THE FUTURE OF CLAIMS

MANAGEMENT

IN

ICARE WORKERS INSURANCE

WHO IS ICARE?

icare (Insurance & Care NSW) is a Public Financial Enterprise governed by an

independent Board of Directors that delivers insurance and care services to the

people of New South Wales.

OUR SERVICES

icare delivers insurance and care services to people with injuries under the NSW

Workers Compensation Scheme, the Lifetime Care and Support Authority, the Dust

Diseases Authority, the NSW Self Insurance Corporation (SICorp) and NSW

Sporting Injuries Compensation authority.

WHAT IS WORKERS INSURANCE?

Workers Insurance is a licensed insurer responsible for providing workers

compensation insurance to NSW employers. It is the single largest workers

compensation insurer in NSW with a 70% market share.

2

REVIEW OF THE WORKERS

COMPENSATION SCHEME

• Clear monitoring of sustainable return to work outcomes

for injured workers

• Clear and simple plain English communications that also

support injured workers with limited English

• Ensure injured workers are supported by people who

have qualifications, training and empathy to meet their

individual needs

RECOMMENDATIONS FROM THE STANDING COMMITTEE ON LAW AND

JUSTICE

3

LISTENING TO OUR

CUSTOMERS WORKERS AND EMPLOYERS – TOP 10 NPS THEMES

TOP 5 ISSUES AND

DRIVERS OF

COMPLAINTS

4

1. Non-payment of weekly benefits

2. Customer Service and management of claims

3. Payment of medical expenses

4. Communication and clarity of insurer information

5. Decision making for treatment

WHAT WILL CHANGE WITH THE

NEW SERVICE MODEL?

5

PRINCIPLES OF THE

NEW SCHEME

A new transparent claims service model that will deliver a better experience for

both employers and workers that gives them support, empowerment and choice.

Enabled by a simple, empathetic and consistent process.

OUR VISION

• Consistency in service delivery and customer experience

• Improving the support for injured workers

• Achieving sustainable return to work outcomes

• Segmentation of claims based on injury and the support needs of workers

• Providing transparency and insights to all parties

• Delivering improved communication and certainty throughout the claim

lifecycle

PRINCIPLES

OF DESIGN

6

THE FUTURE RETURN TO WORK

AND SUPPORT SERVICE MODEL

<1%

7%

18%

14%

60%

7

WORKERS CLAIMS JOURNEY

THE NEW MODEL

ANGELA is 27, fit and healthy, with no adverse medical

history. Angela sustained a laceration to her right hand while

using the guillotine in the copy room at work.

Initial assessment identified that she would remain fit for full

time work, with some functional limitations, for 1 week.

A full recovery is indicated within 2 weeks, and the main

expenses will be minor medical treatment.

SCENARIO

8

NOTIFICATION AND LODGEMENT IN

THE NEW MODEL

Angela consults her Doctor

and a certificate of capacity

is submitted

Angela receives notification

that her claim is lodged and

is asked to provide any

missing details as well as

some psychosocial

questions

June (Employer) lodges

the claim using the portal;

fills out a simple injury

notification form (injury

type, when and how)

The system collects information

from the certificate of capacity

provided by the Doctor

System starts triage by

collecting treatment,

comorbidity and cost

information

BENEFITS: Angela feels looked after; June knows what to do; it’s simple and easy to lodge a

claim

9

CLAIMS MANAGEMENT IN

EMPOWER

Angela’s back at work the

next day

Treatment calls for stitches and a physio

appointment, which is approved and

commenced

BENEFITS: Angela receives the right treatment and care; June finds it easy to support her employee

10

CLAIMS MANAGEMENT IN

GUIDE

Proactive contact made

with Angela – triggered

by the number of

treatments she has

received / treatment

spend or claim inactivity

Angela consults her

Doctor, where she is

certified with no capacity

to work and referred for

an MRI

BENEFITS: Angela feels heard, supported and knows icare has her best interests in mind;

June is kept up to date on her employee’s condition and recovery

11

CLAIMS MANAGEMENT IN

SUPPORT

Dedicated Case Manager supports

Angela with her recovery and assists

June in identifying suitable duties to

support a safe and durable return to

work

Support continues until finalisation

MRI results and a

surgery

recommendation

triggers an activity for

Case Manager in

Support

BENEFITS: Angela feels cared for and listened to; June is able to prepare and plan for her

business needs

12

SPECIALISED AND CARE CLAIMS IN

THE NEW MODEL

CARE

Claims medically managed

by Workers Care for lifetime

care and support

SPECIALISED

Fatality claims

Medically complex claims

Primary psychological injuries

Sensitive claims

13

INITIATIVES

ALREADY UNDERWAY

• NPS and the customer experience

• Community Support Services

• Medical Support Panel pilot

• Grief Pack

• Simplifying communications

• Workers Care

• And many more …

14

LOOKING

AHEAD

• CGU and QBE will continue to provide workers compensation

services until 31 December 2017

• Claims will gradually transition to GIO throughout 2017

• All CGU and QBE existing claims will transition to GIO during 2017

• GIO and Allianz will continue to manage these claims after 1

January 2018

• EML will continue to manage their current claims in 2017

• From 1 January 2018, EML will manage all new claims

15

WHO ARE EML?

• EML’s core business is personal injury claims management

• From small beginnings, we’ve grown to manage premiums exceeding $1 billion,

employing over 1,500 people nationally

• As a mutual, EML reinvest part of our profits to help our customers create safer

workplaces and achieve better return to work outcomes

OUR SERVICES IN WORKERS INSURANCE NSW

• EML's services are dedicated to helping people across NSW get their lives

back following a workplace injury

• As a specialist provider in workers compensation, our teams are committed

to delivering the best outcomes for workers, employers and our industry partners

16

TRANSITIONING CLAIMS

AT EML

Key: HC is headcount 17

EML IN

VICTORIA

EML commenced providing support to Victorian workers and employers from 1

July 2016

FOCUSED ON CREATING A SMOOTH

TRANSITION FOR OUR CUSTOMERS

• Our customer contact program enabled our

customers to connect with us on day 1

• Our dedicated communication channels enabled

direct engagement with our customers and

prompt response to their enquiries

• Invested in additional resources for transition to

ensure minimal disruption to the customer

experience in critical areas including processing and

payments

WE ARE MAKING A

DIFFERENCE

• Servicing more than 27,000 Victorian employers and

their workers

• Seeing early signs of significant improvement in

facilitating early RTW outcomes for Victorian

workers

• Emerging customer experience performance is

positive – with workers reporting high satisfaction

levels

18

INSIGHTS FROM

HISTORICAL DATA*

Number of new

claims per annum

*Average figures based on five years of claims historical data across all scheme agents 2011 - 2015

Of claims return to

work within 4 weeks Of claims falling

under ‘Empower’

historically returned

to work in less than 4

weeks

Of claims falling

under the ‘Care’

service portfolio last

longer than 130

weeks

Note: the statistical profile for each service is expected to change over time, once new triage factors are considered.

55.3k 73% 82% 100%

19

EML ARE ACTIVELY PREPARING

FOR CHANGE

Collaborative planning, designing and implementing architectures with icare - ready for 1

January launch

Dedicated representatives from icare and EML have commenced Ways of Working

Project launched in a workshop on 17 May and each stream has commenced separate workshops

We’re focused on creating a smooth transition for our customers

Our aim is to be ready by October allowing three months for testing, practicing and refining

20

RESOURCING THE

NEW MODEL AT EML

SYSTEMS, PROCESSES &

TECHNOLOGY PEOPLE & CAPABILITY COMMUNICATION

• Employee numbers to

double

• Investigating options for

new sites / site expansion

• Identifying recruitment,

induction, learning and

development needs

• Organisational team

structure

• Developing KPIs and

measures

• Standardising

communication to ensure

clear consistent messaging

for our stakeholders

• Ensure documentation

supports a consistent

customer experience

• New forms from icare that

can be submitted via the portal

in a simplified, more customer

friendly format

• Phased approach to change

systems and technology

• Icare are developing a user

interface that supports the

service model

• Simplification of processes

• Change management

21

CLAIM SEGMENT

DESIGN

SUPPORT GUIDE EMPOWER SPECIALISED

• Identify competency and skill requirements

• Determine ideal caseloads

• Team structure and specialist support

• Resource requirements

• Risks and opportunities

• Understanding the target Customer

journey and experience

• Work practices, processes and

frameworks

• Business requirements

• Segment triage, triggers and key

events

22

?

23

CONTACTS

ICARE CONTACT DETAILS

icare Workers Insurance

T: 13 44 22

W: www.workersinsurance.icare.nsw.gov.au

EML CONTACT DETAILS

EML Workers Insurance

T: 02 8251 9000

E: info@eml.com.au

W: eml.com.au

© 2016 Employers Mutual Limited

ABN 67 000 006 486

24