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icare invites workers suspecting underpayment to come forward

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NSW insurer icare is inviting injured workers in the state to come forward and seek assessment if they believe they were underpaid entitlements.

The request applies to NSW workers who received weekly workers' compensation payments from 2012-2019.

Last year, icare uncovered many hundreds of cases of over and under-payments based on the pre-injury average weekly earnings (PIAWE). The calculation of PIAWE is used to determine the amount of weekly benefit payments paid for a work-related injury while the recipient is unable to work, as part of a workers' compensation claim in NSW.

The State Insurance Regulatory Authority (SIRA) instructed icare to take swift action to fully quantify the scale of this issue and required that icare repay any underpaid workers.

icare bears responsibility for repaying any injured workers impacted by an error in calculating weekly benefits, and associated remediation costs, the regulator has said. icare will not recover any overpayments.

In September last year, the NSW Government published amendments to the PIAWE regulations intended to reduce the complexity of these determinations.

icare said today the “sheer volume” of data and information that was required for PIAWE under legislation and the complexity of the PIAWE calculation was behind the errors.

“Employers found it difficult to provide insurers with the required data and information to determine PIAWE, and insurers were only able to pay an injured workers' weekly payment based on the information provided to them by employers,” icare says.

Insurers had also been required to assess and commence provisional weekly payments within seven days of being notified of the injury and that short timeframe meant initial payments were often based on incomplete information and in many cases were later recalculated and payments adjusted.

Of around 3000 claim files reviewed during icare’s investigation last year, roughly a quarter were potentially underpaid and a quarter potentially overpaid. Where weekly payments were incorrect, premium calculations for businesses may also have been incorrect.

At this stage the remediation program covers workers' compensation payments for private sector employees in NSW.

Workers' compensation payments for icare’s Treasury Managed Fund, a NSW government agency workers’ compensation and government property insurance scheme which was not included in icare’s earlier review of claim files, and payments by Specialised Insurers and Self Insurers are being handled separately.

An independent review of icare’s culture, governance and accountability is now underway and the icare Board has also established a new Committee on Corporate Governance.