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Berkshire Hathaway Specialty Insurance
Berkshire Hathaway Specialty Insurance

EML makes rocky start in NSW workers’ comp role

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EML’s performance as the NSW workers’ compensation scheme agent has been criticised in a statutory review that highlights rising complaints since the company took sole responsibility for the role this year.

The Workers’ Compensation Independent Review Office (WIRO) annual report “notes with concern” that many complaints have been raised by large employers that have made a “universally unfavourable comparison” of claims management in NSW compared with other states.

Complaints include problems communicating with EML, lack of staffing and having to deal with a number of different people in ways that add to inefficiencies.

Insurance & Care NSW (icare) last year selected EML as its sole workers’ compensation agent for new claims starting from January 1. CGU and QBE ceased services last year, while GIO and Allianz continued as transition agents. The WIRO report is for the year ended June 30.

But EML says that with the introduction of icare’s new claims management model “it was always understood that there would be a need for the model to continuously evolve to best meet customer needs”.

“icare and EML recognised that one element of this evolution was an expanded workforce, an EML spokesman told today. “We have worked closely together to make these changes and will continue to monitor and adjust as required.”

WIRO says a significant number of NSW employers have complained about difficulties communicating with EML by phone, saying there is inadequate staffing on the contact line, too much time is spent on hold and improperly trained or overworked staff are answering calls.

Employers say EML has developed a general reluctance to reasonably excuse claims unless specifically requested to do so by the policyholders.

“Further, EML does not seem to be complying with the seven-day timeframe for determining provisional liability,” WIRO says. “As a result, a default decision is made to commence provisional payments without adequate investigations being conducted.”

Several employers complained they had not been assigned a dedicated account manager, which was contrary to experience with EML and other previous scheme agents before the system change and compared with other states.

“They have complained that a different person appears to answer their calls each time an enquiry is made about individual claims and that the staff member who takes the call is then scrambling to get up to speed and clearly therefore lacks the level of knowledge that is required to enable them to provide assistance,” it says.

icare said in August it was recruiting a 30-strong workers’ compensation claims team to offer an enhanced service to customers, and the organisation had been working with EML to bed down changes.

“The introduction of icare’s new claims services model on January 1 was the first major overhaul of the NSW workers insurance scheme in 30 years. We acknowledge that as with any new system it takes time to get it right,” a spokesperson told today.

“We listened to feedback from our customers and addressed delays and communications issues. Average call wait times are now around 47 seconds and 98% of liability decisions are now made within seven days.”

icare says it acknowledges that there were some problems with the level of services during the transition from QBE and CGU to GIO.

“Backlogs were identified and cleared rapidly and in November 2018 over 90% of calls were answered within 60 seconds,” the spokesperson said.

The NSW Business Chamber last week called on Treasurer Dominic Perrottet to commission an urgent review of the workers’ compensation system due to complaints about poor practices following a wider overhaul of arrangements under 2015 reforms.

A spokesman for Mr Perrottet told the changes have brought “huge improvements”, with businesses facing premium rises of 28% under the old scheme, which was predicted to be at least $4.1 billion in deficit.

“Today the most injured workers are receiving more support, business premiums have been reduced, and the scheme is back in the black,” he said.