The State Insurance Regulatory Authority (SIRA) has released the results of a major review into claims management practices within New South Wales, proposing a series of changes intended to better align the system with the evolving needs of workers and employers.
The review, prompted by the Law & Justice 2023 Review of the Workers Compensation Scheme, places particular emphasis on addressing the complexities associated with psychological injuries and the necessity for more individualised support.
According to SIRA, the review was informed by data analysis, audits, and input from various stakeholders.
Four main findings and 14 recommendations have been set out, with a central theme being the move towards a person-centred model for managing claims.
The authority is advocating for a system-wide approach that prioritises early intervention and tailored assistance, which it believes can improve recovery rates and facilitate a smoother return to work for injured employees.
SIRA intends to incorporate this approach into its upcoming Return to Work Roadmap, scheduled for implementation from 2026.
The aim is to influence not only scheme design but also the practices of employers, service providers, and insurers involved in case management.
Under the recommendations, insurers will be expected to integrate person-centred principles into their claims handling processes. This includes changes to how they communicate, plan for injuries, and make decisions throughout the claims lifecycle.
SIRA has indicated it will enhance its regulatory oversight to ensure these practices are adopted and will collaborate with insurers to strengthen the skills of case managers.
The review also highlights the need for clearer guidance and more proactive engagement for both workers and employers during the claims process.
SIRA will monitor insurer performance through ongoing supervision, with a focus on ensuring that support is both meaningful and accessible.
For psychological injury claims, insurers are expected to implement cohort-based models to provide more tailored care.
In an effort to reduce administrative complexity, SIRA plans to reassess its regulatory approach, seeking a balance between principle-based, prescriptive, and risk-based regulation.
Updates to guidelines and audit tools are anticipated, with the goal of minimising unnecessary administrative tasks while reinforcing the shift to person-centred case management.
SIRA chief executive Mandy Young said the findings of this review highlight the need to prioritise individuals throughout the claims process.
“By shifting to a more empathetic, people-first claims model, which operates within the legislative parameters of the Workers compensation system, we can better support recovery and return to work for people injured at work. Helping people return to work not only improves individual outcomes; it supports a more sustainable and efficient workers compensation scheme,” she said.
Earlier this year, SIRA introduced its SIRA 2028 strategy, outlining the authority’s priorities for the next three years.
The plan is designed to build on recent progress and ensure that insurance schemes in New South Wales continue to offer effective protection and support.
The SIRA 2028 strategy identifies five key objectives:
“SIRA’s Customer Experience Framework, launched last year, provides the tools for us to put customers at the centre of everything we do. This, together with our regulatory approach that is detailed in SIRA’s Regulatory Framework, will support our efforts to ensure people in NSW can access the support they need and are protected by accessible, affordable, and financially stable insurance schemes,” Young said.
