The State Insurance Regulatory Authority (SIRA) has released its regulatory update for the final quarter of 2025 – outlining enforcement, remediation, and fraud-related actions across the New South Wales Compulsory Third Party (CTP), Workers' Compensation, and Home Building Compensation (HBC) schemes. The report covers activity from Oct. 1 to Dec. 31, 2025.
The quarterly update – aligned with SIRA’s Regulatory Priorities 2025-26 – details supervisory interventions, enforcement measures, and education initiatives involving insurers, employers, builders, and healthcare providers. Data is reported as at Dec. 31, 2025. In the CTP scheme, SIRA issued eight letters of compliance to licensed insurers and oversaw 13 remediation plans during the quarter. Three plans commenced in the period, and four were closed after SIRA assessed that insurers had demonstrated substantial and sustained compliance with their obligations.
QBE received a civil penalty on Dec. 5, 2025, for non-compliance relating to treatment and care obligations. Over the same period, SIRA received 12 new referrals for suspected CTP fraud, bringing the number of open fraud investigations in the scheme to 37. Fourteen matters were before the NSW Local Court, with another 10 cases awaiting the commencement of criminal proceedings at quarter-end. SIRA also recorded 19 significant matter notifications in the CTP scheme for the quarter, comprising legal matters, privacy or information breaches, “other” notifications, and investigations under its significant matter framework.
In the NSW Workers' Compensation scheme, SIRA reported ongoing regulatory activity across the Nominal Insurer, self-insurers, specialised insurers, and the Treasury Managed Fund, as well as direct oversight of employers. Special licence conditions were imposed on Woolworths Group Limited on Oct. 10, 2025, in relation to claims management practices. SIRA also reported two earlier cases, not previously published, where special licence conditions were applied to Thomas Foods (effective Aug. 31, 2025) and Kelsian Group Limited (effective July 14, 2025). In total, 18 insurers were subject to special licence conditions at the end of the quarter.
The regulator commenced six remediation plans with self and specialised insurers following claims performance audits. These involved Toll Holdings Limited, Coca‑Cola Europacific Partners API Pty Ltd, Sonic Healthcare Limited, Council of the City of Sydney, Guild Insurance Limited, and Randstad Holdings Pty Ltd. Four additional remediation plans arose from insurers’ self-assessments against their obligations, and 21 remediation plans remained open as at Dec. 31, 2025. On employer compliance, SIRA used direct engagement to address non-insurance and under-insurance. During the quarter, 5,031 employers received emails reminding them of their obligation to maintain workers' compensation cover, and 1,500 employers received letters prompting them to arrange a policy. This activity resulted in more than 1,300 new policies incepted, extending cover to over 4,000 additional workers and identifying about $3.78 million in additional premium.
A pilot project with icare, focused on larger employers that had not lodged Actual Wage Declarations, led to hindsight premium adjustments of approximately $1.66 million. Across non-insurance and under-insurance investigations, SIRA issued 89 penalty infringement notices and 40 double avoided premium notices, with total penalties and recovered avoided premiums in the high six figures. Under-insurance investigations identified more than $1.2 million in additional premiums and 962 additional workers brought into cover. In the same period, SIRA received 37 new workers' compensation fraud referrals, triaged six cases, and reported 50 active fraud investigations at quarter-end. Ten significant matters were notified in the Workers' Compensation scheme, including legal matters, privacy breaches, and regulated entity obligation breaches.
In the HBC scheme, SIRA reported that it issued three cautions to builders – Zreika Group Pty Ltd, PCM Pty Ltd, and Five River Construction NSW Pty Ltd – for failing to include the cost of insurance cover in residential building contracts. As scheme insurer, icare Home Building Compensation Fund (HBCF) is also subject to regulatory model approvals. SIRA completed its review of icare HBCF’s updated eligibility model and decided not to reject it, allowing the model to apply without discretion from March 2, 2026. SIRA separately approved icare HBCF’s updated claims management model, which is to be applied without discretion from Jan. 12, 2026.
Across the CTP and Workers' Compensation schemes, SIRA continued its oversight of health and rehabilitation providers. As at Dec. 31, 2025, the regulator recorded 15,564 approved allied health practitioners, 527 health practitioners authorised to give evidence, 69 injury management consultants, 258 hearing service providers, and 100 workplace rehabilitation providers. During the quarter, SIRA conducted onsite evaluations of workplace rehabilitation providers, imposed additional conditions on one provider’s approval based on evaluation findings, and cancelled two approvals for failure to comply with the relevant framework. The regulator also issued directions to relevant service providers to supply information, directed one provider to cease delivering psychological and counselling services due to a separate investigation, and issued a letter of compliance to an allied health provider following non-compliance relating to collaboration and peer review obligations.
Separate to the quarterly statistics, SIRA has outlined a series of prosecutions since January 2024 relating to fraud and non-insurance in both the workers' compensation and CTP schemes. In the Workers' Compensation scheme, 11 matters involving fraud or non-insurance have resulted in court outcomes over that period. These include:
Non-insurance prosecutions in the Workers' Compensation scheme involved Hospicare Pty Ltd, Archi Glass Pty Ltd, and Kalwars Auto Pty Ltd – each fined and ordered to pay costs and double avoided premiums for failing to maintain a workers' compensation policy.
Within the CTP scheme, SIRA has finalised four fraud-related prosecutions since August 2024. Outcomes have included Intensive Corrections Orders, Community Corrections Orders, fines, cost order, and repayment of benefits. In one case, Tina Pour‑Zahrouni was prosecuted in October 2024 under the Motor Accident Injuries Act 2017 (NSW) after receiving $55,698.06 in benefits from insurer GIO while working full-time. She 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.
In another matter, Issa Abid was prosecuted on May 8, 2025, under the Crimes Act 1900 (NSW) for dishonestly obtaining payments by deception by submitting false certificates and declarations to a CTP insurer while employed. He had received $135,166.01 in weekly loss-of-income benefits, which were repaid before sentencing. The court imposed a 12‑month Intensive Correction Order, prosecution costs, and a direction to submit fingerprints to police.
On Nov. 6, 2025, Zheng Liang was prosecuted under Section 192E(1)(b) of the Crimes Act 1900 (NSW) for falsely representing that he was unable to work while employed, having received $4,853.41 in compensation. He received a 15‑month Community Corrections Order and was ordered to pay professional costs. 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 professional costs of $4,000. SIRA has linked these prosecutions to its broader stance on fraud in statutory insurance schemes, stating: “Cheat the system, and you will be caught and punished.”
