COMCARE PREMIUMS. Your guide for

Transcription

1 COMCARE PREMIUMS Your guide for

2 1 This guide explains key concepts used to determine annual workers compensation premiums for Australian Government agencies. It sets out: > the drivers of estimates of claim costs and premiums > what agencies can do to reduce premiums. TERMS USED The premium is the amount an agency is required to pay Comcare. Premiums fund the costs of claims, including Comcare s claims administration costs. The premium rate is a percentage of the agency s payroll for that fi nancial year. The prescribed amount is the main component of the premium. This amount is the product of the premium rate for the agency and the agency s payroll for that fi nancial year. The bonus or penalty is an adjustment amount due to a revision of the premium rate for the previous year and also a share of an additional margin which aims to improve the ratio of assets to liabilities of the premium funded scheme. An injury year is a calendar year in which injuries occur (regardless of when a claim is made or accepted). Lifetime claim cost means payments to date plus an estimate of possible future costs for a claim.

3 2 THE WORKERS COMPENSATION FRAMEWORK FOR AUSTRALIAN GOVERNMENT AGENCIES Federal workers compensation legislation established Comcare to work with Australian Government agencies and their employees to prevent injuries in the workplace, process claims and pay the costs of workers compensation. The legislation: > provides for an integrated safety, rehabilitation and compensation system for agencies and employees > empowers agencies to work with their employees to maintain an injured employee at work or to achieve an early, safe and durable return to work through high-quality return to work programs > provides benefi ts for injured employees, such as income support (until retirement age if necessary), medical and home help assistance, and other benefi ts > requires Comcare to fund costs through annual premiums. THE PREMIUM AND CLAIM PERFORMANCE The premium for each agency responds to trends in their claim performance, as well as trends across the whole system. This acts as a direct fi nancial incentive to agencies to reduce workers compensation costs by effective health, safety and rehabilitation measures. Agencies can monitor their claim performance throughout the year online via Comcare s Customer Information System (CIS) at In addition, Comcare supplies a Premium quick reference sheet with the premium result every year. The quick reference sheet summarises the agency s premium and claim performance over recent years. The quick reference sheet shows the premium amount payable and four years of information on premium rates, claim cost and frequency. Information for all agencies combined is also shown for comparison.

4 3 HOW CLAIM PERFORMANCE IS ASSESSED AND REASSESSED Claim performance is assessed using measures of claim frequency and claim cost. Claim frequency is an estimate of the number of accepted claims from injuries which occur in the injury year, expressed as a frequency per $million of payroll. Claim cost is the total estimated lifetime costs of accepted claims for the injury year. Comcare sets a premium for the coming year while the claims for past injuries are still being accepted and those already accepted are at a very early stage of their potential development. Premiums are intended to respond to trends in each agency s claim performance, but early assessments of claim performance are uncertain. Comcare s premium model takes this uncertainty into account in assessments of an agency s claim performance. The premium calculation balances stability in the premium from one year to the next against responsiveness to each agency s claim performance, which can change signifi cantly from one injury year to the next. The premium responds to trends in claim performance but it is not meant to match claim performance in a single year. If all claims were short term, the payments made to date on each claim would be a suitable measure of each agency s claim cost performance. However, the legislation provides benefi ts that may continue for many years after an injury. While most claimants have only days or weeks off work, some will accumulate many months off work and a small percentage will continue to receive benefi ts and accumulate time off work over many years. To assess each agency s claim performance fairly, an estimate of the lifetime cost of each claim is needed. Lifetime cost means payments to date plus an estimate of future costs for each claim. Comcare uses sophisticated software to estimate the lifetime cost of each claim. However, no method can reliably forecast the lifetime costs for every claim, especially early in the life of the claim. At the time a claim is accepted, the estimate of the lifetime cost must be based on the minimal information available about the claim. This includes the claimant s age, gender, normal weekly earnings, type of injury, and the delay between their injury and acceptance of their claim. The estimate of lifetime cost can only refl ect average outcomes of similar past claims. As months and years pass, the initial indicators become less important and the emerging development pattern for the individual claim becomes more important. Important factors include: > the claimant s cumulative time off work and the pattern of time off work (the number and length of periods off work) > whether the claimant is at work or off work, and how long that has been the case > if the claimant is on a graduated return to work program, the number of hours they spend at work each week > the claimant s pattern of medical and rehabilitation costs > whether a third party recovery action has been initiated, and the progress of that action.

5 4 Assessments of each injury year s claim cost performance change and become more reliable over time as more information about the development of each claim becomes available and the estimate of lifetime cost for each claim is updated. Estimates of lifetime costs increase or decrease for each claim, depending on the changing pattern of actual costs and time off work for the claim. The premium model applies a cap to claims for an injury year to spread across all premium payers the impact of the largest individual claims. When an injury year is assessed or reassessed, a claim cost cap for that injury year is set at a level where the sum of the claim costs above the cap is 5 per cent of the sum of the costs of all claims. Then the premium calculation uses the below the cap cost of each claim plus 5 per cent. For example, the cap amount in premium calculations is $ for injuries suffered in Also, some claims are accepted long after the injury date. Often these claims are highcost claims. The claim frequency measure includes an estimate of claims not yet accepted. Reassessments of past injury years refl ect the acceptance of those claims as well as the development of existing claims. Claims for injuries suffered in each injury year are assessed four times for premium calculations. For example, injuries suffered in 2009 were initially assessed for premium calculations in 2010, then reassessed in 2011 and 2012, and reassessed for the fi nal time for the premium calculations in 2013.

6 5 THE PREMIUM CALCULATION The premium amount for each agency is the sum of two parts: > The main component is called the prescribed amount. This amount is the product of the premium rate for the agency for and the agency s payroll for > The other component of a premium is called the bonus or penalty. Some of this component is based on a revision of the agency s premium rate for and some is a share of an additional margin which aims to improve the ratio of assets to liabilities of the premium funded scheme. The core component of the premium is the premium rate. Comcare sets a unique rate for each agency for each fi nancial year which responds to trends in claim performance as explained above. The premium rate also responds to overall trends in the number and cost of claims and the total amount that Comcare must collect for that fi nancial year from all agencies combined. Bonuses and penalties make premiums fairer for each agency because they take account of more development of claims. Estimates of the lifetime cost of each claim become more reliable over time as more information about the development of the claim becomes available. The fi rst part of the bonus or penalty in the premium refl ects a revision of the agency s premium rate based on the development of the agency s claims for injuries suffered in 2009, 2010 and If the agency s rate for is revised downwards, this fi rst part is a bonus and reduces the premium. If the agency s rate for is revised upwards, this part is a penalty and increases the premium. Generally, this part of the bonus or penalty amount refl ects the effectiveness of the agency s programs to manage return to work and rehabilitate injured workers. The success of return to work programs is the key driver in reducing the ongoing costs of claims for past injuries. However, reassessments of past injury years also refl ect the late acceptance of claims. Some or all of the change for a past injury year may be due to claims for injuries that were suffered in that injury year but only accepted after last year s premium was calculated. The second part of the bonus or penalty was introduced in 2013 to improve the ratio of assets to liabilities for the premium funded scheme. The valuation of Comcare s liabilities for claims incurred in previous years has increased signifi cantly in recent years. This has caused the ratio of assets to liabilities to fall. Long-term sustainability of the workers compensation scheme requires a return to a fully-funded position. Comcare has adopted a premium setting framework which aims to restore full funding over a period of around 10 years through an extra margin in the premium pool each year. Each agency s share of this additional margin is calculated proportionally to agency premiums for and the three prior years, based on the latest revision of each agency s premium rates and payroll for those years. This amount is added to the fi rst part of the bonus or penalty for the agency.

7 6 HOW AGENCIES CAN REDUCE PREMIUMS To reduce future premium rates, agencies must: > reduce the number of claims by preventing injuries > reduce the claim costs. Payments for time off work make up the largest component of the cost of claims. Therefore, the best way for agencies to reduce claim costs is to manage the early, sustainable return to work of each claimant. While most claimants have less than one week off work, the few claimants who will be on benefi ts for more than one year create most of the claim costs. PAYMENTS AND APPEALS Each agency must pay its premium to Comcare by 31 July or 30 days after Comcare sends the premium notice, whichever is later. Comcare will charge interest on any amount not paid by the due date. Within 14 days of the premium notice, the principal offi cer of a premium-paying agency may, by written notice of objection, ask Comcare to review the premium. The notice of objection must set out the grounds of the objection and should be addressed to: Chief Executive Offi cer Comcare GPO Box 9905 Canberra ACT 2601 Comcare will review the premium and notify the agency of whether the amount is confi rmed or varied. Within 14 days of that advice the principal offi cer may, by another written notice of objection, request the Safety, Rehabilitation and Compensation Commission to review the premium. An agency s request for a review of its premium does not alter the due date for payment of the premium. If a review reduces a premium, Comcare will refund the difference with interest. FURTHER INFORMATION AND ASSISTANCE Agencies have access to information on individual claims performance and agency-level trends through Comcare s Customer Information System (CIS) at Further information on claim issues can be obtained through Comcare s Recovery and Support Services group on The Framework for Settings Premiums April 2013, available at describes the overall prudential framework for premiums and liabilities. Comcare s Prudential Management team can explain the premium amount for a particular agency. Agencies can contact the Prudential Management team on

8 PUB 026 (June 2013) COMCARE.GOV.AU