Enhancing the icare workers insurance service model - improving outcomes for injured workers

icare’s workers insurance claims service model is focused on achieving the best possible outcomes for injured workers in terms of care, rehabilitation and return to work.

Since introducing the model in January 2018, icare has continued to listen to customer feedback, and also identify aspects of the model that may evolve to better reflect the needs of employers and injured workers.

One area that has a critical impact on outcomes for injured workers is how claims are initially allocated. Not getting the right treatment, care or rehabilitation in these early stages of a claim can heavily influence how long it takes a worker to return to their pre-injury duties.

icare is therefore targeting implementation of changes during July as to how claims are allocated to the segments that provide support ensuring that the model better predicts risk at an earlier stage of the claim life-cycle. Additionally, icare is changing claim allocation rules which determine the team claims are sent to and what type of claims service they receive.

As part of these changes, icare will adjust the types of claims that are managed within its Support Centre. Currently the Support Centre manages claims which are expected to return to work within four weeks or less and have no other identifiable psychosocial risk factors.

Following the changes to the claim allocation model, the Support Centre will manage claims that: 

  • have no time loss at the time of notification
  • a return to full hours of work is expected within two weeks of injury
  • have no other identified risk indicators flagged by our triage criteria.

These adjustments aim to better meet the needs of employers and injured workers by improving Support Centre efficiency and overall return to work outcomes. They will also allow Support Centre teams to focus more on faster processing of reimbursement only claims (claims that are managed on the spot, at the time of lodgement and where the injury doesn’t require a worker to take any time off work).

After these changes are implemented, if a worker is predicted to have more than two weeks of time loss, or other risk indicators have been flagged, their claim will be transferred to be managed by a dedicated Case Management Specialist.

This will ensure that both workers and employers are able to establish a stronger relationship with their Case Management Specialist who will manage a higher volume of their claims.

icare believes its frontline staff must be confident and able to make decisions within the framework of the model, and that customers should be able to contact the decision maker wherever possible. These changes will enable claims teams to do this more routinely.

icare plans to start implementing these changes from July. The overall time-frame for implementation will depend on a number of factors including careful planning of change, changes to the workforce  including appropriate training to ensure minimal impact to our customers.

While stakeholders most impacted have been informed of these changes - i.e. appointed service provider EML, employers and brokers – icare will continue to communicate with all stakeholders and customers on this issue over the coming months.

icare Pop-Up Offices popping up near you

While we were on the road during 2018 our customers constantly let us know how much they appreciated talking with us face-to-face in their home regions and local community. Most of all they were happy that we would stay back and answer their questions following the Mobile Engagement Team (MET) sessions.

So we've decided to add a new concept to the 2019 calendar – the Pop-Up Office.

Employers can now pre-book a 30 minute slot with one of our MET relationship managers and discuss anything and everything workers insurance – including workers insurance basics, claims, policies, medical office and any other burning questions you may have.

To make sure the idea would work, we piloted a session in Coffs Harbour and one in Wagga Wagga. Both were very successful, with 100% of attendees telling us it was a great concept and they found the meeting extremely valuable and helpful.

Based on how well received the pilot sessions were, we're rolling more out across the state. Don't miss your chance to meet with our MET at a pop-up office near you.

Here are the current proposed dates and locations, and more are being added all the time: 

  • Grafton – 5 June
  • Nowra – 11 June
  • Tweed Heads – 17 July
  • Gold Coast – 15 October
  • Albury – 14 November

For more information on all our upcoming events please click here, or alternatively to register your interest for a meeting slot on any of these days please email us at  mobile.engagement@icare.nsw.gov.au.


Source: icare