Delivering the future now:

Claims management in

icare Workers Insurance

At icare, we deliver

insurance and care

services to the

businesses, people and

communities of NSW.

Whether a person is

severely injured in the

workplace or on our

roads, icare supports

their long-term care

needs to improve quality

of life, including helping

people return to work.

Insuring the businesses of NSW

3.4million

workers

protected across more

than 288,000 NSW

businesses

$180b i l l i o n

of the State's assets covered.

icare self insurance, through

Insurance for NSW, is the

largest public sector self-

insurer in Australia

$1.7billion in

benefits

medical expenses and

return-to-work solutions

paid to injured workers

$114.8m i l l i o n i n

treatment, rehabilitation

and care services for

lifetime care participants

$91.1million in

benefits

paid to people with work-

related dust disease

$14.6b i l l i o n

in residential

projects insured

2

3

Customer engagement

1 Employer engagement sessions

Comprehensive program:

2 Portal demonstrations

3 Employer and Broker Webinars

4 Claims Model Website – source of information

5Direct engagement with employers and industry

bodies by Commercial Engagement Team and EML

4

What we designed in the new model

Adversarial model

• Workers struggle through

• Lack of case manager competency on complex claims

• High turnover of case managers

• Process driven bureaucracy

• Customer has no input or control

• Lack of empathy

Empowered model

• Scheme that facilitates return to work/life

• Partners as extension of icare

• Straight through processing where possible

• Resources attending to claims in need

• Empowered customers

• Empathetic customer service

5

Claims model - vision and objectives

Consistency from

scale in service

delivery and customer

service

Improving the

support for injured

workers

Achieve sustainable

return to work

outcomes

Delivering improved

communication and

certainty throughout

the lifecycle

Providing

transparency and

insights to all

parties

Segmentation of

claims based on injury

and the support of

workers

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.

The icare claims model

6

80%

<1%

4%

15%

Anticipated

volume

Actual

volume

<1%

4%

16%

79%

New Claims 2018 - Webinar

The lodgement portal

7

Enter

8

The business rules segmentation model

Claims data

capture,

lodgement

questions

Care Filter

Specialised

Filter

Support Filter

Guide Filter

Initial Triage Segmentation Rules

Care

1% of claims

Specialised 4% of claims

Return to

Work15% of claims

Guide 10% of claims

Empower 70% of claims

Injury Code

Injury Code Anticipated RTW

Injury Code Anticipated RTW > 2 weeks

Language Injury Concerns Suitable Duties

Injury Date

Environment Concerns Pain/Recovery Concerns

9

Care claims

Characteristics

Severe injuries

Moderate/Severe brain

injuries

Spinal cord

Amputations

Serious burns

Care Profile and benefits

Managed within the icare Workers

Care team

Highly trained and knowledgeable

case managers

Access to specialist services

Care

Claims

10

Specialised claims

Characteristics

Workplace fatalities

Primary psych injury

claims

Complex injury types

Injuries resulting

from extreme

traumatic events

Care Profile and benefits

Dedicated Case Management Specialist

Consistent experience

Holistic support from lodgment to full

recovery

Highly trained and technically capable team

– experts in mental health claims

Support for families and colleagues – Grief

pack

Greater

empathy and

tailored case

management

11

Support claims

Characteristics

Incapacity is likely to be

greater than 6 weeks

Significant risk factors

that could impact

expected recovery

timeframes

Claims where surgery is

indicated

Care Profile and benefits

1:1 Case Management Specialist

Customised level of support dependent

on requirements

Provide expertise, assistance and advice

Proactive communication

Industry segment knowledge

Longer term outcomes improved

More

targeted &

supported

care

12

Support centre claims

Characteristics

Incident Only

Medical only claims

Frank incidents

Low risk injuries,

where full recovery is

most likely

Care Profile and benefits

Self-managed or Support

Centre

Empathetic &

knowledgeable team

No dedicated case

manager – everyone

owns the claim

Typically 1-2 phone calls

Low impact claims have

less red tape

Simple and easy to

lodge and complete

notification

Positive claims

experience

Support Centre

Claims

13

Who’s who in the new model

Support Centre RTW/Support and Specialised

Groupings

Corporate

Small Business

Industry Segments

Teams aligned to

business size and

industry sectors

Technical

Specialist

Triage

Specialist

Injury

Management

Specialist

Team Leader

Claims

Advisors

Employer

Worker

Employer Worker

Team

Leader

Injury

Management

Specialist

Technical

Specialist

Claims

Management

Specialist

Medical

Support

Panel

14

Service levels and stabilisation

Portal updates –policy number at front

Notifications – automate process, injured worker name in acknowledgement email

Last agent call routing

Resources continue to ramp up – additional resources deployed to manage backlog

Portal performance

Call waiting times and

returning calls

Backlog of tasks to be

completed

Injured worker feedback

Employer feedback

Triage engine

• Around 9,000 claims lodged

• An additional 3,500 ‘injury only’ notifications• 35,000 inbound calls handled

• 26,000 outbound calls made, including

approximately 14,000 HUG calls made

Focus for this year

15

Client

Service

Managers for

one point of

contact for

claims

Combined

claims

reporting

Industry level

benchmarking

and reporting

Single point claims

management contact

Conduct claims reviews

and support claims

reporting

Day to day touch point

for employers

Partner and advisor on

claims impacts and

claims management

strategies

Maximising the access to

wider EML data, insights

and reports

16

Client service model

Employer

icare Relationship

Manager

icare

policy

EML

Service Manager

Escalation point for the EML service manager

Facilitate claims reviews across Scheme

Agents

Support underwriting queries eg: premium,

invoicing and late payments

Maximise access to wider icare data/insights,

including benchmark reporting and yearly

strategic reviews

Represent the customer and support access to

wider icare functions

Lead the renewal process

Support relationship manager with the

performance and strategic review process

Monitor performance and develop prevention

strategies

Resolve technical issues

17

Consolidated reporting

Claims Data

Existing Claims

Claims Data

New Claims

Consolidated

Reporting Suite

Collate and distribute from existing sources

Cost of Claims

reporting

No need for employers/brokers to gather information from

multiple sources

Q1 reporting available

in April

Co-design with employers for future

needs

18

Industry data insights tool

A sneak peek into what’s coming throughout

2018…

19

Fully

integrated

solution

Dynamic

triage

Enhanced

portal

Automatic

approval

of

treatment

requests

Track the

progress

of

individual

claims

RTW Plans

online

Thank you.