Synopsis by Topic

Increasing Workers’ Health Literacy to Improve their Claims Experience

Kirsty Smith

Submitting a claim after a workplace incident and entering the workers’ compensation scheme can be a confusing and overwhelming experience for an injured worker. The legalistic nature of the system and the medical terminology used to discuss the injury itself can reduce a worker’s sense of ownership over their recovery and ability to return to work.

We know that this lack of health literacy can lead to confusion, disengagement and a sense of hopelessness after a work-related injury. To address this inadequacy of knowledge and help injured workers confidently approach and engage with their claims scheme, EML has developed a series of video resources to support them as they navigate the recovery and return to work process.

The videos inform workers about what to expect from a first appointment with a clinician and the types of treatment they should expect to receive. Clinicians featured include a psychologist, psychiatrist, exercise physiologist, General Practitioner and an Independent Medical Examiner. An overview of what to expect from their case manager, a spotlight on PTSD and a spotlight on persistent pain were also developed to complement the series.

Key messages in the videos inform workers that:

• they should be getting best-practice treatment
• they have the right to ask their clinician what treatment they will be receiving and what evidence supports it
• they should expect to recover
• they need to play an active role in their recovery and that some treatment will be emotionally or physically painful

We will present on the importance of an engaged, hopeful and health literate injured worker and the subsequent impact of the video series.

Taking a ‘Whole Family’ Approach to Recovery in Workers’ Compensation

Elisa Hitchens, Dr Gianfranco Giuntoli 

Injured workers are 25% more likely to divorce than the non-injured population.

As this startling statistic shows, workplace injuries place considerable strain on relationships as social roles are disrupted, financial hardship may be experienced and additional support is required.

To address these issues, EML has undertaken a research project to better understand the needs of injured workers and their families with the assistance of the Social Policy and Research team from the University of New South Wales.

Injured workers call on their families for assistance while they recover and their incapacitation can cause significant stress for the wider family depending on the permanency and/or duration of the injury. EML has been working to better assess worker needs to enhance the prospects of recovery. However, it became clear that assessing the needs of injured workers also required an understanding of the relationships and factors that might help or hinder their recovery.

Previous research has highlighted that key concerns for family members after an injury include:

• Having time to yourself in the day
• Knowing what to expect in the future
• Practical help in the home
• Looking after your own health
• Dealing with your feelings and worries

To confirm our understanding of how to approach a family conversation and when to do this, we initiated a research project. The project involved three components, including a rapid evidence assessment Case Manager, employer focus groups, and interviews with injured workers and their families. The work undertaken will be followed up by a pilot to qualitatively and quantitatively assess the success of taking a ‘whole family’ approach.

This presentation will provide an overview of the learning gained through the rapid evidence assessment, focus groups and interviews and how this ‘whole family’ approach will be applied to claims going forward.

Blurring the Boundaries – The Implications of Rideshare on CTP

Andy Kanchik, Vivian Tse, Ning An, SIRA

With the popularity of rideshare for passengers and drivers, regulators in all jurisdictions are faced with the challenges of this emerging trend.  There are many aspects requiring consideration including maintaining a level playing field for other scheme participants, pricing implications, equity, legislation and futureproofing the scheme to handle further disruption.

The purpose of the presentation is to:

1. Explore the history of ridesharing companies in NSW and how the NSW CTP scheme caters for rideshare vehicles in the context of existing participants (e.g. taxis). Walking through the “evolution” of ridesharing companies, as well as the legislative landscape in which rideshare vehicles operate in NSW.
2. Provide findings from ongoing analysis of rideshare claims experience to date. As ride sharing companies and taxis are paying vastly different premiums, we explore whether this is being justified by the experience. Are CTP premiums in NSW fair for rideshare vehicle owners? Are they fair for the taxi industry?
3. Compare rideshare experience in the NSW CTP scheme to other jurisdictions both locally and abroad, identify key drivers of claims experience and how this compares on a local and international stage. Are other jurisdictions facing similar challenges? If so, what are they doing about it.
4. Explore the possible future(s) of rideshare and the subsequent emerging risks, as well as challenges faced by the regulator in designing a fair and equitable CTP policies for the future.

Data-Driven Fraud Prevention

Justin Toh, Greg Kabashima, Sophie Gemmell

Provider fraud is a well-known threat to both scheme sustainability and client outcomes, but the challenge is often in identifying, quantifying and proving inappropriate or illegal behaviour.

The presentation will showcase our work in identifying and addressing fraud and non-compliance in the healthcare system, providing real-world examples of the approaches and impact achieved.

Topics covered include:

• The spectrum of provider fraud -from low value care through to illegal activities
• The promise of data-driven approaches to fraud identification
• Common challenges and the capabilities required to overcome them
• Clinical engagement and behavioral economics to address issues
• Translating insights into enforcement and investigations

Performance Enhancing: A look at Modern Operational Performance Rating Models

Hugh Miller

KPIs and performance are mainstays of scheme management. We would like to know which groups (be they regions, insurers, teams or individuals) are delivering good outcomes relative to others and which are underperforming. In some cases, such measurement can be linked to explicit performance incentive payments, so the measurement is important.

However, in many cases there are challenges. Groups may be working with different cohorts with different characteristics which makes like-for-like comparisons difficult. The number of observations might introduce uncertainty and the need to understand the significance of differences. And results need to be combined and communicated in a way that is meaningful.

The paper looks at models of performance ratings that focus on setting baseline performance at an individual level by means of a model. By doing this, we can adjust for caseloads and make formal estimates of uncertainty. These types of models are directly relevant to injury schemes which have significant information collected at an individual claim level.

We also present several examples of such models in practice our main case study are the star rating models used in Commonwealth employment service programs, where these types of models are used to correct for large differences in client characteristics.

Drivers not wanted: Debunking the relative risk of passenger vehicles versus SUVs

Jon Vallance and Christine Min

With the substantial growth in the popularity of sport utility vehicles (SUVs) over the last couple of decades and the conflicting views on their safety, SIRA is undertaking a relative risk study comparing the experience for various classes of passenger vehicles versus SUVs.

The analysis will utilise NSW CTP policy data and claims data over a recent ten-year period, and includes data across all insurers to form a scheme-wide view.   Vehicles have been grouped with reference to the Federal Chamber of Automotive Industries listing.

Our presentation will provide:

• An initial overview of the NSW CTP premium system including current scheme prescribed premium mechanisms will open the session to provide context.

• A brief high-level discussion on the technical build of the analytical model, which will control for factors such as owner/driver age, region, vehicle age, and claimant role
• A focus on the insights arising from the analysis and what significance these insights may hold from the lenses of the regulator and NSW CTP insurers. 

At the time of this synopsis writing, final conclusions are pending.

Will legal tech change claimants' use of lawyers?

Genevieve Grant and Clare Scollay

Legal technology is transforming the way legal information and services are provided across a host of sectors. Legal tech with the most relevance for injury and disability schemes includes digital self-help and legal information tools (such as legal apps and chatbots based on decision trees and expert systems) and online dispute resolution platforms. Developments in this field hold great promise for improving a range of client outcomes known to be negatively affected by delayed, complex and combative claims processes. Major access to justice reviews have also lauded their benefits. Despite the promise, however, legal tech remains underutilised in injury claims.

This presentation introduces legal tech and its potential applications in the injury compensation and disability scheme sectors. It explores the current and likely future influence of legal tech, and the associated barriers and facilitators. In particular, it investigates whether legal tech will change the dominant models of claimants’ engagement and use of legal services in injury claims.

The analysis draws on qualitative research with claimants about their claiming decisions and use of legal services, together with emerging evidence about digital legal capability in the community. Showcasing local and international examples, the presentation will identify best practices and traps in the design, implementation and evaluation of legal tech for the sector.

This presentation will be topical for scheme, insurer and other stakeholders interested in understanding the dynamics and likely future course of claimants’ use of legal services.

All in the mind? Causes of Psychological Injury Claims and Options for Prevention

Sue Freeman, Raj Kanhai

Does the trend of increasing awareness of mental health conditions in the community and in workplaces suggest that more psychological injury claims are inevitable? Our presentation examines:

1. Common circumstances and potential contributing factors relevant to the notification of psychological injuries
2. Options for organisations to prevent such psychological injuries or claims.

We provide an overview of the possible root causes of psychological claims under a framework that recognises the interacting influences of People, Systems and Environment.

We then look at circumstances and factors associated with these claims, including alleged bullying/harassment, management practices, performance or grievance management, interpersonal conflict, workload issues etc. We highlight that many people who lodge a claim relating to a psychological condition have a variety of personal vulnerabilities, including pre-existing mental health conditions. 

We also look at other factors that contribute to the making of psychological injury claims, such as:

• Increased community awareness and acceptance of mental health conditions
• The ‘medicalisation of distress’
• Typical workplace avenues for managing grievances and providing mental health support
• The role and influence of GPs andtreatment providers
• The role and influence of work supervisors and managers, HR Departments and unions.

We suggest that management of mental health conditions in the workers compensation system is often not in the best interests of the sufferer.  We ask whether effective early and appropriate intervention and support can reduce psychological distress and address the workplace drivers of such distress.  Further, we suggest that direct managers having the skills to recognise early signs of distress, as well as the confidence to discuss them openly and look for solutions, could possibly avert many claims by providing pathways to address the issues and provide support outside the workers compensation system. 

Preventative measures must first take into consideration the known workplace factors likely to impact workers’ mental health.  We suggest strategies that could be specifically tailored to address the types of circumstances we have identified. We use the framework of ‘People, Systems and Environment’ to describe an integrated approach incorporating key initiatives in each of these areas. 

Finally, we discuss elements of a comprehensive strategy for employers to address the underlying issues giving rise to psychological injury claims:

• Commitment
• Employee engagement
• Comprehensive operational strategy in several key areas, which we outline
• Stakeholder engagement and support
• Measuring and monitoring

Best Practice Treatment whilst Protecting Scheme Sustainability

Lisa Boyd, Kevin McMahon

Delivering the right treatment at the right time is essential in supporting the recovery of compensable patients.  However experience has shown that having the right treatment policy frameworks and commercial fee structures are also critical to getting the best outcomes.

In this presentation we will look at some of WorkSafe’s recent successes and some of the challenges encountered in developing the treatment pathways, policy frameworks and commercial arrangements that underpin good patient outcomes.  The right policy position and commercial arrangements are equally relevant to the treatment of both mental and physical injuries.  Work on improving these areas can have a positive impact on scheme sustainability along with providing better outcomes for compensable patients.

We will also cover the benefits of structuring provider fees to drive patient outcomes, incentivise appropriate treatment and ensure case complexity is not a barrier to treatment.  Conversely, we will look at examples where incorrect commercial arrangements with high fees have created the incentive for over servicing and on occasion's unnecessary or harmful treatment.  

And we will look at new opportunities to reduce provider fee pressure.  Examples include:

• Development of innovative commercial funding arrangements incentivising correct provider behavior
• System controls and audit practices to mimimise inappropriate billing
• Strategies to control over servicing
• Reviews of existing commercial arrangements
• New partnership service models.

Comcare’s Trial of the NewAccess Program

Natalie Bekis

Poor mental health effects one in five Australians and is costing Australian workplaces $10.9 billion.  In addition to the economy, the ripple effect impacts personal relationships, families and the community at large.  It’s inevitable that all employers will need to manage mental health issues whether or not they are work-related and early intervention is key to reducing its impact, however there can be confusion around choosing an appropriate early intervention programs that will have the desirable human and financial impact.

NewAccess is a Low-intensity Cognitive Behavioural Therapy (Li-CBT) early intervention program developed by Beyond Blue to assist adults with mild to moderate anxiety and/or depression to manage life stressors.  The program is delivered by lay people with training in a specific form of Li-CBT and is currently provided as a community-based program through selected Primary Health Networks.  

Comcare has worked closely with Beyond Blue to trial the NewAccess service and explore its effectiveness when offered within a workplace setting.

The small scale trial which was evaluated by PricewaterhouseCoopers (PwC) successfully delivered recovery rates of 78% for participant employees at diagnosable levels of anxiety and/or depression (well above the 67.5% recovery rate of the community-based program).  This presentation will provide the audience with an in-depth look at the Comcare trial of the NewAccess Program.

The presentation will cover:

• the poor trends for mental health in Australia highlighting the dire need for workplaces to address the issue of poor mental health;
• Comcare’s statistics on psychological-related workers’ compensation claims and Comcare’s business case for the development of the trial;
• the unique methodology used for the trial to enable integration into the workplace and the high success rate;
• the results of the trial including benchmarks with other like services, post service survey results, and an actuarial analysis conducted by PwC to better understand the impact of delivering this service on a wider scale; and
• Comcare’s next steps and ideas for scaling up the service to ensure the maximum benefit to employers.

Comcare would like to share the details of the trial with industry as the results provide a different perspective on how to effectively manage mental health issues in the workplace.

"You'll be fine – you've only sprained your brain": Practical Steps Toward Normalization of Expectations and Improvement of Treatment for Emotional Harm

Robert Aurbach

Despite solid evidence that most mental health concerns are treatable and have good prognosis, we continue to see extended periods of treatment and long term disability that are not consistent with evidence based best practices or the long term interests of the patient/claimant.  Patient/claimant expectations have a huge influence on their recovery and claims costs.  When little distinction is made between minor complaints with excellent prognoses and more serious concerns, expectations are not managed.  When diagnosis is based exclusively on the symptoms reported by the patient to non-specialist treaters, the probability of correct diagnosis and appropriate intervention is diminished.  When a snapshot "initial diagnosis" is treated as continuing definition of the current condition of the patient, the fluidity of mental health concerns is ignored. When clinical evidence concerning appropriate therapy is ignored, the treatment given can focus a patient on their symptoms to the detriment of his or her recovery. The medical and psychological/psychiatric professions have not sufficiently taken the lead in minimizing the danger and cost of these sources of "medicalization" of mental health concerns. 

There are practical steps that can be taken at the legislative and claims administration levels that will encourage correct diagnosis, setting of positive expectations for recovery and utilization of the best available therapies.  Getting a correct diagnosis is necessary to guide evidence – based treatment.  Utilization of the evidence based best practices for treatment, including setting of appropriate recovery expectations and periodic reassessment, is necessary to ensure that the treatment given does not further harm the patient.  Simple practices that can be implemented by claims administration staff can influence treater behavior and patient recovery trajectory.  Surgical legislative changes can empower further changes and provide guidance for reviewing tribunals.

Collectively, these steps have the potential to significantly impact mental health claims and secondary psychological overlay on mental and physical harm.  Both the systemic and human costs of these claims can be reduced.

Translating Research into Effective Workplace Mental Health Programs

Samantha Barker

Introduction

Mental health is one of the major health issues affecting Australians, representing 12% of the overall burden of disease.¹ It is estimated that one in five working Australians will experience an affective, anxiety or substance use disorder in any given year and the cost of mental health conditions to Australian business is estimated at $10.9 billion per year.^{2, 3} WorkSafe Victoria, through the Institute for Safety, Compensation and Recovery Research (ISCRR), has invested in a range of research projects to improve preventive workplace mental health programs.

Methods

ISCRR’s program of work in this area has included: systematic reviews of available evidence, environmental scans of best practice initiatives globally, evaluations of current programs and analysis of workplace compensation claims data.

This research has led to many valuable insights, including:

• Programs that effectively prevent work-related mental health conditions deliver a financial return to companies.
• Workload management is critical to preventing work-related stress and tools exist to assist organisations to better manage workload.
• Tools have been developed that provide a more accurate measure of the effectiveness of prevention programs than injury or time loss data.
• There are critical links between musculoskeletal injuries and mental health conditions that must be understood to prevent both injury types.

Conclusion & Recommendation

ISCRR has been actively translating the research findings to inform the development of new workplace mental health promotion programs, including Victoria’s new $50 million state-wide initiative WorkWell.  Organisations planning workplace mental health programs can utilise the growing evidence base to identify effective approaches.

1. Australian Institute of Health and Welfare. Impact and causes of illness and deaths in Australia 2011. Canberra; 2016.

2. PwC. Creating a mentally healthy workplace: return on investment analysis. beyondblue, National Mental Health Commission,The Mentally Health Workplace Alliance; 2014.

3. Department of Health. Prevalence of mental disorders in the Australian population Canberra; 2009. Available here.

Psychological distress in Australian workers' compensation claimants: prevalence, predictors and mental health service use

Alex Collie

Workers’ compensation is the primary means via which Australian governments provide treatment and financial support to people with work-related conditions. Psychological distress can complicate recovery from physical injury, however the prevalence and predictors of distress among injured workers are not well documented. This study sought to (1) determine the prevalence and predictors of psychological distress among injured and ill workers, and (2) determine the prevalence and predictors of mental health service use in workers reporting psychological distress.

This cross-sectional survey was conducted April to May 2018. Participants were recruited to complete the National Return to Work Survey (NRTWS) conducted biannually by Safe Work Australia with the input of nine Australian workers’ compensation schemes. This analysis includes a convenience sample of adults with work-related musculoskeletal disorder or mental health conditions and accepted workers’ compensation claims with at least one day off work. The main outcome measures are psychological distress measured using the Kessler-6 scale, and self-reported mental health service use.

Survey participation rate was 82%. A total of 3755 workers met inclusion criteria and were included in the study (Musculoskeletal disorder = 3,160; Mental health condition = 595). Of these, 1034 (27.5%) and 525 (14.0%) recorded moderate and severe psychological distress, respectively. The majority of workers with a mental health condition claim (61%) recorded psychological distress while a large minority of workers with musculoskeletal conditions (38%) also recorded psychological distress. Multivariate ordinal logistic regression revealed that being off work, poor general health, low work ability, pain, financial stress, poor workplace support, younger age, requiring support during the claim, stressful interactions with healthcare providers and having diagnosed mental health condition were significantly associated with presence of psychological distress.

Of included workers with mental health condition claims, 91.1% (n=541) reported accessing specialist mental health services, including 94.5% (n=342) of those with moderate or severe psychological distress. In contrast, of workers with musculoskeletal disorders and either moderate or severe psychological distress (N= 1197), only 20.5% (n=170) of workers moderate distress and 42.3% (n=155) of workers with severe psychological distress reported accessing mental health services. Severe psychological distress, being off work, employment in education or public administration, worse general health, requiring support during the claim, having stressful interactions with healthcare providers, and extensive contact with the insurer were associated with greater odds of mental health service use.

The prevalence of psychological distress among workers’ compensation claimants is high. Most workers with musculoskeletal disorders and psychological distress do not access mental health services. Screening, early intervention and referral programs may reduce the prevalence and impact of psychological distress. 

Minimising the Inherent Psychological Risks of Serious Injury and Illness

Samantha Breust

This presentation examines;

• What the research says – the mental health consequences of serious illness or injury

• A Case study review – the lessons of experience

• What can we do – preventive factors and the biopsychosocial approach to compassionate recovery. This includes;

• Minimising the inherent psychological risks of severe illness and injury

• Approaches to employee support for compassionate recovery

• Working within the biopsychosocial model to maximise recovery

• Tailoring service provision to the individual

The audience will understand the concept of post-traumatic Resilience; what it is; what it takes to develop and follow the journey of “Alex” through a case study.

Biopsychosocial implications of serious injury and illness are discussed offering practical steps to help these

Finally, understanding the personality traits of seriously ill or injured employees and how doing so may assist with the customisation of programmes to assist to minimise the risk of developing psychopathology.

Life Expectancy for People with Catastrophic Injuries

Darryl Frank

Life expectancy is a critical determinant of costs for lifetime care schemes. With all states and territories having no-fault catastrophic motor and workplace injury schemes, now is an opportune time to review and analyse the mortality experience for participants of these schemes.

This is an update of analysis that was presented at the 2013 Injury Schemes Seminar, which showed that the amount of care participants required was a strong predictor of life expectancy.

This presentation focusses on the following aspects of mortality rates for people with brain and spinal cord injuries:

• How the 2013 mortality assumptions compared against actual experience for scheme participants from Victoria, New Zealand and Tasmania.
• A comparison of the approaches used to project mortality rates for different schemes.
• Enhancements to the methodology and refinement of mortality assumptions based on experience to 2019.
• The importance of reliably projecting the number of deaths within different participant cohorts. The large variation in lifetime costs for different participants means that without delving into different cohorts there can be large movements in liabilities even when the total number of deaths is close to expected.

Silicosis – The Dust has not Settled

Gavin Moore, Khar Mun Tang

Recently there has been an increased focus on the emergence of silicosis following a significant increase in the number of workers diagnosed with the disease. The emergence of silicosis has raised important questions as to the occupational, health and safety standards of workers, in particular stonemasons, and the ability to be able to detect this disease early through medical screening. Of particular concern is the number of younger workers who are being diagnosed with the disease. In response, the coalition government has promised to spend $5m to establish a taskforce to set up a national dust diseases register and to commission research into occupational lung diseases.

We will be discussing the recent experience in respect of silicosis including the reasons for the high number of recent reports and the potential impacts on injury schemes around Australia.

Step-Downs Decrease the Amount of Compensation Paid to Injured Workers to Encourage Return to Work. Are they Effective?

Tyler J Lane, Luke Sheehan, Shannon Gray, Alex Collie

Step-downs reduce the amount paid to injured workers at set points in the life of the claim. Originally introduced in the 80s and 90s to control rising premiums, they are now promoted and justified as a means to incentivize return to work. However, there is almost no research into whether they actually have an effect. Nevertheless, every major Australian jurisdiction has adopted them. Each varies substantially in when they take effect (timing) and how much compensation is reduced (magnitude). Given the nine major jurisdictions in Australia, there is an excellent opportunity to analyse whether step-downs affect the benefit leaving rate and if this varies by timing, magnitude, or condition type.

For this study, we will apply a regression discontinuity design. This is considered one of the most powerful quasi-experimental study designs which, if conducted properly, simulates randomized controlled trials. Our data are from the National Dataset for Compensation-based Statistics, a case-level administrative dataset compiled by Safe Work Australia from each Australian workers’ compensation jurisdiction. These data will be converted into summary tables specifying the proportion of claimants leaving the scheme each week.

Analysis is currently underway. To refine our approach we have practiced with Victorian claims. These results suggest small but statistically significant increases to the benefit leaving rate in the week prior to the step-down taking effect at 13 weeks of compensation. Preliminary results by condition type suggest considerable variation, with mental health and neurological conditions having the strongest responses.

Once individual analyses are complete, we will combine results into a meta-analysis to determine overall step-down effect and whether this varies by timing, magnitude, and condition type. The study has been pre-registered with the Open Science Framework (https://osf.io/pt876/).

Waging war: A new wage inflation forecast model

Hugh Miller and Glenn Cardinio

Wage inflation is a key concern for injury schemes, where small differences in average growth rates can lead to large differences for pricing and reserving estimates. Market forecasts can suffer from poor accuracy and volatility over time, meaning that there is a lack of good objective estimates of future wage growth.

We present an inflation forecasting model for Australian Weekly Earnings, built with actuarial implications in mind. It is composed of:

• A Consumer price index (CPI) inflation estimate, which depends on a long-run assumption, the shape of the current nominal bond yield curve and the gap between nominal and inflation-linked bond (ILB) yield curves.

• An AWE gap (AWE minus CPI) estimate, which depends on a long-run assumption, the shape of the current nominal bond yield curve and the unemployment rate (either national or state).

We show the derivation of our proposed model and test its effectiveness in a variety of ways. Two of the key features is natural integration between inflation and discount rates and also the improved stability over time compared to other market forecasts.

Read the paper.

Analytics to Inform Claims Triage Design – Building on WorkSafe and Industry Experience

Justin Toh, Christian Thorn, Kathryn Gulifa, Donald Freudenstein

This talk will cover a data-driven approach to Claim Triage that supports a client-centric and prevention-led approach to workers compensation claims management, as well as the insights yielded from the experience. At its heart, it uses past claims experience to understand the basis of risk and worker needs for support to help with RTW.

This presentation will cover:

• WorkSafe’s journey with Data and Analytics as part of its 2030 Strategy
• The importance of data and analytics to design a claims triage approach that supports workers on the basis of risk and need
• An innovative approach to identifying claims where case manager intervention can yield the greatest benefit to worker return-to-work outcomes
• Insights as to the key risk factors impacting worker return-to-work outcomes, and how these factors differ between Mental Health and Physical Injury claims
• Events arising over the life of a claim that shift the predicted level of worker need
• The importance of considering risk tolerance and a robust approach to piloting and testing

Could Insurer Policies and Procedures Inadvertently Contribute to Risk Factors for Delayed Recovery? The Case of Perceived Injustice

M.J.L. Sullivan PhD, Rachel Elphinston PhD

Emerging research suggests that individuals who experience high levels of ‘perceived injustice’ following injury are at high risk for delayed recovery. The relation between perceived injustice and delayed recovery has been demonstrated in several countries, and in the context of a wide range of debilitating health and mental health conditions.  High levels of perceived injustice have been associated with several adverse recovery outcomes including more severe symptoms, susceptibility to developing mental health problems, prolonged work absence and litigation. Research has also shown that current treatment approaches used in the management of disabling injury have not yielded meaningful reductions in perceived injustice. Our group has been involved in a program of research aimed at identifying the factors that contribute to perceived injustice in the 6-week period immediately following claim submission. We have recently completed two research studies, one in Queensland, AU, and one in Quebec, Canada, where claimants with high perceived injustice scores were interviewed about the factors that contributed to their sense of injustice. This presentation will summarize findings on the range and prevalence of injustice-eliciting factors in the early post-injury period. Special attention will be given to injustice-eliciting factors that are potentially preventable. Recommendations will be made for changes to insurer policies and procedures that might be effective in preventing the emergence of perceptions of injustice following debilitating injury.

Exploring the Drivers of Increasing Medical Costs for Schemes and Hospitals

Scott Collings, Julia Cooper, Dai Liu

Medical and related costs are increasing for injury and disability schemes, in some cases much faster than general economic inflation. This is not an isolated phenomenon, however, as there are clearly observable financial pressures more broadly across our entire healthcare system which is also challenged by the increasing cost of delivering clinical services.

We examine these cost pressures from the perspective of both injury and disability schemes and hospitals, seeking to understand the underlying drivers. In particular, we explore the broader societal drivers of increasing medical costs (eg. mental health, chronic disease and demographics) as well as factors that are more specific to the operating environments of injury and disability schemes and hospitals.

Lifetime Care Schemes: Setting, Achieving and Measuring Participant Outcomes

Aaron Cutter

Australia’s lifetime Care schemes and the NDIS have ‘participant outcomes’ as one of their key goals. These schemes use a participant’s own goals and aspirations as part of the treatment and recovery plan with the aim of achieving participant specific outcomes and efficiency in treatment expenditure for the scheme.

This presentation will cover the results of a national survey of Australia’s lifetime care schemes and the NDIS including:

• A comparison of at how participant based outcomes are measured – reporting on similarities and innovations in measuring outcomes.
• If relevant, a summary of how these measurements have evolved
• How do schemes use measurement of outcomes to drive internal case management or claims practices
• Do they measure achievement of participant outcomes?

Finally, as a resource for other schemes, we will use the survey results to present a straw man of the best outcome measures and processes for using these in case management design and practices.

Made to Measure: Wellbeing Frameworks, Linked Data and Person-Centred Outcomes

Laura Dixie, Hugh Miller

Over the last fifteen years broader client outcomes have increasingly become a focus for injury schemes. A desire to understand elements such as health, quality of life, social supports have complemented traditional financial sustainability measures. This has, in part, been helped by the increased collection and availability of data. Return-to-work outcomes and participant satisfaction form concrete examples of metrics which have been monitored for several years. More recently there have been movements toward developing full outcomes frameworks, where progress is tracked across multiple domains (most notably by the NDIS[1]).

These developments are mirrored in other sectors. THE OCED reports on a well-being framework in its How’s Life? publications[2]. Internationally, Governments are broadening their focus to consider citizen wellbeing and happiness[3].

Australian government departments are increasingly interested in including measures of societal benefits provided by services when evaluating programs. They are focused on evaluating services based on their delivery of positive outcomes across a range of well-being domains instead of solely measuring the cost of the service delivery net of any reduction in future service usage. For example, NSW has adopted the NSW Human Services Outcomes Framework, which specifies seven wellbeing domains for the NSW population: safety, home, economic, health, education and skills, social and community, and empowerment[4]. Target outcomes are identified for the short , medium and long term. Any particular program can then be linked to the intended outcomes. Data which can be used to monitor the outcomes is collected and monitored. The NSW Premier has also set twelve objectives across these domains against which progress is publicly tracked[5]. Wellbeing measures tend to be more challenging to identify and measure than cashflows. Some measures can be subjective. Measures can also be difficult to compare. While there are standard practices for netting cashflows off against each other, it’s less clear how improvements in health compare to improvements in education (and by extension how you trade them off against each other). This can require a shift in mindset in reporting and interpretation.

This presentation will give an overview of wellbeing frameworks and recent developments on their use in various jurisdictions. This will be complemented by examples of how the frameworks are being used in practice.

We will also spend some time examining one particular cross-sectoral analysis paper we have undertaken for the New Zealand Government, where we examined movements off welfare in New Zealand[6]. This provides an interesting case study of measuring outcomes using linked administrative data. It also represents the early phases of a move to a broader view of outcomes and performance than just financial metrics. The work was carried out in the Stats NZ Integrated Data Infrastructure (IDI) which holds a vast collection of administration data as well as census and survey responses. The data is de-identified but linked across the different services providing the opportunity to explore outcomes across a range of sectors.

We studied a cohort of 140,000 people who exited welfare over a two-year period. Using linked cross-sectoral data we could observe these people for the subsequent two years. We could identify a fairly broad set of activities over the period including:

• Return to welfare
• Income from employment
• Tertiary education enrollments
• Training course enrollments
• Movements overseas
• Prison spells
• Age pension receipt (NZ Super)
• Deaths

  Through this work we could make many observations about welfare exits. This included developing shorter-term indicators for longer-term results, and the risk factors associated with poorer outcomes (less work and higher rates of return to benefits).

  The New Zealand Ministry of Social Development has since carried out an analysis based on this with a more recent cohort[7]. This has enabled them to identify how outcomes have changed over time and for whom. For example, they found an increase in the rate of sole parents moving from benefits to work – this is consistent with reforms focused on encouraging sole parents into work.

  This case study, and the broader discussion, is highly relevant to modern injury schemes, who all face challenges around:

• How to create and use linked datasets effectively
• Identifying what measures are important across a variety of domains
• Developing good indicators that can be used to guide performance and inform service design in the short to medium term.
  

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Proactive Delivery of Common Law Compensation - A Transport Accident Commission Initiative

Nick Cicer

Prior to 2018, Victoria’s Transport Accident Commission (TAC) had traditionally managed common law compensation in a strictly reactive manner.  Injured clients would apply, via their lawyer, for a ‘serious injury certificate’ to enable them to pursue common law compensation.  Following a client centric program to ‘Reimagine Common Law’ and improve client outcomes, the TAC has been proactively contacting clients to inform them of their entitlement to pursue common law compensation.  If the time is not right to agree on a final settlement, the TAC offers partial payments of common law compensation.

Whilst the TAC continues to reactively manage requests from injured clients for common law compensation, its proactive compensation initiative provides earlier acknowledgment of the consequences of a client’s injury and provides an earlier opportunity to deliver compensation.  Both factors align with the TAC’s aim to support clients in getting their lives back on track.  Feedback from clients and the plaintiff lawyer community have been overwhelmingly positive. 

The TAC is currently undertaking an evaluation of our proactive compensation initiative and we would be pleased to share the findings of this evaluation at this conference. 

Safe Work Australia’s National Return to Work Strategy 2020-2030

Anthea Raven

Safe Work Australia will launch the National Return to Work Strategy 2020-2030 (the Strategy) at the Injury and Disability Schemes Seminar 2019.

The Seminar theme of Insights and Outcomes is highly relevant to the Strategy, which sets out a ten-year plan for national action to improve return to work outcomes for workers with a work-related injury or illness.

The Strategy is built on a shared desire to make a difference. It was developed in collaboration with the Commonwealth, states and territories, and employer, industry and union groups. Consultation with the insurance, health, legal and academic sectors was valuable in shaping the priorities for the Strategy.

This presentation will highlight the key elements of the Strategy including strategic outcomes, guiding principles for a positive return to work outcome, and five action areas for national change.

Collaboration is key to the Strategy’s success.

The Seminar provides an opportunity for the sector to hear first-hand about this significant national policy initiative and be inspired to take action to minimise the impact of work-related injury and illness and enable workers to have a timely, safe and durable return to work.

Social Risk Assessment Driven by a Brief Powerful Conversation

Carolyn Mounce, Sophie Potter

The purpose of the social risk assessment tool is to concurrently connect, assess and influence an injury or illness claim.

Research clearly points to the social determinants of health as correlating more strongly than the health condition in disability outcomes. (Aylward M, Marmot M, Haslam S)

The six question assessment, used at claim inception and at 26 weeks, combines social identity theory and practice in one coherent tool. The tool assesses the individual’s confidence, commitment and expectation of return to work. Its simplicity means that consistency and quality of conversation can be achieved with minimal need for upskilling.

The effectiveness lies in the questions asked, the language used, and the prepared phrasing available to team members to ‘nudge’ their client past barriers and objections.

Stage 1 involved a trial within Gallagher Bassett Northern Territory, where statistical analysis shows an improvement in return to work outcomes in the 0-26 week claim cohort (this includes a reduction in income maintenance and medical costs).

Stage 2 extends the initiative into strategy design across targeted risk cohorts and is expected to drive results even further.

Our presentation will share the theory and lessons learnt from adopting a simple tool and supporting team members to have brief but powerful early conversation.

What is Really Under the Hood of the Claims Business?

Samantha Fuller, Matthew Vickers

Actuaries (and actuaries) are well known for their ability to analyse date. However, in many (if not most) cases this is done so at arms lengths from where that data is generated.  Even within most Corporates the actuarial function sits centrally and interactions between the claims and underwriting functions are somewhat limited. Very few actuaries will work in a deeply embedded business role, or ever lead an operational team.  Yet the benefits, both for the business and the actuary are substantial. By genuinely being a part of the day to day business operations opportunities arise to optimise claims performance.

A case study in working in partnership will be provided by an Actuary and the General Manager of a Workers Compensation claims operation, with a focus on outcomes for injured workers, the operational function of claims teams and ultimately profitability of the business.

National Disability Insurance Scheme update

Sarah Johnson

The NDIS has grown from supporting around 30,000 participants at the end of trial (30 June 2016) to almost 300,000 at 30 June 2019. During this time the amount and reliability of data collected has also grown, enabling the first public release of data and reports in July 2019, in conjunction with a series of Insights Forums held around Australia.

This presentation will provide a brief update on Scheme experience, including characteristics of participants and their plans. The data, reports and analyses that are currently available for public use will also be described. Some key insights obtained from deeper analysis of Scheme data, including longitudinal analysis of outcomes data, will be shared.

Claimant Service Rating: First Learnings from SA

Ivan Lebedev

A unique feature of South Australian new competitive CTP scheme for 2019-20 is the publication of insurer Claimant Service Rating on the registration renewal forms and online. The Claimant Service Rating provides a new dimension for insurer competition, in addition to price and incentives.

The presentation will discuss the design of claimant survey underpinning the Claimant Service Rating and the experience from the first months of the competitive scheme operation.  

Skewed Schemes – How CTP is Failing to meet the Real Needs of Customers

Matthew Kayrooz

The chorus of self-congratulations over declining CTP premiums relative to AWE ignores the manifest failings of scheme designs that put outdated ideology and financial self-interest ahead of customer needs.

Surveys in at-fault jurisdictions consistently show the vast majority of the community expect their CTP insurance to cover injuries that, in reality, are not covered. When they learn the truth, it comes as a shock and they want it changed. One recent survey in Queensland showed 86% of people, once informed of what was not covered, wanted reform that meant everyone injured was covered.

The Royal Commission exposed numerous examples of where insurance products were not meeting community expectations. At-fault CTP cover can certainly be included in this category. Yet the guardians of adversarial common law – lawyers and insurers who are comfortable with the disproportionate amount of each premium dollar it consumes – continue to defend this misguided and fundamentally unfair design. The victims are the injured who are subjected to a protracted legal process, rather than having their needs met through a recovery model delivered through defined benefits.

The third-party aspect of CTP denies customers the fundamental right to choose who manages their claim if they’re injured on the road.  South Australian motorists are now provided with claimant satisfaction ratings for each insurer, but how many of them will mistakenly believe that by choosing an insurer, they will be looked after by that insurer if they make a claim. Even insurers that constantly proclaim they are ‘here to help’ customers, have blocked moves to provide first-party cover.

Choice and healthy competition are manifestly in the interests of customers. Monopolies will inevitably mean customers pay more for less. This is evidenced by the substantial price falls and expanded coverage that occurred in the ACT when competition commenced. While claims frequency nationally has steadily fallen as vehicle safety improves, this has not been mirrored in the premium trajectory within monopoly jurisdictions. This is diagnostic when assessing the ability of competition to deliver real results for customers.

While all insurers, be they public or private sector, will publicly worship at the altar of customer centricity, the fundamental design flaws of CTP schemes tell a different story. A recognition of how schemes are failing to meet the reasonable expectations of customers to be provided a fair an efficient scheme is a necessary first step.

The Vanishing – Where Did the NSW CTP Claims go?

Estelle Pearson, Tony Mobbs, John Jeaitani, Francis Beens

The Motor Accident Injuries Act 2017 changed how the NSW CTP scheme operates for accidents post 1 December 2017.  The changes followed some years of escalating claim frequency in the NSW CTP scheme, which had led to increasing CTP prices, as well as the establishment of Taskforce Ravens – a NSW police initiative targeting fraud in the scheme.

The new Act extended benefits to at fault drivers, aimed to get benefits to injured people more quickly by introducing statutory benefits for medicals and income loss, aimed to reduce the incentive for fraud by removing lump sum common law entitlements for those with minor injuries, and to reduce frictional costs by placing limits on legal costs and insurer profits.

More than twelve months into the new scheme one of the biggest surprises is the big reduction in the number of non-minor claims.  Where have these claims gone and why?  Those with non-minor injuries have the same entitlement to benefits under MAIA as in the previous scheme; it is just the ‘style’ of benefit that has changed.  If these injured people are not making CTP claims is support being provided instead by families, Medicare, employers or the social welfare system?

If the low frequency of non-minor claims is sustained, it raises some valid questions about the degree to which the rationale for reform has been met, as well as the cost of ‘entitlement to justice’ through common law, versus ‘access to support’ through statutory benefits.  As other jurisdictions in Australia, such as the ACT, move to restrict access to common law, exploration of the emerging experience in NSW for the non-minor injury group should provide an interesting case study on how the form of benefits and associated legal costs impact behaviour, outcomes and ultimately scheme costs passed on to motorists.      

Queensland CTP Scheme Update

Neil Singleton, Motor Accident Insurance Commission

• Overview of trends and developments in the scheme
• Update on scheme reform activity
• Other Regulatory activity
• Looking to the future

Are Regulators monitoring the right activities?

Darren Parker, SIRA

Regulators have typically monitored the activities of their licence holders. They have in the process turned their focus away from individual customers.

It is the individual customer though that bears the benefit or burden of good or bad regulation. How do Regulators refocus to make a positive impact to the lives of their customers?

Mr Darren Parker, Executive Director of Workers Compensation and Home Building for the NSW State Insurance Regulatory Authority will present what they are doing to regulate using “the voice of the customer”.

Western Australian Workers’ Compensation Scheme Update

Chris White,  WorkCover WA

The Western Australian (WA) workers’ compensation scheme is the largest privately underwritten scheme in Australia, with an approximate scheme expenditure of $1.2 billion per annum.

WorkCover WA closely monitors the performance of all aspects of the WA workers’ compensation and injury management scheme (the scheme). Understanding scheme trends through the collection and analysis of data is vital to ensuring the ongoing stability of the scheme, and early detection of emerging issues.

The WA scheme update will cover the WA scheme framework and market structure, WA’s scheme performance in comparison with National benchmarks, legislative review, key trends as well as stakeholders’ expectations, regulator’s focus, insights and outcomes.

NIISQ update

Sally Noonan, NIISQ

The National Injury Insurance Scheme, Queensland (NIISQ) has been making lives better for individuals seriously injured in motor accidents in Queensland since 1 July 2016.

We are at an exciting time as we shape our identity as Queensland’s lifetime care scheme for people injured in motor accidents. This presentation will provide an overview of NIISQ and the unique model implemented in Queensland compared with other lifetime Schemes. We will also highlight key Scheme statistics and emerging trends at this early stage of the Scheme, while also discussing our current challenges and opportunities.

NSW Lifetime Care and Support Scheme Update

Suzanne Lulham and Shikha Bajpai

The Care function within icare delivers support to participants, injured workers and clients across Lifetime Care, Workers Care, Dust Diseases Care and now CTP Care.  We are in the process of changing the way we deliver this support and building a new operating model for CTP Care.  In this presentation we will discuss:

• Some high level scheme statistics
• Operating model development and changes
• Protecting our customers
• Leveraging technology

Does reform ever stop?

Michael Francis

RTWSA has undergone 7 years of reform covering leadership reform, organisational reform, service reform, scheme culture reform, claims agent contract reform, legislative reform, data analytics reform, (2015), premium pricing reform. You will see a snapshot of results of the comprehensive suite of reforms and hear what it means for the South Australian business community and our focus as we continue peeling the onion – inevitably more reform!

The ACT's new Motor Accident Injuries Scheme

Lisa Holmes

In May 2019 legislation passed the ACT’s Legislative Assembly that provides for wide-ranging reform to the ACT’s current compulsory third-party insurance arrangements. Once the new Motor Accident Injuries Scheme commences in February 2020, everyone who is injured in a motor vehicle accident will be entitled to receive treatment, care and lost income benefits for up to five years – no matter who was at fault. People who are more seriously injured will continue to be able to make a claim for further compensation through common law. The new scheme was developed through an extensive consultation process that commenced with Canberra’s first citizens’ jury in 2017.

This update will provide an overview of why the ACT reformed its compulsory third-party insurance arrangements and the key features of the new scheme.

SA CTP Scheme Update

Kim Birch, South Australian CTP Insurance Regulator

• Scheme overview and key statistics
• Implementation of insurer competition
• Premium regulation
• Support to injured persons
• Future priorities

Scheme Update: WorkCover Queensland

Andrew Currie, WorkCover Queensland

An update on recent WorkCover Queensland experience and initiatives.

South Australia's Lifetime Support Scheme Update

Tamara Tomic, Lifetime Support Authority of South Australia

An update on key outcomes and trends for South Australia's Lifetime Support Scheme.

Comcare Scheme Update

Natalie Bekis

The presentation will provide an update on Comcare scheme coverage and recent performance trends. It will also update attendees on some recent developments in the scheme, including new initiatives being undertaken.

WorkSafe Victoria Scheme Update

Mark Arnott

The presentation will provide an overview of the recent Victorian experience, some emerging trends and issues, and how WorkSafe’s Strategy 2030 is investing in data and analytics.

icare Workers Compensation Scheme Update

Dai Liu and Elizabeth Uehling

icare presents an update of the icare’s workers compensation schemes, Nominal Insurer and Treasury Managed Funds, claims experience and an update on the changes icare is working on.

TAC Scheme Update

Natalie Williamson

• Overview of key trends and developments in the Scheme
• Progress towards TAC2020
• Looking to the future - next steps

NZ ACC Scheme Update

Loren Howson

Loren Howson, ACC Research Manager Customer Experience, will be presenting an update on customer experience work and shifting towards greater customer centricity at ACC, NZ’s accident compensation scheme.

Future relevance of workers compensation

Rosi Winn

This paper aims to start a conversation about the future direction of the workers compensation system.

In the paper we consider the trends impacting workforce and examine whether the workers compensation system is meeting the needs of the current and future workforce. We then consider what a future-fit system might look like and suggest options for how the system could be changed to better support workers.

Tasmanian CTP Scheme (MAIB) Update

Paul Kingston

The MAIB is a Tasmanian Government owned business, which operates the compulsory third party insurance scheme in Tasmania. The scheme provides medical and income benefits on a no fault basis to people injured as a result of a motor vehicle accident, while also enabling access to common law. This presentation will cover:

• Scheme overview and key statistics;
• Update on premiums and claims management;
• Current issues being addressed; and
• Future strategies.