The Ombudsman has commenced an own motion investigation into the claims process followed by employers that self-insure their workers, and WorkSafe’s oversight of them.
Following its two previous investigations into WorkSafe complex claims management ( Investigation into the management of complex workers compensation claims and WorkSafe oversight & WorkSafe2: Follow-up investigation into the management of complex workers compensation claims ), which looked at the claims management practices and oversight of agents, the Ombudsman has received complaints and submissions from injured workers highlighting concerns with self-insurer claims management.
Self-insurers are mostly large corporations approved by WorkSafe to manage their own workers compensation claims. As of 14 July 2022, there were 34 self-insurers operating in Victoria, representing about 5% of total scheme remuneration.
The complaints include lack of access by injured workers of self-insurers to the Workers Compensation Independent Review Service (WCIRS), which was set up following a recommendation by the Ombudsman in December 2019.
WCIRS independently reviews certain disputed ‘reviewable decisions’ when requested by workers after an unresolved conciliation. WorkSafe has powers to direct agents to overturn decisions which would not be sustainable or have a reasonable prospect of success at Court.
‘Reviewable decisions’ do not include decisions made by, or on behalf of, a self-insurer.
A gap exists for self-insurers because of the differences in the schemes and the legislation in relation to WorkSafe’s powers.
There are also complaints about the low levels of oversight of self-insurers by WorkSafe.
WorkSafe’s Annual Reports in 2020 and 2021 indicate that injured workers were less satisfied with the service provided by self-insurers than were injured workers dealing with WorkSafe agents.
Following another Ombudsman recommendation, in March 2022, the Victorian Government published a report by Peter Rozen QC, ‘Improving the experience of injured workers’, which noted that ‘self-insurers stand outside some of the accountability mechanisms under the [WorkSafe] scheme’. Some submissions to the Rozen Review described poor handling of claims by self-insurers.
The Ombudsman’s investigation will cover:
- whether the claims management processes of self-insurers provide fair and equitable outcomes for their injured workers
- whether the oversight processes of WorkSafe contribute to fair and equitable outcomes for injured workers of self-insurers
As part of the investigation, the Ombudsman is also interested in evidence of best practice by self-insurers in managing workers’ compensation claims.
We would like to hear from:
- injured workers managed by self-insurers
- employees or former employees of self-insurers
- agencies or individuals that provide assistance to injured workers managed by self-insurers or have knowledge of claims management and dispute processes including unions, lawyers and medical professionals
- any other person or body that may have relevant information.
Please send your submission to:
