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New claims model in action

Workers insurance in NSW took a major leap forward on 1 January 2018 when claims started being managed under icare’s new customer-focused service model.

Why change?
For many years the NSW Workers Insurance Scheme endured an unintended reputation as being fragmented, with a number of insurance companies acting as scheme agents on behalf of the Scheme, which effectively descaled its effectiveness. Rather than enabling useful competition between agents, the resulting wide variation in service levels led to some employers and injured workers being frustrated by inconsistency and inefficiencies from the system.

Employers told us they wanted better communication, a better claims process, lower premiums, more engagement with medical providers, an improved policy renewal process and improved customer service. Workers also wanted improvements in communications, claims processing, employer support and a more empathetic approach to rehabilitation and recovery; icare’s new model is designed to deliver these improvements.

What has changed?
We have embarked on a unique partnering relationship that brings together the strategic focus, oversight and direction of icare with the operational excellence of EML [the appointed claims service provider for claims management under icare’s workers insurance scheme]. The new model is focused on customers and achieving the best outcome for them. It is staffed by highly capable specialist teams to deliver a service that is aligned to the needs of employers and workers. New technology also supports these teams in delivering a better experience.

Throughout the development of the new model we engaged with employers, injured workers, brokers and other stakeholders to attain their input on its design. Feedback through various engagement forums during 2017 was positive and we incorporated consistent and relevant feedback into the model to go live on 1 January. We will continue to evolve the model throughout 2018 and beyond, taking into account more feedback as the model continues to develop.

How is this better?
Our goal was to make the claims process simple, transparent and effective, which is why we developed a segmented claims model that ensures the appropriate levels of support and management are matched to the circumstances and complexities of the claim. By asking a number of new questions, we are now able to quickly allocate the claim to a specialist who is most capable of providing the employer and worker the support they need. For instance, if the claim is non-complex, such as a medical-only claim, we can reduce the intervention levels required and deliver a faster resolution for customers. More complex claims, however, can be quickly assigned to highly trained and experienced specialist case managers.

A new digital portal allows quick notification of an injury that can be acted upon quickly. The triage of each claim ensures that the most appropriate level of case management and support is assigned. Employers, workers and brokers have the choice to give notification of a claim through the portal, or they can still contact EML by email or phone to speak to a case manager for assistance.

EML has recruited and on-boarded new specialised teams to deliver the high level of customer experience embedded in the new claims model, with more than 100 new recruits in specialist roles in place in Newcastle, Parramatta and Sydney CBD. Although many of the team already had experience in the workers’ insurance industry, they still underwent over 12 weeks of specialist training in the new model to align with icare’s expectations for the customer-focused service they are delivering.

Content provided by icare (Insurance and Care NSW)


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