they apply to assist workers recovering and returning to work, they can have completely different outcomes," he said.
EML manages about 90,000 personal injury claims a year. The majority of those claims are in workers' compensation, but also across accident and health, compulsory third party (CTP) and group insurance. That cross-scheme visibility, Pickering said, exposes a structural blind spot: accident and health remains designed primarily around income replacement, while the factors that actually drive recovery - early intervention, structured injury management and embedded return-to-work capability - are left to the employer.
The disciplines that produce good outcomes are hardly unknown to employers - they apply them every day under workers' compensation, because the law requires it. The same rigour rarely follows an employee whose injury happened on a weekend sporting field or on the commute, both typically excluded from workers' compensation and picked up by accident and health cover.
"Despite it not being workers compensation, it's still a people risk product and can be managed in a similar way," Pickering said.
Inside many businesses, he said, workers' compensation sits under a safety, insurance or risk function with systems, governance and systematic follow-through - frequent contact with the worker and structured return-to-work planning. Accident and health claims often land elsewhere, such as HR, where that machinery simply does not exist. The result is a two-tier recovery experience for employees of the same organisation, split by the technicality of where and when they were injured - a dynamic brokers advising on workers' compensation mental health claims challenges will recognise.
For brokers, the commercial logic is direct. Because accident and health is employer-funded, faster return-to-work outcomes feed straight back into the underwriter's view of the account.
"Those injury management and return to work practices can be adopted regardless of whether they're required in the policy - the same level of sophistication and discipline seems to be lacking in accident and health compared to workers comp," Pickering said.
The product also has structural advantages employers rarely exploit. Pickering pointed to the General Insurance Code of Practice (GICOP), which he said requires insurers or claims agents to make liability decisions typically within 10 days. This is far faster, in his view, than workers' compensation schemes or life insurers, where waiting periods can stretch to six months. A quick decision means attention can turn to recovery quickly too - if the employer is set up to act on it.
The theme echoes findings across the wider income support ecosystem, where the Council of Australian Life Insurers (CALI) has mapped 11 separate income support systems and warned that poor coordination stalls recovery - pressure that is already exposing gaps in disability insurance products.
For brokers, the message is that accident and health advice can no longer stop at placement. The clients who transplant their workers' compensation discipline across the border - early contact, injury management, return-to-work planning - will run cheaper, shorter claims. The ones who treat it as a passive income replacement product will keep wondering why identical policies produce such different bills.
