SIRA imposes new conditions on major workers' compensation self-insurer

The State Insurance Regulatory Authority (SIRA) has imposed special licence conditions on Thomas Foods International Consolidated’s workers' compensation self‑insurer authority following an audit that identified compliance issues in claims and injury management processes. 

The conditions have applied since Aug. 31, 2025, and follow an audit carried out under section 202A of the Workers' Compensation Act 1987. That provision allows SIRA to review whether insurers and self‑insurers are conducting workers' compensation activities in line with statutory requirements. In Thomas Foods’ case, the assessment found issues with injury management planning and the processing of weekly benefit entitlements. For self‑insurers and scheme agents in New South Wales, the action demonstrates how audit outcomes can lead directly to changes in licence conditions where SIRA identifies deficiencies in claims handling or related systems.

Remediation plan and reporting obligations for Thomas Foods

Under the special licence conditions, Thomas Foods is required to operate in accordance with a remediation plan approved by SIRA and to complete the actions in that plan within specified time frames. The conditions require the company to: 

• Implement the SIRA‑approved remediation plan as set out
• Establish a quality assurance program that reviews both the remediation activity and broader claims management compliance
• Provide SIRA with monthly quality assurance reports outlining remediation steps taken, progress against milestones, and any changes in performance
• Submit separate monthly updates on remediation status within 10 business days after the end of each month until the plan is finalised

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The quality assurance program must review the corrective measures adopted in response to the audit findings and assess whether ongoing claims management remains consistent with legislative and regulatory requirements. According to SIRA, Thomas Foods is implementing measures to address the identified issues and to improve longer‑term claims performance. The regulator continues to monitor the self‑insurer’s conduct under the special conditions, including adherence to the agreed timetable and the content of the reports provided. For insurance professionals, the case shows how audit findings can translate into enforceable remediation frameworks that affect a self‑insurer’s licence status and oversight arrangements in the NSW workers' compensation system.

Fraud and non‑insurance actions across the workers' compensation scheme

Alongside its supervisory action in relation to Thomas Foods, SIRA is continuing enforcement activity in Workers' Compensation and Compulsory Third Party (CTP) schemes. In its 2025 report, SIRA said: “Since January 2024, SIRA has continued its focus on detecting and responding to fraud. This has led to 11 successful prosecutions relating to fraud or non-insurance matters, with many more currently before the courts or under active investigation.”

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Recent workers' compensation fraud prosecutions include: 

• SIRA v Andrew Leslie – On Dec. 13, 2024, Andrew Leslie was prosecuted under section 192E(1)(b) and section 192G of the Crimes Act 1900 (NSW) after failing to disclose full‑time employment while receiving workers compensation benefits totalling $147,566.40. The court imposed a 12‑month Intensive Corrections Order with supervision and ordered repayment of $147,566.40 and $26,000 in prosecutors’ costs.
• SIRA v David Stevens – On May 15, 2025, David Stevens was prosecuted under section 235C of the Workplace Injury Management and Workers' Compensation Act 1998 (NSW) for using counterfeit Certificates of Capacity. He was fined $1,500, placed on a 12‑month Community Corrections Order, and ordered to pay $3,595.63 in professional fees.
• SIRA v Tyson Cloos – On Sept. 18, 2025, Tyson Cloos was prosecuted under section 192E(1)(b) of the Crimes Act 1900 (NSW) in relation to $39,675 in workers' compensation benefits obtained while working a secondary job. The court made a 12‑month Community Corrections Order including 100 hours of community service and ordered restitution of $39,675 and $3,000 in professional costs.

SIRA has also taken action against employers for non‑insurance offences under section 155 of the Workers' Compensation Act 1987 (NSW):

• SIRA v MOS Insulation Pty Ltd & Moshin Nabi – On Jan. 28, 2025, MOS Insulation Pty Ltd and director Moshin Nabi were prosecuted for failing to obtain a workers' compensation policy. The company was fined $9,900, ordered to pay a Double Avoided Premium of $11,000 and $5,500 in prosecutors’ costs, while Nabi was fined $5,500.
• SIRA v Hospicare Pty Ltd – On Aug. 13, 2024, Hospicare Pty Ltd was fined $1,000, ordered to pay $2,991.33 in prosecutors’ costs and Double Avoided Premiums of $9,558.12 for failing to maintain a policy.
• SIRA v Archi Glass Pty Ltd – Also on Aug. 13, 2024, Archi Glass Pty Ltd was fined $500 and ordered to pay $2,805.56 in prosecutors’ costs.
• SIRA v Kalwars Auto Pty Ltd – On June 19, 2025, Kalwars Auto Pty Ltd was fined $1,250 and ordered to pay $1,000 in professional costs for failing to maintain a workers' compensation policy.

CTP scheme prosecutions and implications for insurers

In the CTP scheme, SIRA has reported four fraud‑related prosecutions since August 2024 involving misrepresentations of work capacity and employment status: 

• SIRA v Tina Pour‑Zahrouni – In October 2024, Tina Pour‑Zahrouni was prosecuted under section 6.41 of the Motor Accident Injuries Act 2017 (NSW) for falsely claiming she was unable to work after a motor vehicle crash while working full time. She received $55,698.06 in benefits from GIO, admitted the conduct, and agreed to repay $40,457.06. The court imposed a 12‑month Intensive Correction Order, a $1,100 fine, and prosecution costs of $6,203.03.
• SIRA v Issa Abid – On May 8, 2025, Issa Abid was prosecuted under section 192E of the Crimes Act 1900 (NSW) after submitting false certificates and declarations to a CTP insurer claiming unemployment while remaining employed. He received $135,166.01 in weekly loss‑of‑income benefits, which were repaid before sentencing. The court imposed a 12‑month Intensive Correction Order, ordered prosecution costs of $12,620.49, and directed him to submit fingerprints to police.
• SIRA v Zheng Liang – On Nov. 6, 2025, Zheng Liang was prosecuted under section 192E(1)(b) of the Crimes Act 1900 (NSW) for representing that he was unable to work while employed and receiving $4,853.41 in compensation. The court imposed a 15‑month Community Corrections Order and ordered $6,000 in professional costs.
• SIRA v Rajbir Singh – On Nov. 13, 2025, Rajbir Singh was prosecuted under section 6.40 of the Motor Accident Injuries Act 2017 (NSW) for making a false and misleading statement. The court imposed a $1,000 fine and $4,000 in professional costs.

Legislative changes to the workers' compensation framework

In addition to supervisory and enforcement measures, further reforms to the NSW workers' compensation system passed the NSW Parliament on Feb. 4, 2026, through the Workers' Compensation Legislation Amendment (Reform and Modernisation) Bill 2025. The latest reforms build on amendments passed in 2025 and are directed at prevention and return‑to‑work outcomes, particularly for psychological injuries. Key elements include: 

• Phased increases to Whole Person Impairment (WPI) thresholds for psychological injury 
• A legislated cap on average premium increases for the Nominal Insurer 
• A new intensive Return to Work program for workers with psychological injury, providing an additional year of medical benefits and income replacement 
• Legislating the Chief Psychiatrist’s review to create a revised system for assessing permanent impairment in psychological injury claims 
• New powers enabling the Treasurer to lower the WPI threshold where this is considered to be in the public interest 
• Changes to terminology related to the reasonable management action defence

For scheme participants, the combination of the Thomas Foods licence conditions, recent fraud and non‑insurance prosecutions, and the updated legislative settings indicates an active regulatory environment in which claims governance, policy compliance, and fraud controls remain central issues for insurers and self‑insurers in New South Wales.