26 September 2023

Ombudsman unsure of self-insurers

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The Victorian Ombudsman has launched an own-motion investigation into the claims process followed by employers that self-insure their workers, and WorkSafe’s oversight of them.

Inviting submissions from the community, Ombudsman Deborah Glass said her investigation was prompted by the complaints and comments her Office had received from injured workers which highlighted concerns relating to the management of self-insurer claims.

Ms Glass said self-insurers were mostly large corporations approved by WorkSafe to manage their own workers compensation claims.

She said that as of 14 July this year, there were 34 self-insurers operating in Victoria, representing about five per cent of total scheme remuneration.

“The complaints include lack of access by injured workers of self-insurers to the Workers Compensation Independent Review Service (WCIRS), which was set up following a recommendation by the Ombudsman in December 2019,” Ms Glass said.

“WCIRS independently reviews certain disputed ‘reviewable decisions’ when requested by workers after an unresolved conciliation,” she said.

“WorkSafe has powers to direct agents to overturn decisions which would not be sustainable or have a reasonable prospect of success at Court.”

Ms Glass said a gap existed for self-insurers because of the differences in the schemes and the legislation in relation to WorkSafe’s powers.

She said there were also complaints about the low levels of oversight of self-insurers by WorkSafe.

“WorkSafe’s Annual Reports in 2020 and 2021 indicate that injured workers were less satisfied with the service provided by self-insurers than were injured workers dealing with WorkSafe agents,” the Ombudsman said.

She said her investigation would cover whether the claims management processes of self-insurers provided fair and equitable outcomes for their injured workers, and whether WorkSafe’s oversight processes contributed to fair and equitable outcomes.

Ms Glass said she would like to hear from injured workers managed by self-insurers, employees or former employees of self-insurers, agencies or individuals that provided assistance to injured workers managed by self-insurers or who had knowledge of claims management and dispute processes, and any other person or body that may have relevant information.

She said submissions could be made by email to the Ombudsman’s Office until 15 August.

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