The NSW insurance regulator says a system-wide move to “person-centred” claims management is needed in workers’ compensation, and it will prioritise the shift in its oversight.

“Insurers will be required to adopt person-centred practices in early intervention, communication, injury planning and decision-making,” the State Insurance Regulatory Authority says.

The regulator’s claims management review has produced four key findings and 14 recommendations, drawing on data analysis, audits and consultations.

It says workers and employers need clearer guidance and more active engagement throughout the claims process. 

The SIRA customer experience program shows an average of 27% of respondents report a negative experience with their case managers, and they often deal with more than one manager. 

Criticisms include the need to repeat themselves, delayed communication, a lack of empathy and understanding, not treating cases in a tailored way, poor professionalism and insufficient knowledge.

The review found significant variations in the quality of claim services and the oversight of providers’ practices by insurers. 

Some 8301 complaints were received by the Independent Review Office in the 2024 financial year, up from 9% in the previous period, with delays in determining liability accounting for 30% of issues. 

“This review has reinforced the importance of putting people at the centre of the claims process,” SIRA CEO Mandy Young said.

“By shifting to a more empathetic, people-first claims model, which operates within the legislative parameters of the workers’ compensation system, we can better support recovery and return to work for people injured at work.”

SIRA completed the claims management review in response to a parliamentary committee inquiry recommendation made in December 2023.