carmel donnelly - sira
TRANSCRIPT
State Insurance Regulatory Authority Towards risk-based regulation in practice
Carmel Donnelly Executive Director, Workers and Home Building Compensation Regulation
28 February 2017 sira.nsw.gov.au
AGENDA 1. Strategic context
2. Challenges
3. Approach
• policy reviews
• insurer supervision model
• operating model
4. Questions
2015 Structural Reform *reflects the structural change implemented 1 September 2015
Re
gu
lati
on
SafeWork NSW
State Insurance Regulatory Authority
(SIRA)
Motor Accidents Insurance Regulation
Workers Compensation
Regulation
Home Building Compensation
Regulation
Deputy Secretary of Better Regulation
and Chief Executive, SIRA Motor
Accidents Assessment
Service
WC Merit Review Service
DEPARTMENT OF FINANCE, SERVICES AND INNOVATION
What we do… PowerPoint title to go here xx Month 2016
SIRA regulates workers compensation insurance delivered by:
The Nominal Insurer (icare)
SiCorp Treasury Managed Fund
55 other Self-insurers
6 Specialised insurers
SIRA regulates motor accidents compensation insurance delivered by private CTP insurers SIRA also regulates the Home Building Compensation Fund which is administered by SICorp in icare.
About SIRA
About SIRA Corporate Model
PowerPoint title to go here xx Month 2016
Governance
GOVERNANCE: Board appointed by the Minister – Trevor Matthews (Chair), Nance Milne (Deputy Chair), Abby Bloom, Graeme Innes, and Anthony Lean (Chief Executive) STRUCTURE: Statutory corporation reporting to Minister for Finance, Services and Property
The big picture….. Strategic context
Better Regulation PowerPoint title to go here xx Month 2016
SIRA
Its better regulation
NSW Fair Trading
Office of the Registrar General
Commerce Regulation Program &
Policy
SafeWork NSW
Workers Compensation System Objectives
Section 3 1998 Act
Secure workers’ health, safety & welfare while preventing work-related injury
Provide prompt treatment & rehabilitation to assist injured workers to return to work
Provide income & treatment payments to injured workers & their families
Provide a fair, affordable & financially viable system
Deliver an efficient & effective system.
Workers compensation
insurance
Nominal Insurer
(icare)
Self Insurance
Specialised Insurance
SICorp TMF
(icare)
About 283,000 policies
About 170 policies
6 licenses
55 licenses
61,033 15,553
10,317
7,002
65%
7% 11%
17%
CLAIMS
PER YEAR About 90,000 new claims per year About 30,000 serious injuries per year SNAPSHOT About 84,000 open claims About 40,000 open claims with weekly benefits
About 3.2bn in premiums per year
System overview
Some key challenges
Prevention Mitigation Insurance Incident or diagnosis
Acute response Recovery Support
Confidence through affordable protection
Purchaser experience and outcomes
Wellbeing through recovery and restoration
Claimant experience and outcomes
Workers Compensation System Better experience Better outcomes
Involvement in the process is stressful (Grant et al, 2014)
Lengthy claims process Medico-legal assessments Poor claims information
Perceived injustice by claimant leads to amplified pain perception and is associated with poor recovery (Sullivan, Yakobov, Scott & Tait, 2014)
‘Compensation factors can impact participant health.’ – Harris et al 2008 and Grant et al 2014
Adversarial relationships lead to negative outcomes (Elbers et al, 2012)
Better Regulation - Consultative - Evidence-informed - Risk-targeted - Outcome-focused - Performance-based - Impartial - Person-centred
Stakeholder engagement model
Implementation of 2015 reforms
Remake of the Regulation & projects
Market Practice & Premiums Guidelines
Reviews:
Self-Insurance Licensing
Claiming Workers Compensation & Permanent Impairment guidelines
Financial and premium supervision
Review of Specialised Insurer Licensing
RTW programs and guidelines
Review of IME framework
Baseline system performance report
Customer centric design & customer experience measures
Injury prevention and rehabilitation strategies
Insurer supervision model
Workers Comp. program
Insurer supervisionmodel
•Conduct •Claimant outcomes
•Financial & Premium
Insurer supervision & system performance
Injured worker and employer experience & satisfaction
Procedural fairness
Information provision
Market practices
Compliance with standards and guidelines
Complaints & disputes
Return to work
Health outcomes
Data quality , audits & reporting
Financial performance benchmarks
Prudential risk management
Premium principles
MEASURING & REPORTING
Improvement towards excellence
Portfolio Manager uses the Insurer Supervision Model metrics to assist them to identify high risk areas for an insurer.
A meeting is held with the Insurer. The Insurer validates data on risk results presented and then provides SIRA with an action plan to mitigate the risks. SIRA monitors impact.
Case Study
Self Insurer
Data Timeliness
Data Quality
RTW
Disputes
High Risk Areas (ISM)# Actions taken by Self Insurer
Insurer action plan to improve data submitted to SIRA
Insurer investigating effect of above Data Issues on RTW statistics RTW action plan Request from WIRO of details of cases – diagnosis and action.
Insurer
Supervision
Model
Better Regulation
How we work
Conflicted Impartial
Prescriptive – influence via rules
Performance based – influence via data and leadership
Leveraging legislation Leveraging licensing conditions –
Insurer / provider supervision
Compliance focus Outcome focus
Reactive, opaque methods Proactive, transparent, and
accountable methods
Data rich but analytics poor Rapid data analytics tools & culture
– evidence and risk
Perceived ‘Defender’ mindset
Open to improvement mindset
Poor stakeholder engagement
Excellent stakeholder engagement
Distant from customer Strong customer understanding
and impact
Culture not enabling innovation
Encouraging innovation
FROM TO
Teamwork
Workers & Home Building Compensation
Regulation
Insurance Policy Insurer Performance Claimant Outcomes Injury Prevention and Rehabilitation
Data Analysis and Reporting
Enforcement and investigations
Design, review, engagement
Monitoring KPIs & driving improvement
Evaluating claimant outcomes & leading change
Expert insight & leading innovation in wellbeing
Enabling evidence, analysis and reporting
How we work
Wellbeing
Focus on “can do”
Inclusiveness
Productivity
Improvement mindset
Outcome focused
Change agents
Alignment and teamwork
Fair and flexible
Accountable decision making
Engaged & consultative
Data analytics culture
Constructive, influencing
Active supervision
Risk based targeting
Person-centred
Thank you.
Questions?