![]() ![]() 1.5 Summary of key observations - Guidewire Key findings and recommendations can be found in subsequent sections of this report. Both physical and psychological claims displayed a wide variance in audit scores, with physical claims averaging 75.2 per cent and psychological claims slightly lower at 73.3 per cent. The individual claim audit criterion scores ranged between 30 per cent and 100 per cent, with the overall audit score calculated as 74.6 per cent. These IMPs were not viewed as a plan and reference document for the workers recovery and RTW, rather they focussed on worker obligations, implying use as a compliance tool. IMPs scored poorly with the audited plans mostly generic, often missing detail, strategies, stakeholder actions and goals. Grievances, complaints, and issues raised Stakeholder notification of outcome of liability decision on treatment requests* Review of identification of risks, strategies and implementation of actions Issuance of Injury Management Plans (IMP) Implement identified strategies to address risksĪppropriately allocate and prioritise the claim SIRA assessed the following aspects of a claim and their alignment with the expectations set in SIRA’s Standards of Practice on Injury Management Plans (IMPs) and early intervention (Standards of Practice 12, 33 and 34). Tailoring action and support to the worker’s needs, and clear communication about claim and return to work processes in the first four weeks following injury, establishes trust between the insurer, a worker, and their employer to optimise recovery and work outcomes. Research confirms a strong link between effective early intervention, positive recovery, and improved return to work outcomes for workers following an injury. Payment of weekly benefits within seven daysġ.3 Summary of key findings - quality and compliance with Standards of Practice Review of liability decisions on claims placed under a ‘Reasonable Excuse’ The insurer makes sufficient efforts to obtain required information prior to reasonably excusing liability on a claim* Initial contact with Nominated Treating Doctor (NTD) The compliance measures that SIRA assessed during this audit were: When a notification of a workplace injury is received by an insurer, the Workplace Injury Management and Workers Compensation Act 1998 (the 1998 Act) outlines actions that insurers must complete within prescribed timeframes. 1.2 Summary of key findings - compliance with legislation It is clear from the audit score and discussions with CSP representatives, there was little consistency in understanding of date claim made data field as defined in the WCIDRR. SIRA scored the following areas for data accuracy during the audit: SIRA relies on icare to provide accurate data in line with the Workers Compensation Insurer Data Reporting Requirements (WCIDRR) to inform insights on the NI’s performance. 1.1 Summary of key findings - data accuracy SIRA would like to thank icare and its CSPs for their participation and cooperation with this audit. Qualityand Compliance with Standards of Practice.įour frontline Case Managers were interviewed at each Claims Service Provider (CSP) to understand their comprehension and application of the Standards of Practice, and any perceived barriers to managing claims. ![]() SIRA’s audit tool (Appendix A) comprised of 26 criteria split across three key areas: The audit sample consisted of 50 workers compensation claims, 33 of which were significant physical injury claims and 17 of which were significant psychological injury claims notified in July 2022. SIRA has conducted this audit in accordance with powers provided in section 202A of the Workers Compensation Act 1987 (the 1987 Act). With heightened concerns on falling RTW rates, SIRA conducted an audit of icare’s management of the first four weeks of 50 NI workers compensation claims. In response to falling claims management performance, two independent reviews (Dore 20191 and McDougall 20212) and its own independent Governance and Culture report, icare has developed and is implementing the icare Improvement Plan. SIRA has observed a deterioration of the Nominal Insurer (NI) return to work (RTW) rates and financial sustainability for several years. ![]()
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