icare workers compensation Claims Service Provider Quarterly Performance Data

As part of our commitment to improve services and support for workers and employers across NSW, we are publishing Claims Service Provider Quarterly Performance Data that tracks a series of performance measures across workers compensation claims. The publication of this data will ensure employers have relevant information available to choose a provider that best serves the needs of their injured workers.

Enhancing support for workers and employers

The Claims Service Provider Quarterly Performance Data focuses on measures related to operations, service and capability for the six providers that manage workers compensation claims for the NSW Nominal Insurer.

These providers are Allianz, EML, GIO, QBE, and the two new providers to the scheme DXC Technology and Gallagher Bassett (GB). This performance data will be published every quarter to help eligible employers choose the Claims Service Provider best suited to care and support their injured workers.

Quick links

Return to Work

Helping injured workers get back to work as soon as possible is important for the health and recovery of workers and for workplace productivity and culture. Return to work (RTW) is a key measure of the performance of the workers compensation system. RTW rates measure the percentage of workers who have been off work for at least one day and returned to work with the same or different employer at full or current work capacity.

The working rate (WR) is another measure introduced that incorporates the RTW rate and also captures workers who have not been off work and remained at work with the same or different employer at full or current work capacity (also known as 'stay at work').

icare has set different targets for each Claims Service Provider (CSP) around their return to work and working rate performance that reflect their mix of claims across different employer sizes, industries and claim types (physical or psychological).

The below table shows how well CSPs have performed compared to the targets set by icare - a positive result shows a CSP is performing better than the target set for their mix of business.

Note: Gallagher Basset and DXC Technology are new entrants to the scheme and results will be published once there is sufficient development of their claims portfolios for each respective measure.

13 weeks - Working Rate 26 weeks - Working Rate 52 weeks - Working Rate

The below dashboard provides the absolute return to work and working rate results for each Claims Service Provider. To achieve the most like-for-like comparison, it is recommended to use the filters to select the employer size, industry and claim type relevant to your business. Note, results may not appear for CSPs where volumes are low. 

 

To view graph data, right click on the graph and select "View data". For best results view on a desktop or tablet. If you experience any issues loading the results please refresh your browser.

Compliance

If a worker is injured at work, they may be entitled to weekly payments. Claims Service Providers must make an initial liability decision on a claim within the legislated timeframe (seven calendar days) and sometimes the Claims Service Provider will start paying the injured worker weekly payments and medical expenses while they assess the claim (provisional liability - PL).

The below tables show the percentage of claims where a Claims Service Provider has made a liability decision (full or provisional) on a claim within seven days, along with initial weekly payments made.

Note: icare introduced a new document management system during the June-24 quarter, and CSP performance across initial weekly payments declined due to processing time delays, and machine learning technology. We do not envisage this happening in future quarters.

 

To view graph data, right click on the graph and select "View data". For best results view on a desktop or tablet. If you experience any issues loading the results please refresh your browser.

Satisfaction

icare uses a Satisfaction score to measure the experience of injured workers and employers throughout their workers compensation journey, whether it's directly with us or through Claims Service Providers. This score helps us and our providers gather feedback and measure the experiences at varying points of the claims process, so we can continuously improve the workers' and employers' experience journey.

Note: Comparing satisfaction scores across different insurers is difficult due to the differences in their portfolios. Satisfaction scores over the June-24 quarter is also impacted by the implementation of icare's new document management system causing some delays in payment processing time as the CSPs transition onto the new system. We do not expect this to continue in future quarters.

To view graph data, right click on the graph and select "View data". For best results view on a desktop or tablet. If you experience any issues loading the results please refresh your browser.

Caseloads

Case Managers are the foundation of our support system for injured workers; they play a crucial role in the delivery of treatment and optimal return to work outcomes. Ensuring Claims Service Providers have adequate and appropriate caseloads underpins our goal to help injured workers in their recovery and return to work and to provide employers with an improved workers compensation experience.

Note: Gallagher Basset and DXC Technology are new entrants to the scheme and caseloads will be published as the teams build a stable portfolio of claims.

To view graph data, right click on the graph and select "View data". For best results view on a desktop or tablet. If you experience any issues loading the results please refresh your browser.

icare Claims Service Provider Choice Information

Watch our tutorial video to help you maximise the Claim Service Provider Quarterly Performance Data.

If you need help accessing this video content, please email accessibility@icare.nsw.gov.au.

Back to top ⇡

Frequently asked questions (FAQs)

    General

  • Who are the Claims Service Providers and why are they important in workers compensation?

    icare has six Claims Service Providers: Allianz, DXC Technology, EML, Gallagher Bassett (GB), GIO and QBE to manage workers compensation for the NSW Nominal Insurer.

    To address the rise of mental health claims, four providers – Allianz, DXC, EML and GB – will provide specialist psychological claims capability with skilled and experienced case managers dedicated to managing psychological claims. This means employers will have greater options to choose the provider to best care and support their injured worker when they need it most.

  • Why is icare publishing Claims Service Provider performance data?

    The Nominal Insurer monitors Claims Service Provider performance to ensure a high and consistent standard of service is being delivered and to continue to improve return to work outcomes.

    We also want to be transparent about how we are tracking provider performance and will publish claims performance data and Claims Service Provider data on a quarterly basis. This ensures that employers eligible to choose their CSP have the information available to them to assist in choosing a provider that best serves the needs of their injured workers.

  • Does this include data on NSW Government agencies?

    This performance data is for the Nominal Insurer Workers Compensation Scheme for the private sector in NSW. It does not include data for NSW Government departments or agencies.

  • What Claims Service Provider performance data is being published and when?

    Claims Service Provider performance data relating to the claims journey of injured workers will be published on a quarterly basis focusing on service, capability and outcome measures. Additional measures will be added overtime as data becomes available.

  • What has changed recently in the Nominal Insurer Scheme leading to the publication of this Claims Service Provider performance data?

    A new claims and injury management model was introduced by icare for the NSW Nominal Insurer scheme from 1 January 2023 that provides employers access to a larger choice of Claims Service Providers, delivers greater transparency of provider performance and helps injured workers get back to health and work faster.

    icare now has six Claims Service Providers: Allianz, EML, GIO, QBE, and two providers that entered the scheme in 2023 - DXC Technology and Gallagher Bassett (GB).

  • How does icare's CSP performance data compare with data published by SIRA?

    The State Insurance Regulatory Authority (SIRA) publishes a range of data in relation to the Nominal Insurer. Any differences with icare's CSP performance data will be due to the parameters and the timing of the data sets.

  • In publishing this data how has icare accounted for differences in size, type of customers and other variables between the Claims Service Providers?

    Each Claims Service Provider has a different mix of open claims. These differences include the total number of open claims they manage, employer sizes and employer industries, and mixes of physical and psychological injury claims.

    Users should be aware that the results across CSPs will reflect these differences and may lead to different results that do not correspond to the underlying claims performance of each CSP.

    Performance measures

  • What is the Satisfaction score?

    icare measures the Satisfaction of injured workers and employers throughout their journey with icare, whether directly or through Claims Service Providers, with a Customer Satisfaction (CSAT) score. The CSAT is a globally recognised metric and it helps us and our providers understand how we engage with injured workers and employers, and take action to improve outcomes.

    Injured workers and their employers receive survey invitations at multiple points of their claims journey (such as claim notification, payments, 12 weeks after notification, claim closure). Exclusions will apply for surveys based on sensitivity reasons or rest periods.

    The CSAT score is expressed as a percentage and represents all respondents scoring 4 or 5 on a 5-point scale, where 1 is extremely dissatisfied and 5 is extremely satisfied.

  • What does the initial weekly benefits data measure?

    Workers injured at work may be entitled to weekly payments. Sometimes the Claims Service Provider will start paying the injured worker weekly payments and medical expenses while they assess the claim.

    Where there has been a loss of earnings leading to an entitlement to weekly payments, the provider will commence provisional weekly payments within the legislated requirement of seven days of being notified of the injury.

  • What does the liability decisions data measure?

    Claims Service Providers must make an initial liability decision on a claim within the legislated timeframe (seven calendar days). Making initial liability decisions promptly, informed by careful consideration of available information and proactive consultation with key stakeholders will ensure that workers and employers can focus on recovery and return to work.

    The provider may make a decision to accept or decline full liability. When full liability is not initially accepted, the CSP can be obliged to start provisional liability (PL) payments or notify parties of a 'reasonable excuse' (RE) where additional information is required to make a liability decision.

  • What does the return to work and the working rate data measure?

    The Workers Compensation scheme is designed to assist injured workers to return to full participation in work and life. Evidence indicates that the faster a worker returns to work in some capacity, the greater their chances are of making a full recovery.

    The return to work (RTW) rate and working rate (WR) are two primary measures of success on the effectiveness in returning workers to work in some capacity.

    Return to work rate is the percentage of workers who have been off work for at least one day and returned to work with the same or different employer at full or current work capacity.

    Working rate is the percentage of workers who have been off work for at least one day and returned to work with the same or different employer at full or current work capacity (that is, RTW) and workers who have not been off work and remained at work with the same or different employer at full or current work capacity (also known as 'stay at work').

  • What does the caseload data measure?

    Caseloads refer to the average number of open claims managed by case managers for each Claims Service Provider.

    Case managers are the foundation of our support system for injured workers; they play a crucial role in the delivery of treatment and optimal return to work outcomes. The Nominal Insurer monitors Claims Service Provider case management practices to ensure providers have access to the appropriate number and level of expertise of case managers.

    Ensuring Claims Service Providers have adequate and appropriate caseloads underpins our goal to help injured workers in their recovery and return to work, and to provide both employers and injured workers with an improved workers compensation experience.

    For large employers eligible for choice

  • Should I use this performance data to choose the best Claims Service Provider for my business?

    The data is provided to complement and inform any decision made. Claims performance indicators are one of many factors an employer or their representative(s) may weigh in choosing the Claims Service Provider that best fits their needs.

    There is no requirement to view and acknowledge performance before choosing a Claims Service Provider.

    Employers should make their own assessment when selecting a Claims Service Provider, and if necessary seek independent professional advice.

  • This data shows that the Claim Service Provider managing claims for my workers is performing poorly. Should I change my Claim Service Provider?

    Claims performance indicators are one of many factors an employer or their representative(s) may weigh in choosing the Claims Service Provider that best fits their needs. icare encourages employers to speak with their Claims Service Provider about their individual claims experience to work through any barriers to return to work outcomes, or remedial activity required.

  • How often am I able to change my Claims Service Provider?

    You can select a Claims Service provider on your annual policy renewal date.

  • How can I find out more about all the Claims Service Providers that I can choose?

    Each Claims Service Provider has an employer engagement team that can articulate the service, claims management, and support offerings. You can find their contact details on the Workers insurance claims enquiry page.

  • What is the process for changing Claims Service Providers?

    You can select a Claims Service Provider on your annual policy renewal date. At that time information will be provided to you on the process for selecting a new Claims Service Provider should you choose to make a change.

  • I’m a small to medium sized employer when will my business have the option to select a Claims Service Provider?

    Since May 2020, employers with an Average Performance Premium (APP) or Group Average Performance Premium (GAPP) of more than $500,000 have been eligible to choose their Claims Service Provider.

    From 30 June 2024, we expanded choice to more experience-rated employers with APP or GAPP of $200,000 or more.

    Effective 30 June 2025, we’re offering choice to more experience-rated employers who:

    - Have an APP of $100,000 or more; or

    - Are a part of a group with a GAPP of $100,000 or more

    For more information on these classifications see:

    Employers eligible for choice of Claims Service Provider will be notified on their policy renewal documentation when they are eligible to select their Claims Service Provider. 

  • How does icare categorise employers?

    icare categorises employers based on Average Performance Premium (Workers Industry Classification rate x actual wages declared).

    These categories are:

    • Small Employers - annual premium of less than $30,000 Average Performance Premium (APP) or Group Average Performance Premium (GAPP)
    • Small-Medium Employers (SME) - annual premium of more than $30,000 to $200,000 Average Performance Premium (APP) or Group Average Performance Premium (GAPP)
    • Medium Employers - annual premium of more than $200,000 to $500,000 Average Performance Premium (APP) or Group Average Performance Premium (GAPP)
    • Large Employers - annual premium of more than $500,000 Average Performance Premium (APP) or Group Average Performance Premium (GAPP)

    Note that employers with an APP or GAPP of $30,000 or more are Experience Rated, which means an employers’ premium are impacted by claims performance. Medium - large employers with an APP or GAPP $200,000 or more can currently choose their Claims Service Provider, while medium employers with an APP or GAPP of $100,000 or more will be able to choose their Claims Service Provider after 30 June 2025.

Back to top ⇡

Glossary

Caseloads 

Refers to the number of case managers employed by Claims Service Providers to manage workers compensation claims. 

Satisfaction score

icare measures the Satisfaction of injured workers and employers throughout their journey with icare with a Customer Satisfaction (CSAT) score. The CSAT is a globally recognised metric used by organisations, and it helps us and our providers understand how we engage with injured workers and employers and take action to improve outcomes.

Initial weekly payments 

The first weekly benefit payment paid within seven calendar days of the date the claim was reported, or when it is the employer paying the worker, the liability letter authorising the employer to pay the worker sent within seven calendar days of the date the claim is reported.

Liability decisions

Liability decisions made within the required seven days. May or may not accept full liability. Those that do not initially accept full liability can be made to either start provisional liability (PL) payments or notify parties of a 'reasonable excuse' (RE) in which additional information is required to make a liability decision. 

Return to work (RTW)  

Based on work status codes used by insurers to record the current work status of a worker. This primarily relates to whether a worker is 'working' or 'not working’. For the RTW rate, this is the percentage of workers who have been off work for at least one day and returned to work with the same or different employer at full or current work capacity. 

Working rate (WR)  

Based on work status codes used by insurers to record the current work status of a worker. This primarily relates to whether a worker is 'working' or 'not working'. For the WR, this is the percentage of workers who have been off work for at least one day and returned to work with the same or different employer at full or current work capacity and workers who have not been off work and remained at work with the same or different employer at full or current work capacity. 

Back to top ⇡

Disclaimer

The content on this page, which includes data internally generated by icare, is provided for information purposes only and does not constitute either an endorsement or a recommendation by icare. icare has exercised due care and skill in its preparation, however access to, and use of the content is on an "as is, as available" basis and does not constitute, and is no substitute for, legal or other professional advice.

icare recommends that users exercise their own skill and care with respect to their use of this content. Before relying on the content in any important matter, users should carefully evaluate the accuracy, currency, completeness and relevance of the information for their purposes and should obtain appropriate professional advice relevant to their particular circumstances.

To the maximum extent permitted by law, icare, its employees, officers, directors, agents and advisers disclaim all liability, including liability for negligence and for any loss, damage, injury, expense or cost incurred by any person as a result of uploading, accessing, using or relying upon the content.

Back to top ⇡

Have a question?

Workers Insurance policy enquiry
Do you have a Workers Insurance policy enquiry?
Workers Insurance claims enquiry
Do you have a Workers Insurance claims enquiry?
Tagged in: