On 15 May 2019 the State Insurance Regulatory Authority (“SIRA”) announced it will be reviewing the work undertaken by Insurance and Care NSW (“icare”) via its agents Allianz, EML and GIO. Amongst other things the review will assess the performance of claims management.
The review initiated by SIRA will be undertaken by an independent expert, Ms Janet Dore and supported by independent actuaries Ernst and Young and authorised officers of SIRA.
One of the important aims of the review is to consult with stakeholders and assess how icare’s agent, Allianz, EML and GIO perform in relation to return to work outcomes, claims management (including guidance, support and services for workers, employers and health service providers), customer experience and data quality and reporting.
If you are dissatisfied with how your claim has been managed by Allianz, EML or GIO on behalf of icare, now is your chance to put your concerns in writing. Public submissions close on 14 June 2019. You can also elect to remain anonymous. Remember the review is not about current unresolved complaints regarding your claim such as physiotherapy not being approved, but, rather feedback on how your claim has or is being managed by Allianz, EML or GIO. Some examples of case management issues are:
- Is correspondence from Allianz, EML or GIO clear and easy to understand?
- Has treatment been approved by Allianz, EML or GIO quickly?
- Has Allianz, EML or GIO advised you of your rights?
- Are you easily able to get in touch with Allianz, EML or GIO?
- Do Allianz, EML or GIO return your calls or emails?
- Have Allianz, EML or GIO quickly appointed a return to work officer?
- Are weekly payments or travel expenses processed promptly by Allianz, EML or GIO?
- Do Allianz, EML or GIO liaise with your employer to ensure payment is forwarded by them promptly?
- Do Allianz, EML or GIO listen to the advice of your treating medical practitioners?
- Does the case management by Allianz, EML or GIO exacerbate your psychological condition?
You can easily participate in the review online at https://www.sira.nsw.gov.au/consultations/review-of-the-nominal-insurer
For your assistance, the specific claims management questions are:
- Please rate your experience with the management of claims by the Nominal Insurer (icare) and/or its scheme agents EML, Allianz and GIO, from 5 (excellent) to 1 (poor).
- What has been your experience with the management of claims by the Nominal Insurer (icare) and/or its scheme agents EML, Allianz and GIO?
- From your perspective, what impact has icare’s new claims management processes had on return to work outcomes and the customer experience?
- What should the Nominal Insurer (icare) and/or its scheme agents EML, Allianz and GIO be doing more of?
- What should the Nominal Insurer (icare) and/or its scheme agents EML, Allianz and GIO be doing less of?
- Are there any improvements you would like to suggest regarding claims management?
- Aside from your experience and views on premiums and claims management by the Nominal Insurer (icare), the scope also includes a review of changes to the Nominal Insurer’s operating model, its data quality and reporting. We are interested in any other matters you may want to raise.
- Are there other matters or areas you like to comment on?
- Are there any improvements you would like to suggest in these areas?
- Do you have any other issues or ideas about the Nominal Insurer (icare) that you want to share?