Review of Self-Insurance Arrangements in Victoria Report of the Self-Insurance Review Team August 2005

Transcription

1 Review of Self-Insurance Arrangements in Victoria Report of the Self-Insurance Review Team August Victorian Workcover Authority

2 About this Report This report presents the outcomes of the Victorian WorkCover Authority s (VWA) Review of Self-Insurance Arrangements in Victoria. The self-insurance arrangements in Victoria have not been reviewed in a systematic and comprehensive way since their introduction in The potential prudential risks of self-insurance have been highlighted by corporate failures and the growing number of self-insurers has increased the complexity of managing the arrangements. Against this background, the VWA undertook a Review of Self-Insurance Arrangements ( the Review ) to address issues raised by stakeholders, increase the efficiency and effectiveness of the self-insurance arrangements and ensure that the arrangements are aligned with, and contribute to, the achievement of the VWA s overall objectives. The terms of reference for the Review were established by the VWA Board and are outlined in Appendix A. The first stage of the Review commenced in August 2003 with an extensive consultation phase, involving a wide range of stakeholders, including selfinsurers, the Self Insurers Association of Victoria, unions, Victorian Trades Hall Council, employer associations, legal firms, prospective self-insurers, VWA Authorised Agents and other interested parties. At the conclusion of consultations, stakeholder submissions were drawn on by the VWA to produce the Review s draft report. The second stage of the Review commenced with the release of the draft report in May This draft report delivered a package of proposed measures designed to address concerns about some key areas of the existing arrangements. It contained 21 preliminary recommendations aimed at delivering benefits to employers and workers under the self-insurance regime. A second phase of consultation was conducted between June and August 2004 to provide an opportunity for stakeholders to comment on the draft report s recommendations. This report represents the final output of the Review. It draws on stakeholder comments received during both stages of the Review and presents the Review team s key recommendations for improving the arrangements for selfinsurance. It contains 23 recommendations. These recommendations will provide a framework to guide ongoing consultation on issues relevant to selfinsurance in Victoria Victorian Workcover Authority Page 2 of 111

3 The VWA would like to sincerely thank all those stakeholders who participated in this Review. Specifically, we acknowledge the valuable written submissions received from the Australian Industry Group, Australian Manufacturing Workers Union, Cambridge Integrated Services, Coles Myer Ltd, Commonwealth Bank of Australia, Insurance Australia Group, Finance Sector Union of Australia, National Tertiary Education Union Victorian Division, National Union of Workers Victorian Branch, Self-Insurers Association of Victoria, Shop Distributive and Allied Employees Association, Victorian Council of Occupational Rehabilitation Providers, Victorian Trades Hall Council and WSA Financial Consulting Pty Ltd. Both the written and verbal submissions received by the VWA have been carefully considered in finalising this report. A list of the written submissions received at each stage of the Review is contained in Appendix B. In addition, electronic copies of all written submissions have been published on the VWA website ( The Review Team would also like to acknowledge the substantial assistance received from internal VWA Divisions and the Victorian Department of Treasury and Finance. Page 3 of 111

4 Contents 1 Overview Introduction Current situation Recommendations List of recommendations Current self-insurance arrangements in Victoria Overview Outline of current model Legal framework Approval requirements Ongoing requirements and monitoring Financial impact of self-insurance Philosophy behind placing OHS requirements on self-insurers National consistency in self-insurance arrangements Current performance of self-insurers Key Findings on Self-Insurer Performance Claims Frequency Rate Average payments per standard claim Return to work Injured worker satisfaction Detailed Recommendations Role of self-insurance Current role of self-insurance Advantages and disadvantages of self-insurance Existence of self-insurance Proposed role of self-insurance Operating model Tripartite working group for self-insurance Oversight models for self-insurance Improvement program Integration within the scheme Flexible renewal periods Access to Self-Insurance Introduction Financial statement from self-insurer Claims resources guidelines Performance indicators Page 4 of 111

5 4.3.5 Consultation at application and re-application stages Access for de-merged entities Oversight Monitoring model Financial Claims management Health and safety Legislative implications Index of appendices Appendix A: Terms of reference Appendix B: Submissions to the review Appendix C: List of current self-insurers Appendix D: Current legislative requirements Appendix E: The history of self-insurance in Victoria Appendix F: Terms and conditions under Schedule 4 of the Regulations Appendix G: Comparison of self-insurance arrangements in other Australian jurisdictions Page 5 of 111

6 List of figures Figure 1 Self-insurers share of total scheme remuneration... 9 Figure 2 Recommendations framework Figure 3 Claims frequency rate (indicative comparison only) Figure 4 Average payments per standard claim (indicative comparison only) Figure 5 Spread of claims grouped by total payments Figure 6 Durable return to work Figure 7 Injured worker satisfaction, large scheme-insured versus self-insured employers28 Figure 8 Injured worker satisfaction, self-insured employers change over time Figure 9 Injured worker satisfaction, individual self-insurers and means (shaded) Figure 10 Recommendations framework Figure 11 Proposed models for self-insurance Figure 12 Proposed improvement program process Figure 13 Schematic of consultation process at application and re-application stages Figure 14 Audit and action plan framework under the existing legislation Figure 15 Audit and action plan framework (Option 2 - legislative change model) Figure 16 Knowledge management framework Figure 17 Self-insurer contributions as a share of remuneration Page 6 of 111

7 List of tables Table 1 List of recommendations Table 2 Characteristics of self-insurers and large scheme-insured employers Table 3 Key differences between the three-tiers (shaded sections apply to legislative change model only) Table 4 Potential key performance indicators Table 5 Subsections of the Act assessed in the performance management framework Table 6 Potential performance indicators Table 7 Example of allocation of self-insurer to a tier Table 8 Costs included under current contributions methodology Table 9 Comparison of third party and in-house claims management arrangements Table 10 Expected legislative change option Table 11 Indicative data on self-insurance arrangements across Australian jurisdictions as at 30 June 2003 (unless noted otherwise) Page 7 of 111

8 1 Overview 1.1 Introduction The Victorian Workcover Authority (VWA) has undertaken the Review of Self- Insurance Arrangements ( the Review ) to address issues raised by stakeholders, increase the efficiency and effectiveness of the self-insurance arrangements and ensure that the arrangements are aligned with, and contribute to, the achievement of the VWA s overall objectives. In consultation with stakeholders, the VWA identified the following key areas for consideration in the Review: the role of self-insurance within the scheme; and the effectiveness of self-insurance administration by the VWA, specifically in relation to: - the financial viability of the scheme; - improving injury prevention; - improving claims management and return to work; and - meeting stakeholder expectations. The Review has identified a number of opportunities for improving the existing self-insurance arrangements. This report from the Review team represents the conclusion of the Review. It draws on stakeholder comments and presents the Review team s key recommendations for improving the arrangements for self-insurance. It contains 23 recommendations. The structure of the framework document is summarised below. Chapter 1: Overview. Chapter 2: Provides an outline of the recommendations. Chapter 3: Summarises the current self-insurance arrangements in Victoria and compares the performance of self-insurers with that of large scheme-insured employers. Chapter 4: Discusses the detailed recommendations (under two models). Chapter 5: Outlines the broad legislative impact of the recommendations. Page 8 of 111

9 1.2 Current situation Self-insurers represent a significant component of the Victorian workers compensation scheme. There has been growth in this aspect of the scheme, with the number of self-insurers increasing over the period to and self-insurance increasing from around 8 per cent of total scheme remuneration to around 10 per cent (Figure 1) over the same period. This is below the proportion of scheme remuneration in other large jurisdictions, where self-insurance represents from 11 per cent to up to 36 per cent of remuneration. 12% 40 % of total remuneration 10% 8% 6% 4% 7.8% 8.3% 8.0% 8.2% 8.2% 9.0% 9.5% 10.1% 9.8% Number of self-insurers 2% 5 0% 1994/ / / / / / / / /03# 0 # remuneration adjusted to include new self-insurers Figure 1 Self-insurers share of total scheme remuneration There has been a perception amongst some stakeholders that self-insurers have outperformed scheme-insured employers. The updated performance analysis indicates that as a group, self-insurer performance, on balance, does not appear to be significantly different to that of large scheme-insured employers. This analysis is indicative only. A number of differences in the individual components of performance were observed: Between and , the average claims frequency rate for self-insurers was broadly similar to that of large scheme-insured employers. However, in more recent years, self-insurers have observed a higher average claims frequency rate than large scheme-insured employers. Over the period, self-insurers have lower average payments per standard claim compared with large scheme-insured employers. Page 9 of 111

10 Based on survey data, self-insurers and large scheme-insured employers have achieved similar durable return to work outcomes. Survey data indicates that overall injured worker satisfaction with the services provided by self-insurers is broadly similar to the level of satisfaction with services provided by the VWA s authorised agents for large scheme-insured employers. Whilst, as a group, self-insurer performance does not appear to be significantly different to that of large scheme-insured employers, there is variation in performance across individual self-insurers. 1.3 Recommendations The Review has analysed the issues raised, consulted with stakeholders, and has identified 23 recommendations for improving self-insurance arrangements. The recommendations are grouped into four broad categories: role of self-insurance; operating model; access to self-insurance; and oversight of self-insurers. In the past, the role and purpose of self-insurance in Victoria has not been clearly defined and this has created mixed expectations amongst the various stakeholder groups. The Review proposes that the following role definition be adopted: The role of self-insurance in Victoria is to provide choice to eligible employers to manage and bear the costs and risks of their own claims. As an integrated component of the overall scheme, self-insurance should: provide direct incentives to improve injury prevention and rehabilitation performance; ensure that workers are treated fairly and equitably; contribute to continuous improvement in health and safety and return to work performance; and facilitate best-practice transfer across the scheme. Based upon the role of self-insurance as defined above, and an analysis of the current model and its weaknesses, it is recommended that the VWA adopt a value-added intervention operating model for self-insurance. Two options are presented. Option 1 the value-added intervention model consists of 20 recommendations and could be implemented within the existing legislative framework. Option 2 the legislative change model includes an Page 10 of 111

11 additional three recommendations and would require amendments to the Accident Compensation Act 1985 ( the Act ) and the Accident Compensation Regulations A brief overview of these two options is provided below. Option 1 Value-added intervention model (within existing legislation) Operating model The value-added intervention model could be implemented within the existing legislation and regulations. It incorporates a number of key structural changes designed to increase the efficiency and effectiveness of the self-insurance arrangements. Self-insurers would be managed under a three-tiered oversight model based on performance. High performing self-insurers would receive a lower level of oversight and prescription than other self-insurers. Conversely, self-insurers whose performance falls below a minimum threshold would be placed on an improvement program for a period of up to 12 months. This program would be designed to encourage and assist these employers to improve their performance. Failure to sufficiently improve performance may, as a last resort, lead to the revocation of self-insurance status. The model also provides for a greater level of integration of selfinsurers into the broader scheme, with self-insurers included in all relevant scheme-wide strategic initiatives, including WorkSafe s targeted programs. This would include ensuring that self-insurers provide sufficient data to the VWA to enable effective OHS enforcement and prevention activity. A tripartite working group would be established to consult on issues pertaining to self-insurance with the aim to improve self-insurance arrangements. Access to self-insurance Under existing arrangements, the criteria for entry to self-insurance (under the fit and proper requirements) are not clearly defined or transparent. To increase the transparency and consistency of the current entry requirements, it is proposed that performance indicators and indicative benchmarks are developed against the relevant matters contained in section 142(2) of the Act. These benchmarks, along with a range of other information, would be used to assess applicants. To further increase the transparency of self-insurance, the Review recommends the introduction of a formal consultation process with key stakeholders at the application and re-application stages. Page 11 of 111

12 Oversight of self-insurers As part of the proposed three-tiered oversight model, strategic occupational health and safety (OHS) action plans and milestone reporting by self-insurers would be introduced to drive continuous improvement at worksites. This requirement would be broadly offset by reduced OHS and claims management self-audit requirements for self-insurers in tiers one and two. The Review s draft report considered the introduction of a Self Insurer Claims Manual, however based on further analysis and stakeholder feedback, a more appropriate solution has been adopted, whereby self-insurers would be required to maintain and publish in-house claims policies and procedures for those areas where they elect not to follow the VWA Claims Manual. Option 2 Legislative change model The legislative change model includes all the above recommendations plus three additional recommendations. The existing legislation and regulations would need to be amended to implement these additional recommendations. To strengthen the targeted oversight approach of the value-added intervention model, the legislative change model would introduce flexible renewal periods based on performance. Under this model, renewal periods would range from three to five years. Currently, all renewals are fixed at four years irrespective of relative performance and risk, with the initial approval period being three years. To provide greater flexibility in access to self-insurance for de-merged entities, legislative change is proposed to enable the earlier consideration by the VWA of self-insurance applications from organisations that are in the process of de-merging. To create greater transparency around health and safety, legislative change is proposed to require self-insurers to report OHS performance in their annual reports (or another suitable form that provides public access). In order to broaden the scope and strengthen the enforceability of a number of the recommendations under the value-added intervention model, under Option 2 the VWA may seek legislative and/or regulatory amendment to strengthen the: improvement program; indicative performance indicators and benchmarks; the monitoring regime (i.e. action plans); and the VWA s ability to oversight strategically significant litigation files. The legislative change model provides stronger incentives and greater opportunities for continuous improvement, targeted oversight and Page 12 of 111

13 enforceability, relative to the value-added intervention model within the existing legislation and regulations (option 1). Figure 2 outlines the full recommendations framework. Highlighted recommendations apply only to the legislative change model (option 2). Role of self-insurance 1 Adopt a clear role Operating model 2. Establish a tripartite working group for self-insurance 3. Introduce a three-tier oversight model based on performance 4 Introduce an improvement program 5. Integrate self-insurers within the scheme 6. Implement flexible renewal periods Access Oversight Monitoring Claims 7. Provision of 12. Implement a 19. Self-insurer in-house financial performance driven claims policies undertaking from audit and action plan self-insurer 20. Implement claims framework litigation notification/ 8. Establish claims 13. Develop a performance consultation and seek management management system legislative power to resourcing 14. Improve worker impose condition guidelines awareness of complaints processes 21. Develop a process to 9. Introduce and introduce share claims history performance complaints reporting information indicators 15. Develop a best practice 10. Implement a transfer program consultation Financial Health and Safety process at 16. Develop an actuarial application and 22. Conduct a survey of peer review process re-application workplace culture 17. Provide scheme stages actuarial information to 23. OHS reporting in in self Mergers De-merger and self-insurers self-insurer annual annual demergers access 18. Increase transparency reports provisions of of contributions Figure 2 Recommendations framework And finally, regarding the complex issue of the amount of contributions to be paid into the WorkCover Authority Fund by self-insurers, the Review proposes that the Minister for Finance refer the matter to the Essential Services Commission for review. Page 13 of 111

14 2 List of recommendations Table 1 List of recommendations Category No. Recommendation Leg/Reg change required Role of selfinsurance 1 That the VWA adopt the following statement defining the role of self-insurance in Victoria. No The role of self-insurance in Victoria is to provide choice to eligible employers to manage and bear the costs and risks of their own claims. As an integrated component of the overall scheme, self-insurance should: provide direct incentives to improve injury prevention and rehabilitation performance; ensure that workers are treated fairly and equitably; contribute to continuous improvement in health and safety and return to work performance; and facilitate best-practice transfer across the scheme. Operating model 2 That the VWA establish a tripartite working group for selfinsurance to consult on issues pertaining to self-insurance, with the aim to improve self-insurance arrangements. No 3 That the VWA implement a three-tiered oversight model for self-insurance, based upon performance. 4 That the VWA introduce an improvement program to assist lesser performing self-insurers to improve their performance. As a last resort, the program may lead to revocation of approval if sufficient improvement is not achieved. 5 That the VWA include self-insurers in relevant strategic initiatives of the scheme. 6 That the VWA introduce flexible renewal periods for selfinsurers based upon performance, ranging from 3 years to a maximum of 5 years. Access 7 That the VWA require each self-insurer s governing body to provide, on an annual basis, a written statement to the VWA regarding the self-insurer s ability to meet its workers compensation liabilities as and when they fall due. No No (but change is preferable) No Yes No Page 14 of 111

15 Category No. Recommendation Leg/Reg change required 8 That the VWA establish indicative standards to guide applicants in understanding what the VWA considers to be fit and proper against the resource requirements for managing claims. 9 That the VWA clearly define and communicate key performance indicators (KPIs) and indicative benchmarks, used to assess an employer s suitability to self-insure. 10 That the VWA implement a formal consultation process with key stakeholders at the application and re-application stages. 11 That the VWA seek legislative change to permit: No No (but change is preferable) No Yes Oversight - Monitoring the consideration of an application for approval as a selfinsurer from a body corporate that is a wholly owned subsidiary of another body corporate; and approval on the condition that the body corporate ceases to be a wholly owned subsidiary prior to the approval being granted. 12 That the VWA manage self-insurers under a performance driven monitoring regime incorporating: variable OHS and claims management self-audit requirements for self-insurers, driven by performance level; strategic action plans designed to drive improvements at worksites, developed by self-insurers and reported against annually; and variable levels of VWA audit and review of self-insurers, based upon performance. No (but change is preferable) Page 15 of 111

16 Category No. Recommendation Leg/Reg change required 13 That the VWA develop a performance management framework for the three-tiered model that includes: No developing a suite of performance indicators to assess self-insurers performance; regular assessment of self-insurers comparative performance, using a range of claims management, occupational health and safety, and other performance data; enhancing systems to capture claims and OHS data for self-insurers, including ensuring that self-insurers provide sufficient data to enable effective OHS enforcement and prevention activity; and regular reporting of performance information to selfinsurers, possibly via the internet. 14 That the VWA develop: No an information and education program to raise awareness amongst workers of self-insurers of the complaints process; and regular reporting and feedback to self-insurers on complaints trends. Oversight - Financial Oversight - Claims 15 That the VWA develop and implement a scheme-wide best practice transfer program in close cooperation with selfinsurers. 16 That the VWA develop a process for the scheme actuary to periodically peer review the self-insurers actuarial assessments of outstanding claims liabilities. 17 That the VWA provide additional actuarial information on scheme trends to actuaries commissioned by self-insurers in order to better inform the annual assessment of selfinsurers claims liabilities. 18 That the VWA request the Minister for Finance to refer to the Essential Services Commission for advice, the amount, and the methodology for calculating the amount, of contributions to be paid into the WorkCover Authority Fund by self-insurers. 19 That the VWA require self-insurers to develop and maintain written in house claims management policies and procedures for selected areas where they choose not to follow the VWA Claims Manual. No No No No No Page 16 of 111

17 Category No. Recommendation Leg/Reg change required 20 That the VWA: Oversight Health and Safety require self-insurers to provide notification of any case to be litigated in the Supreme Court, Federal Court, High Court or Court of Appeal; consult with self-insurers regarding their proposed litigation strategies for those cases to be litigated in the above courts; seek legislative change to provide a power to impose a condition upon self-insurers that a submission is not made in relation to cases to be litigated in the above Courts where the matter or submission is identified as significant in accordance with the related Ministerial directions; and provide information on a regular basis to self-insurers regarding case law and related matters. 21 That the VWA develop a process by which self-insurers and VWA agents are able to exchange necessary and relevant information on a claimant s prior claims history in a manner consistent with applicable privacy laws. 22 That the VWA introduce a survey of employees regarding their employer s claims management and health and safety practices/workplace culture. 23 That the VWA require self-insurers to report their OHS performance annually in their annual reports or another suitable form that provides public access. No No Yes No No No Yes Page 17 of 111

18 3 Current self-insurance arrangements in Victoria 3.1 Overview Self-insurance is a significant component of the Victorian workers compensation scheme. The number of self-insurers has grown by over 50 per cent from the 24 self-insurers in At 31 May 2005, there were 39 selfinsurers in Victoria, accounting for approximately $8.9 billion remuneration and representing around 10 per cent of total scheme remuneration. A list of the current self-insurers is contained in Appendix C. Self-insurance arrangements have not been reviewed in a systematic and comprehensive way since their introduction in The prudential risks have been highlighted by corporate failures, and the increasing number of selfinsurers has increased the complexity of managing the arrangements. Against this background, the VWA has undertaken the Review of Self- Insurance Arrangements to assess the effectiveness and efficiency of the selfinsurance arrangements in Victoria in achieving the VWA's health, safety and return to work objectives. The Review s terms of reference are contained in Appendix A. 3.2 Outline of current model Legal framework The Accident Compensation Act 1985 allows for eligible organisations to be approved by the VWA as self-insurers. Part V of the Act sets out the processes and requirements for self-insurance. Self-insurers are responsible for managing their workers compensation claims and for meeting their claims liabilities. In order to be approved as a self-insurer an employer must be considered fit and proper in accordance with the assessment criteria (outlined in section 3.2.2). The initial approval is for a period of three years. Any subsequent reapprovals are for a period of four years. Once approval is granted self-insurers must meet ongoing requirements including conducting annual self-audits and regular provision of data to the VWA (see section 3.2.3). Page 18 of 111

19 All self-insurers must comply with the Act and the Accident Compensation Regulations Workers employed by self-insurers have the same rights and entitlements as workers employed by other employers. Employers who are self-insured continue to be subject to the requirements of the Occupational Health and Safety Act 1985, the Dangerous Goods Act 1985, the Equipment (Public Safety) Act 1994 and all other relevant acts, regulations and codes Approval requirements Sections 141 and 142 of the Act set out the matters that the VWA must consider when assessing an application for self-insurance. The employer must be a body corporate and not a subsidiary of another body corporate (although they may be a subsidiary of a foreign company under the meaning of the Corporations Act 2001, where the company, at the time of application, is not a registered foreign company). In addition, partnerships (within the meaning of the Partnership Act 1985) and the Municipal Association of Victoria (established under the Municipal Association Act 1907) may apply to become self-insurers. Prior to 1996 a body corporate could only make an application for approval if the following requirements were met: the applicant employed at least 1000 full time workers (reduced to 500 in 1994); and the assets of the applicant exceeded its liabilities by at least $200 million. However, these restrictions were removed by the passage of the Accident Compensation (Further Amendment) Act The VWA may approve a body corporate as a self-insurer if it is satisfied that the body corporate is fit and proper. The current requirements which cover financial viability, capacity to administer claims, incidence of injuries and claims costs, workplace health and safety, compliance with the Act and other matters the Authority thinks fit are provided in Appendix D. The VWA initiates a consultation process at the application stage, whereby key stakeholders have an opportunity to provide comments on prospective self-insurers. During the Review s consultations a number of unions suggested that the VWA should consider requiring a prospective self-insurer to obtain agreement with its employees and their unions on such things as claims management processes (e.g. agreed claims processing times, involvement of Health and Safety Representatives). The unions believed that where this had occurred in the workplace it had improved the employer s claims administration processes and therefore benefited the employees. The VWA acknowledges the potential benefits of collaboration between employers and their employees and would encourage co-operative efforts of Page 19 of 111

20 this nature. In terms of a prospective self-insurer s claims management resources and processes, these are assessed by the VWA against the requirements of the Act. A brief history of self-insurance in Victoria is provided in Appendix E Ongoing requirements and monitoring The legislative requirements that a self-insurer must meet after the granting of self-insurance approval include: possess a bank guarantee for actuarially assessed liabilities; participate in an annual self-audit program; contribute quarterly to the WorkCover Authority Fund; possess a contract of insurance in respect of contingent liabilities for an unlimited amount; and provide annual certification of remuneration. The Accident Compensation Regulations 2001 prescribes terms and conditions that apply to all approved self-insurers. These provisions are outlined in Appendix F Financial impact of self-insurance The Review has assessed the likely financial impact of self-insurance on the scheme. The changes proposed by the Review are unlikely to significantly alter the current access trends in self-insurance. In terms of scale, if the 50 largest, non-government, scheme-insured employers were to self-insure, the relative size of the self-insured pool would rise from around 10 per cent to around 17 per cent of total scheme remuneration. The Municipal Association of Victoria, which is also eligible to apply for self-insurance in Victoria, represents approximately a further 1 per cent of scheme remuneration. An analysis of premium data over the last four financial years indicates that, over the medium term, continued gradual growth in self-insurance is unlikely to have a significant adverse effect on the scheme s overall financial position. This is due to the fact that applicants for self-insurance are from diverse industries and sectors, with varying risk profiles and claims experience. To protect long-term scheme viability, the VWA should regularly assess and monitor the financial impact of self-insurance on the scheme as prospective self-insurers seek access to self-insurance Philosophy behind placing OHS requirements on self-insurers The VWA is the regulator of Victoria s occupational health and safety (OHS) regime. Preventing workplace injury, illness and death is critical to the long- Page 20 of 111

21 term viability of the whole scheme and is a social imperative. The VWA through its OHS arm, WorkSafe Victoria, takes the lead role in the promotion and enforcement of health and safety in Victorian workplaces. Self-insurers enjoy a special position within the context of workers compensation. In effect, the State delegates the responsibility for workers compensation administration to the responsible self-insurer. Due to this special position, Victoria imposes restrictions upon an employer applying for self-insurance and must satisfy itself that the applicant will not abuse its position in managing workers claims and their injuries. Whilst OHS regulation may be, theoretically, distinct from workers compensation, Victoria continues to see an employer s OHS performance as one way of indicating its approach to claims and injury management and commitment to rehabilitation and achieving durable return to work outcomes. As such, it is appropriate for selfinsurers to demonstrate a good OHS record. This approach is consistent with most other Australian jurisdictions in that workplace safety is taken into consideration when assessing an application for self-insurance. The VWA s philosophy of promoting health and safety in Victorian workplaces is reflected in the proposed role statement for self-insurance, specifically the extract contribute to continuous improvement in health and safety (see section 4.1) National consistency in self-insurance arrangements Approximately two-thirds of Victorian self-insurers are self-insured in multiple jurisdictions. Variations in processes or requirements between states may add to the overall costs of self-insurance for these organisations. Accordingly, it is relevant to consider where there is potential to align self-insurance arrangements across states and territories. Indeed, there is a strong national movement to work towards harmonisation of self insurance requirements and Victoria is actively engaged in this inter-jurisdictional work. Page 21 of 111

22 Areas with the potential for national consistency in self-insurance arrangements include: occupational health and safety audit tools; actuarial standards for self-insurance WorkCover liability assessment; bank guarantees; contingent liability insurance; entry requirements; financial contributions; and data capture. Broad consistency has been achieved in some of these areas, to some extent, although the specifics of the arrangements may differ. In other areas, there may be scope for greater consistency in arrangements. The Review recognises the potential benefits of national consistency in selfinsurance arrangements; however, a detailed consideration of opportunities for national consistency is beyond the scope of this Review. The Review attempts to bring improvements to the Victorian scheme which also will inform the broader debate in progress.. A comparison of self-insurance arrangements in other Australian jurisdictions is provided in Appendix G. 3.3 Current performance of self-insurers The Review has compared the performance of self-insurers with large scheme-insured employers (those with remuneration greater than $20 million). As self-insurers are relatively large employers, this is a more relevant comparison of performance, than a comparison against all scheme-insured employers. The performance of an employer may be affected by the industry in which it operates and its inherent risk. Therefore, to test the validity of the proposed comparison, we have estimated the notional industry risk rates of self-insured and large scheme-insured employers. The rate is calculated using WorkCover Industry Classifications (WICs) and is subject to a number of caveats 1. 1 WorkCover Industry Classifications reflect the industry in which an employer operates. Industry rates indicate the risk level of the particular industry group and are based on WorkCover's historical records of the claims experience of all the employers in the group. High risk industries are more likely to have claims and consequently the industry rate will tend to be higher. Page 22 of 111

23 The analysis suggests that self-insured and large scheme-insured employers had similar overall indicative risk industry rates of 1.95 per cent and 2.00 per cent respectively in These rates are indicative only. Table 2 outlines the characteristics of these two employer groups in Self-insured Large scheme-insured employers employers (>$20M) Number of employers Indicative notional industry risk rate Total number of claims 4,554 11,088 Key industry groups represented Finance & property Manufacturing Trade Transport & storage Communication services Finance & property Manufacturing Recreation & other Trade Transport & storage Table 2 Characteristics of self-insurers and large scheme-insured employers The data used to analyse the claims performance of self-insurers and large scheme-insured employers has been updated since the Review s draft report. The updated data reflects: three additional quarters of claims development data; improved mapping by some self-insurers of their claims data to the electronic data transfer (EDT) file that is provided quarterly to the VWA (i.e. resolution of a software supplier issue); and an update to the methodology to identify a self-insurer standard claim 2 in order to enhance the comparability with the scheme-insured employer standard claims data Key Findings on Self-Insurer Performance The updated performance analysis indicates that as a group, self-insurer performance, on balance, does not appear to be significantly different to that of large scheme-insured employers. This analysis is indicative only. A number of differences in the individual components of performance were observed: The notional industry risk ratings in these analyses have been estimated using the average of WorkCover Industry Classifications (aggregated to the level of sub-division) weighted by the spread of employer remuneration across these industries. Calculations are based upon the Gazetted Industry Rates. 2 Standard claims are defined as any claim that accrues 10 or more days off work or a minimum payment of $495, where payments include medical and like payments. Page 23 of 111

24 Between and , the average claims frequency rate for self-insurers was broadly similar to that of large scheme-insured employers. However, in more recent years, self-insurers have observed a higher average claims frequency rate than large scheme-insured employers; Over the period, self-insurers have lower average payments per standard claim compared with large scheme-insured employers; Based on survey data, self-insurers and large scheme-insured employers have achieved similar durable return to work outcomes; and Survey data indicates that overall injured worker satisfaction with the services provided by self-insurers is broadly similar to the level of satisfaction with services provided by the authorised agents for large scheme-insured employers. Whilst, as a group, self-insurer performance does not appear to be significantly different to that of large scheme-insured employers, there is variation in performance across individual self-insurers. The sections below discuss the performance comparisons in greater detail Claims Frequency Rate The claims frequency rate 3 provides a proxy measure of the injury rate for an employer. Over the period to , the average claims frequency rate for self-insurers was broadly similar to that of large scheme-insured employers. However, from to , the rate for self-insurers has been higher than that for large scheme-insured employers. This analysis is indicative only. (Figure 3). The Review notes that a number of scheme-insured employers moved across to self-insurance from onwards. To remove the effect of these new entrants and to enable a trend analysis of self-insurer performance over the period, a separate analysis has been conducted for the 21 employers that have been self-insured since at least Such an approach was suggested by the SIAV during the consultation phase. 3 Claims frequency rate is equal to the number of standard claims reported per $ million remuneration for that year. Page 24 of 111

25 The analysis indicates that the performance of the group of 21 self-insurers is similar to that of large scheme-insured employers over the entire period. This appears to indicate that the apparent increase in the self-insurer claims frequency rate from onwards may relate to the entry of new selfinsurers Claims per $m remuneration Scheme-insured over $20M 21 self-insurers from All self-insurers Figure 3 Claims frequency rate (indicative comparison only) Average payments per standard claim The average payment per standard claim indicator provides a proxy measure of return to work performance and/or injury severity. Average payments for claims in more recent years are expected to be lower than for claims in earlier years as these claims have had fewer years to develop. For example, claims recorded in have had only one year of development, compared to claims from which have had nine years of development. Hence, lower average payments in more recent years do not necessarily reflect better claims management performance. The analysis indicates that self-insurers as a group have lower average payments per standard claim than large scheme-insured employers (Figure 4). As claims mature, the gap between self-insurer average payments and large scheme-insured average payments widens. That is, self-insurers pay relatively less on older claims compared to large scheme-insured employers. The exception appears to be claims recorded in where average payments for the two groups are similar. The pattern of average claims payments for the group of 21 employers that have been self-insured since at least is broadly similar to that for all self-insurers. This analysis is indicative only. Page 25 of 111

26 $30,000 Average payment per claim $25,000 $20,000 $15,000 $10,000 $5,000 $ Scheme-insured over $20m 21 Self-insurers from 1995/96 All self-insurers Figure 4 Average payments per standard claim (indicative comparison only) To better understand the basis for the lower average payments made by selfinsurers, the distribution of claims based on payment size has been analysed, in particular the extent of smaller claims (Figure 5). The indicative analysis reveals that over the two comparison years ( and ) there is no significant difference in the proportion of smaller claims between self-insurers (ie. the group of 21 self-insurers in both of the comparison periods) and large scheme-insured employers. However, the analysis indicates that, in the two comparison years, largescheme insured employers had a greater proportion of claims with payments in excess of $50,000. This higher proportion of large claims would contribute to the higher average payment per claim figure for large scheme-insured employers relative to self-insurers. 60% 50% 40% Scheme-insured over $20M in Self-insurers in Scheme-insured over $20M in Self-insurers in % 20% 10% 0% <$2k $2-5k $5-20k $20-50k >$50k Figure 5 Spread of claims grouped by total payments Page 26 of 111

27 3.3.4 Return to work Assisting injured workers return to the workforce is a key responsibility of any workers compensation scheme. The return to work (RTW) rate provides an indication of the effectiveness of claims management activities in returning injured workers to work. Survey data from the Return to Work Monitor indicate that self-insurers and large scheme-insured employers have achieved similar durable return to work outcomes, with rates of 81 per cent and 80 per cent respectively 4 (Figure 6). 81% 74% 80% 84% 82% Self-insured Scheme insured Scheme insured >$20m Scheme insured private >$20m National >$20m Source: Campbell Research and Consulting, RTW Monitor Comparison with other large employers, May Figure 6 Durable return to work Injured worker satisfaction Injured workers are also surveyed by the VWA about their satisfaction with the workers compensation services provided by their employer, either selfinsurers or agents for scheme-insured employers. Survey data indicate that overall injured worker satisfaction with the services provided by self-insurers (58.1 per cent) is broadly similar to the level of satisfaction with services provided by agents for large scheme-insured employers (60.5 per cent) (Figure 7). 4 Durable RTW refers to an injured worker who has returned to work and who is still working at the time of interview, 7 to 9 months after making their claim. Page 27 of 111

28 Per cent Total satisfied Neither Total dissatisfied Scheme >$20m (Sep 02-Feb 03) Self-insured (Jul-Dec 02) Source: Social Research Centre, 2003 Customer Satisfaction Monitor Survey of injured workers covered by self-insurers. Figure 7 Injured worker satisfaction, large scheme-insured versus self-insured employers The survey data also indicate that overall injured worker satisfaction with the services provided by self-insurers has improved over time increasing from 51.9 per cent in 2001 to 58.1 per cent in 2002 (Figure 8) Per cent Total satisfied Neither Total dissatisfied Self-insured (2001) Self-insured (Jul-Dec 02) Source: Social Research Centre, 2003 Customer Satisfaction Monitor Survey of injured workers covered by self-insurers. Figure 8 Injured worker satisfaction, self-insured employers change over time However, the survey data also suggest that there is variation in injured worker satisfaction amongst individual self-insurers, with an indicative range from 44 per cent satisfied employees to 67 per cent satisfied (Figure 9). Page 28 of 111

29 Per cent A B C D E Scheme-insured >$20m F G Self-insurers H I J K L Figure 9 Injured worker satisfaction, individual self-insurers and means (shaded) Page 29 of 111

30 4 Detailed Recommendations Figure 10 outlines the recommendations framework which contains the proposed role statement, followed by the proposed operating model for selfinsurance. The operating model is supported by access requirements and oversight arrangements for self-insurance. Role of self-insurance 1 Adopt a clear role Operating model 2. Establish a tripartite working group for self-insurance 3. Introduce a three-tier oversight model based on performance 4 Introduce an improvement program 5. Integrate self-insurers within the scheme 6. Implement flexible renewal periods Access Oversight 7. Provision of financial undertaking from self-insurer 8. Establish claims management resourcing guidelines 9. Introduce performance indicators 10. Implement a consultation process at application and re-application stages Mergers De-merger and demergers access provisions Monitoring 12. Implement a performance driven audit and action plan framework 13. Develop a performance management system 14. Improve worker awareness of complaints processes and introduce complaints reporting 15. Develop a best practice transfer program Financial 16. Develop an actuarial peer review process 17. Provide scheme actuarial information to self-insurers 18. Increase transparency of of contributions Claims 19. Self-insurer in-house claims policies 20. Implement claims litigation notification/ consultation and seek legislative power to impose condition 21. Develop a process to share claims history information Health and Safety 22. Conduct a survey of workplace culture 23. OHS reporting in in self- self-insurer annual annual reports Figure 10 Recommendations framework Highlighted recommendations apply only to the legislative change model (option 2). Page 30 of 111

31 Role Operating Model Oversight Access Monitoring Financial Claims Health & Safety 4.1 Role of self-insurance Recommendation 1: That the VWA adopt the following statement defining the role of selfinsurance in Victoria. The role of self-insurance in Victoria is to provide choice to eligible employers to manage and bear the costs and risks of their own claims. As an integrated component of the overall scheme, self-insurance should: provide direct incentives to improve injury prevention and rehabilitation performance; ensure that workers are treated fairly and equitably; contribute to continuous improvement in health and safety and return to work performance; and facilitate best-practice transfer across the scheme Current role of self-insurance Employers who are self-insured are responsible for managing their workers compensation claims and for bearing the costs and risks of the claims. This is in contrast to scheme-insured employers who pay an annual premium to transfer this risk and the claims management function to the VWA and its Agents. The role and purpose of self-insurance in Victoria is not clearly articulated in the Act. Stakeholder views on the role of self-insurance are mixed. In its September 2003 submission, the Self-Insurers Association of Victoria (SIAV) discussed self-insurance in terms of it providing employers with the choice to cover their own workers compensation liabilities and the incentives to provide safer workplaces and to minimise the impact of injury on injured workers. Page 31 of 111