Work Account: Experience Rating Consultation. Submission by: The Southern Cross Medical Care Society

Transcription

1 Work Account: Experience Rating Consultation Submission by: October 2010

2 Work Account: Experience Rating Consultation Page 2 1. Introduction This submission is made on behalf of The Southern Cross Medical Care Society ( Southern Cross ) as outlined below: Private Bag Newmarket Auckland Contact: policy@southerncross.co.nz Southern Cross welcomes the opportunity to comment on the proposal to introduce experience rating into the ACC Work Account from 1 April Southern Cross s submission takes into consideration its role as; An employer (with 500 staff) with responsibility for workplace health and safety and management of workplace injuries under the ACC Partnership Programme. A Third Party Administrator for the ACC Partnership Programme. Our Care Advantage business provides case and claims management services to employers who take responsibility for the management of workplace injuries. Southern Cross supports the provision of a 24-hour, no-fault accident compensation scheme. Introducing experience rating to the ACC Work Account is a further step in the application of an insurance model to ACC. If experience rating is appropriately structured and effectively implemented then it should achieve its stated objectives (i.e.): provide a financial incentive to prevent injuries encourage appropriate return-to-work programmes Make levies fairer for businesses by ensuring that low-risk employers do not subsidise high-risk employers. Our comments are based upon the proposed Experience Rating Framework. If the framework was modified (e.g. reducing the size of the discounts) then clearly this would impact on the success of the programme. Southern Cross supports the introduction of experience rating into the Work Account but has some comments on the proposed framework, transitional arrangements and service delivery options for employers.

3 Work Account: Experience Rating Consultation Page Recommendations These recommendations are described in further detail in sections ACC provides employers with relevant information that will enable them to objectively assess the merits of the Experience Rating and ACC Partnership Programmes. 2.2 ACC makes it clear to employers that the Experience Rating Discount and No Claims Discounts are being funded by increasing base levies (and reducing the WSDP and WSMP discounts). 2.3 ACC enables Experience Rated employers to choose their case manager (from ACC or selected Third Party Administrators). TPA s could be contracted to ACC to provide claims management services to employers.

4 Work Account: Experience Rating Consultation Page 4 3. Proposed Experience Rating Framework Experience rating and the no claims discount are compulsory (unless the employer is in the ACC Partnership Programme). They replace the standard employer levy rates. In theory, this means that employers will have similar choices to those they had prior to the introduction of experience rating. However, as experience rating introduces incentives to recognise work place injury claims, employers may wish to reconsider their alternative option of the ACC Partnership Programme. In addition some employers in the ACC Partnership Programme may wish to evaluate the merits of moving to Experience Rating. To evaluate their options, employers will require a range of information including: Experience Rating Programme: Their workplace injury claims history The employer s industry rate group and industry peer group WSMP discounts that may apply Residual Claims Levy ACC Partnership Programme: WSMP discounts Full Self Cover or Partnership Discount Plan discounts Unallocated Primary Healthcare Charge Administration Fee High Cost Claims Cover Stop Loss Insurance premium Residual Claims Levy TPA fees Claims costs Assessing these options will require detailed analysis. Some employers may seek independent advice on their workplace insurance options In a competitive insurance market an adviser would assist the employer to evaluate these options. This adviser could be an insurance broker, consulting actuary or accountant. Insurance brokers are often remunerated through commission which is included in the insurance premium charged. However, there is no indication that ACC is planning to pay for this advice. ACC needs to consider this issue and its role in providing robust, objective information to employers.

5 Work Account: Experience Rating Consultation Page 5 It is recommended that ACC provides employers with relevant information that will enable them to objectively assess the merits of the Experience Rating and ACC Partnership Programme. 4. Funding the Experience Rating Programme The consultation documents clearly indicate that Experience Rating and the No Claims Discounts will be funded by increasing the base levies and reducing the WSDP and WSMP Discounts. The consultation documents do not indicate if any of the expected reduction in workplace injury claims has been included in the levy and discount calculations for 2011/12. Therefore, we can only assume that there is limited (if any) behavioural change anticipated in the levy calculations. This means that all employers (on average) are effectively paying for the experience rating discounts that they are receiving. While employers with good workplace safety record will receive lower levies than those with a poor record, they may not see a significant reduction in their levies as they transition to the new programme (due to the experience rating discount being offset by an increase in base levies and reduction in the WSDP and WSMP Discounts). ACC needs to ensure that employers understand how the Experience Rating Programme is being funded. 5. Providing employers with a choice of claims manager The consultation documents indicate the key lessons learned from other jurisdictions about experience rating programme including: Any financial incentive needs to have strong links with injury prevention and injury management programmes. Employers will take action to reduce claims costs when they consider that the financial impacts on them are high and that they can influence the financial impacts, and where any discount is received within one to three years. There are risks around adverse behaviours with experience rating systems. Particular issues include underreporting of injuries, reporting work injuries as non-work injuries, employees returning to work before they are sufficiently recovered, and employers not hiring workers who have previously been injured.

6 Work Account: Experience Rating Consultation Page 6 With strong financial incentives, experience rated employers will seek the required skills and expertise to help them manage their: Injury prevention and management programmes Case and claims management Rehabilitation This expertise resides within ACC and in the private sector. The ACC Partnership Programme has led to the development of significant private sector capability (through TPA s and large employers) in the prevention and management of workplace injuries. However, under current proposals, experience rated employers will not have a choice of service provider (that will be funded through the programme). A wider choice of service provider (comprising ACC and selected TPA s) is expected to encourage greater engagement in the programme because employers will have a wider range of skills to apply to the prevention and management of their workplace injuries. If one service provider is not able to meet the employer s requirement then they can select an alternative and assess whether they are able to help them achieve their particular goals. Furthermore, as TPA's are already involved in the ACC Partnership Programme they have some understanding of the risks associated with employers adverse behaviours associated with experience rating. These risks are currently being managed through the ACC Partnership Programme by employers, TPA s and ACC. It is recommended that ACC contracts directly with selected TPA s to provide services to experience rated employers. ACC could manage the contracting process. Employers could then simply select their service provider. Unlike the ACC Partnership Programme many experience rated employers may not have sufficient scale to warrant them managing their own contacting process for a service provider.