Workers compensation has always run on a simple sequence: injury, claim, recovery, return to work. But recently, Australia’s largest personal injury claims management provider EML is seeing that sequence being disrupted at the front end, before any claim is lodged at all.
Chief executive, EML Management, Don Ferguson says psychosocial hazards, an increase of mental health conditions and a rising prevalence of workplace conflict are creating a complex environment for employers. As the 115-year-old company marks a decade in Victoria and two decades in South Australia, its experience across multiple jurisdictions is a key part of how it cross-pollinates effective practice and spots emerging risks.
One reason EML is ahead of the curve on workers compensation trends is its long history across multiple schemes.
"It's really the milestones that speak to the enduring strength of EML's brand and purpose. Reaching 10 years in Victoria and 20 years in South Australia reflects more than just our longevity. It demonstrates our ability to adapt and lead and deliver through significant change across personal injury in Australia," Ferguson recently told Insurance Business.
He said the anniversaries reflected confidence built over many years with employers, workers, brokers and government scheme partners.
"At its core, it's mostly about trust. Employers, workers, brokers and scheme partners continue to place their confidence in EML to support people through what could be their most challenging moments in their working lives."
That experience also allows ideas to move between schemes rather than remaining confined to one jurisdiction.
"Our national experience allows us to bring our best ideas from one scheme into another. Operating across jurisdictions over many years gives us a unique ability to identify what works and then translate, while being respectful of local context, evidence informed practice and scaling approaches that improve recovery and return to work."
The results have also translated into growth. Since entering Victoria in 2016, EML has doubled its market presence and now supports about a quarter of the state's workers compensation market. Across Victoria and South Australia, it works with more than 80,000 customers.
The legislative settings in South Australia and Victoria have changed markedly during EML's time in both markets.
"We were there at the commencement of the Return to Work Act in South Australia in 2015 and supported the scheme through a period in which it moved from significant unfunded liabilities to a fully funded position, which has also been able to provide reductions in premiums to employers."
Victoria has undergone its own period of reform, with recent changes reflecting the rising cost and complexity of psychological injury claims.
"In Victoria, we've played a role through a significant period of scheme modernisation. We supported the implementation of the modernisation reforms in 2024 at a time when the focus shifted from predominantly physical injury and body stressing claims to the growing complexity and cost of mental health claims."
Yet Ferguson believes legislation tells only part of the story. Some of the biggest advances have come through changes in the way injured workers are supported.
South Australia became the first jurisdiction to introduce mobile case management, replacing a model built largely around office-based administration with face to face engagement.
"It really helped to humanise personal injury across the industry."
The success of that approach prompted EML to introduce it into Victoria after entering the market, before later expanding it into New South Wales.
"It brought greater empathy to claims management and recovery and improved the timeliness and quality of decision making. It also helped build stronger connections through engaging with injured workers and employers in a much more meaningful way."
South Australia also pioneered concurrent liability assessment and return to work planning, allowing injured workers and employers to receive support while claim eligibility was still being determined.
Ferguson said those changes kept the focus on recovery rather than administration.
Despite extensive reform, Ferguson believes one of the biggest unmet needs now sits outside workers compensation itself.
Rather than focusing only on managing claims, employers increasingly need help addressing psychosocial risks before those issues become formal claims.
“Great employers create cultures that support wellbeing and prevent harm before it occurs.”
He said many organisations were confronting increasingly complicated workplace issues without specialist support.
"So many employers are now managing increasingly complex enterprise risks, employee relations and industrial relations issues, often without the specialist support needed to manage psychosocial hazards and interpersonal conflict early and effectively."
Changing workforce expectations have added another layer of complexity.
"People don't all experience workplace issues in the same way. Generational differences, roles and personal circumstances can shape how people respond to conflict, change, feedback and workplace dynamics."
Those individual differences are not always easily accommodated within scheme rules.
"People's individual circumstances can be quite complex as well, and schemes can't necessarily be tailored to every circumstance. That's where claim managers need to tailor the way they provide support."
Ferguson said EML had used its mutual ownership model with its Mutual Benefits program funding a range of initiatives across both Victoria and South Australia, with a combined investment of more than $25 million committed for additional services, tools and products for employers, worker and communities over the past decade. The program which is unique to its mutual heritage, includes an offering which assists people whose needs extend beyond compensable injuries. In Victoria, those initiatives include a transition support programmes and recovery case managers who assist people leaving the scheme or dealing with broader issues affecting recovery.
"There is an emerging gap for workers who need support but may no longer meet scheme entitlements."
He said employers increasingly carried responsibility for supporting those workers.
"Just because something is not eligible for support through the workers compensation system doesn't mean that issue doesn't remain for that individual. The employer is then needing to find ways to support that outside of the structured workers compensation system."
Mental health claims continue to attract attention across the sector, but Ferguson argued that workers compensation captures only part of a much broader workplace issue.
Last year EML partnered with Monash University to produce a white paper examining mental health in Australian workplaces. He said the research reinforced the need to look beyond claims data.
"The white paper shows that workers compensation mental injury claims are only part of a much broader workforce mental health challenge."
Greater awareness of mental health has encouraged more people to seek help, but it has also blurred the distinction between compensable workplace injuries and wider psychological distress.
"As awareness and recognition of mental health issues have increased, the boundary between compensable workplace injury and broader psychological distress has become more complex. That has created growing expectations of workers compensation, even though many treatment, prevention and support pathways sit outside of the scheme."
EML intends to update the research annually to build a stronger evidence base for employers with its next insights report to be released in October.
"We've committed to updating the mental health white paper each year for the next few years so we can keep building the evidence base. It helps employers understand emerging risks and strengthen prevention and support their people earlier."
Ferguson also challenged the view that the increase in psychological claims can largely be attributed to COVID.
"Mental health claims increased in the five years from 2015 to 2020 by more than 100%. There is clear evidence of structural issues rather than short term pandemic effects."
Technology has also altered workplace relationships in ways that are still being understood.
"Technology has created new ways to connect and work and access support, but it's also changed workplace dynamics, communication patterns and expectations. Less face-to-face interaction, reduced tolerance for conflict and heightened sensitivity to feedback can contribute to more complex interpersonal issues."
That makes early intervention particularly important, he said, before disagreements become formal claims.
For Ferguson, good claims management still comes back to one simple principle: Technology can improve systems, but it cannot replace human judgement.
"It starts with the human aspect of claims management. Systems can only do so much, but really it starts with the human and the moments that matter most."
He said injured workers often entered the claims process during one of the most difficult periods of their lives.
"The quality of each interaction really matters. Good claims managers are present in conversations, constructive in identifying solutions, clear, transparent and efficient in the way they communicate."
Empathy alone is not enough. Claims managers also need practical skills that keep recovery moving.
"A standout claims manager has a high degree of empathy and the ability to provide practical support. Building trust, communicating authentically and helping people stay motivated is the key."
The strongest practitioners can often identify problems before they escalate.
"The best claims staff can identify relationship tensions early, help prevent things from escalating and guide people constructively through genuine conversation and practical advice while keeping both workers and employers focused on recovery and sustainable return to work."
Technology still has an important place, provided it supports rather than replaces personal service.
Ferguson said EML had invested heavily in technology developed internally to remove unnecessary administration and give case managers more time to focus on interactions with customers.
"Our in-house technology solutions deliver better service by removing unnecessary administration that sits within many claims environments."
Ferguson also pointed to workforce stability as a significant contributor to claims outcomes.
In South Australia, around 70% of frontline claims staff have been with EML for more than two years. In Victoria, the figure is about 65% and its NSW portfolio average 60%.
He said that period was significant because it represented the point at which claims professionals typically became highly proficient.
"The more tenured your workforce is, the greater the capacity to support people to return to work effectively."
Developing staff is a major focus for the business.
"We have an internal purpose at EML to support our people to develop personally and professionally, as well as our external purpose to help people get their lives back. One absolutely requires the other to be successful."
Recruitment also reflects that philosophy.
"We recruit largely for fit and attitude, then support people through our national EML Grow programme to develop their technical capabilities over time."
While South Australia's mobile case management model became one of the company's most visible contributions to Victoria, Ferguson said the flow of ideas works in every direction.
The company's national leadership team regularly shares successful approaches between jurisdictions, regardless of where they originated.
"Our leadership team works very cohesively to share best practice across the group in whichever direction has the opportunity to benefit most."
That approach extends beyond government agencies and employers.
Ferguson said partnerships with industry groups, unions and research institutions had become an important part of improving outcomes across the schemes in which EML operates.
"We've built strong partnerships with industry, unions and research institutions across different jurisdictions to help drive practice improvement. Working within that broader ecosystem means you can affect change at a more systemic level and tap into the expertise, wisdom and connections of other parts of the system."
This article was produced in partnership with EML Group
