The NSW State Insurance Regulatory Authority (SIRA) has called out weaknesses in wage reimbursement processes, injury management planning, and claims handovers in QBE’s handling of workers' compensation claims for the Nominal Insurer (NI) and the Treasury Managed Fund (TMF).
The regulator examined 50 active claims managed by QBE between May 26 and 30, 2025, splitting the sample between 20 NI claims and 30 TMF claims. The review forms part of SIRA’s ongoing program of quarterly audits of icare, which oversees the NSW Workers' Compensation Scheme and claim service providers (CSPs) such as QBE. icare manages about 83% of workers' compensation claims in New South Wales and is responsible for both the NI and TMF schemes, with CSPs undertaking day-to-day claims management on its behalf.
SIRA’s latest review was triggered by several converging issues: earlier concerns about the handling of large employer claims in the NI, complaints from NSW government agencies about QBE’s TMF claims, and QBE’s removal from the TMF CSP panel following an icare tender.
QBE stopped managing TMF claims from October 2025, creating a transfer of claims to new CSPs. SIRA framed this as a transition risk and used the audit to test how claims were being managed ahead of the handover. Within the TMF sample, SIRA found evidence of “a high level of case manager turnover,” and said it was concerned about “the accuracy and quality of claims handover records” on affected files. In 16 TMF claims where responsibilities had shifted between case managers, only 5 contained a documented handover.
icare acknowledged the issues and advised SIRA that its TMF transition plan sets out different handover requirements for cohorts of claims depending on assessed risk, and that external transfers between QBE and incoming CSPs are being managed through a separate process from the internal handovers reviewed in the audit.
On the NI side, SIRA revisited questions raised in its November 2024 audit regarding the potential influence of large employers on claims decisions. In the 2025 sample, the regulator did not find evidence that employers were driving liability or management outcomes.
Instead, the key NI issue related to the way wage reimbursements were being handled. QBE had wage reimbursement agreements in place with large employers, but SIRA found that wage reimbursement schedules were only sometimes submitted in line with those agreements, and that case managers were not consistently following up late or missing schedules.
According to SIRA, this practice reduced the level of oversight of workers’ weekly benefit payments and left limited assurance that reimbursements matched statutory entitlements. The regulator said case managers should be requesting details of a worker’s earnings for each period covered by wage reimbursement schedules and using that information to test employer calculations.
SIRA also highlighted gaps in the management of provisional liability. In NI claims where liability was accepted on a provisional basis, only a minority showed prompt action to gather missing information, and some did not move to a full liability decision within 12 weeks. While SIRA noted that the use of provisional acceptance was technically within the rules, it warned that reliance on provisional decisions where full information was already available added administrative and compliance risk for CSPs.
QBE told the regulator it had already identified the wage reimbursement issue before the audit and had started work with large employers to improve timeliness and adherence to agreed processes.
In the TMF portfolio, SIRA’s findings extended beyond the transition risk to broader operational practices by agencies and QBE. Only 35% of TMF injuries in the audited cohort were reported to QBE within 48 hours of the agency being notified. Some injuries were notified several days or months after the event. SIRA said these delays constrained CSPs’ ability to manage claims and have been referred internally to its Employer Supervision and Return to Work functions for follow-up with TMF agencies.
The audit also identified shortfalls in injury management planning. Where a significant injury should have triggered an injury management plan (IMP), a plan was on file for about two-thirds of relevant TMF claims. Evidence of consultation with key stakeholders – such as workers, treating practitioners, and employers – was only recorded in half of the cases where a plan was established. SIRA also found that subsequent updates to IMPs were infrequent relative to changes in work capacity or treatment.
Summarising the TMF position, SIRA said there is “an opportunity in the TMF to uplift capability around injury management planning at initial and subsequent stages of the claim.” The regulator pointed to prior collaborative work with icare and NI CSPs on IMP quality and indicated similar activity is planned for the TMF scheme.
Unlike the NI arrangements, there were no formal wage reimbursement agreements between QBE or SICorp (as TMF insurer) and TMF agencies. Wage reimbursement schedules were generally provided in line with agency payroll cycles in around two-thirds of relevant cases, but the absence of documented agreements meant there was no standard cadence for submission or follow-up.
SIRA reported that communication on key benefit milestones, such as the 13-week step-down and annual indexation of pre-injury average weekly earnings (PIAWE), was recorded on only a minority of files. With TMF agencies submitting reimbursement schedules in arrears, sometimes months after the period being claimed, the regulator considered there to be an elevated risk that underpayments or overpayments could accumulate before being detected.
In response, SIRA recommended that icare introduce formal wage reimbursement arrangements for TMF agencies “to ensure timely and accurate payment of worker’s weekly benefits entitlements.”
Across both the NI and TMF audits, SIRA identified recurring data issues, particularly in the recording of the “date claim made,” significant injury dates and work status codes. The regulator said QBE’s internal flow chart for determining the date claim made did not align with definitions in the Workers' Compensation Guidelines, and suggested that similar approaches might be in use across other CSPs.
icare has asked for further engagement with SIRA and SICorp to clarify the interpretation of the date fields and support consistent use by CSPs.
SIRA said icare will use the findings to change how it works with CSPs, including QBE, and will use the TMF findings to shape transition and scheme changes across the NSW workers' compensation schemes.
