The evidence on how to get injured workers back to work is not especially mysterious. Support them early, move them between systems without making them start from scratch and judge the result by whether they actually recover rather than by whether the file is closed. What is striking, according to personal injury claims manager EML, is how rarely all three happen.
That argument runs through EML’s new white paper on the pressures reshaping personal injury and superannuation claims.
“These are three practical steps that will make a material difference and in many cases, don’t actually happen now,” said Dan Walton (pictured), EML's group executive, strategy and growth based in Sydney, when he discussed the findings of The Complexity Premium: the cross-scheme pressures impacting claims in super with IB.
For brokers advising employers on workers' compensation, and increasingly on the group life and income protection cover that sits alongside it, the claim is worth pausing on because the same three steps bear directly on claim costs, premiums and the experience their clients’ staff have at their most vulnerable.
The first is timing. Psychological and vocational support, EML argues, should arrive at first contact rather than after a prolonged investigation into liability because the longer someone is out of work, the less likely they are ever to return, regardless of personal motivation. For psychological injury that lag is acute: median time lost per mental injury claim runs more than four times longer than for physical injuries, on Monash University figures cited in the paper and the duration of working time lost to mental injury rose 53% in the five years to 2020, according to Safe Work Australia.
The second is the handover. Workers routinely move between schemes: workers compensation, income protection in super and social security. The boundary is where recovery momentum tends to stall, as people repeat forms and retell their story to each new administrator. EML’s prescription is warm administrative transfers, shared records and, ideally, a single accountable case lead, so no one has to begin again each time they cross a line.
The third is the measure of success itself: recovery and a return to work, not the closing of a claim. This is arguably the most fundamental change because it determines what a claims team is actually rewarded for doing.
The case rests on more than principle.
“We had Taylor Fry conduct an independent evaluation of one of our core programs and found that participants are 247% more likely to return to work within six months when these processes are in place,” Walton said.
That figure was published by Comcare, the federal workers’ compensation scheme, following the evaluation by actuarial firm Taylor Fry of a pilot run between 2021 and 2022. The program targeted a hard cohort - long-term injured workers with psychological conditions who had already failed to return through standard rehabilitation - and found that 37.9% of participants were back in some form of work within six months, against 11.7% of non-participants. It was a small pilot, with only a few dozen completers but the evaluation reported the effect as strong and statistically significant and Comcare has since made the service ongoing.
The wider evidence that claims handling is where the system fails people is not in dispute, and it does not come only from EML. Delays in claims handling are the single biggest driver of superannuation complaints to the Australian Financial Complaints Authority (AFCA), which traces most of them to poor communication and unmet expectations. The Australian Securities and Investments Commission (ASIC) is suing one major fund, Cbus, over alleged repeated failures to process insurance claims on time. Consumer advocates argue the problem runs deeper than processing speed: Xavier O’Halloran, CEO of Super Consumers Australia, has warned that funds and insurers reach too readily for blunt instruments - tightening claims processes or lifting premiums - when claims rise. “Neither of these lead to good outcomes for consumers,” he said. That is, in effect, the gap EML says its three steps are designed to fill - though the same logic invites scrutiny of whether claims managers themselves consistently deliver it.
The financial backdrop is sharpening as reforms bite. As workers compensation schemes in Victoria and New South Wales tighten access to psychological injury claims, EML’s modelling - conducted by the University of Melbourne - suggests income protection lodgements inside super could rise around 19% over a decade as displaced claims migrate. The pressure is already visible: mental illness is now the single largest cause of total and permanent disability claims, on Council of Australian Life Insurers (CALI) figures cited in the paper, and some funds have flagged total and permanent disability (TPD) premium increases of up to 40%. Regulators are moving, too - the federal government has announced mandatory member service standards for super funds, covering the timely handling of insurance claims, echoing the pressure from AFCA, APRA and ASIC.
For brokers, this once again demonstrates that claims handling is no longer a back-office detail to be assumed away on price. How early an insurer or scheme acts, how cleanly it hands a claimant over and what it actually measures are becoming live differentiators that show up in renewal pricing and client retention. EML’s pitch is that the three steps are a relatively easy place to start. On the evidence - its own and others’ - the harder question for the rest of the market is why they don't start there too.
