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future scheme agent arrangements

General Q&As

why did icare conduct a selection process in deciding which scheme agents would provide icare workers insurance claims management services?

The selection process was undertaken because the current scheme agent contracts under the NSW Workers Compensation Scheme expire on 31 December 2017.

A selection process is conducted every two to three years. This selection process also coincides with the next exciting phase in how icare is improving workers insurance.

Our new claims service model will deliver a better experience for both employers and workers, through a transparent service that gives them support, empowerment and choice. We want it to be a simple, empathetic and consistent process regardless of its simplicity or complexity.

who made the decision?

The evaluation process included several senior representatives across icare, who ensured all aspects of claims management were considered. They considered alignment with icares customer value proposition - to protect and support customer by offering simple and affordable insurance, injury protection and return to work solutions.

What is an icare claims service agent?

icare claims service agents are organisations appointed by icare to manage workers insurance claims under the NSW Workers Compensation Scheme.

Who are the Claims Service Agents from 2018?

icare workers insurance has selected EML, GIO and Allianz to continue as Claims Service Agents beyond 31 December, 2017. These organisations will work closely with icare and our customers to transition to the new claims service model.

CGU elected to cease providing claims services to workers insurance as at 31 December 2017 and QBE will also cease to be our workers insurance claims service agent at that date. We thank both CGU and QBE for supporting the NSW Workers Compensation Scheme.

how did icare workers insurance choose its new claims service agents?

icare undertook a formal selection process against criteria aligned to our future service delivery model. All current scheme agents were invited to participate.

how will employers and workers know if they are affected by the changes?

All workers compensation policy holders and claimants will be contacted from mid June 2017 to update them on their individual circumstances.

when will these changes happen?

Until 31 December 2017 the current scheme agent panel will continue to deliver services to injured workers and employers under the NSW Workers Compensation Scheme. If your claim is moving to another scheme agent, you will be contacted before the transfer occurs.

how will icare workers insurance manage the transition?

For the remainder of 2017 icare workers insurance will work with scheme agents as we transition to the new claims service model.

Our customers will be at the centre of all decisions – we want a smooth and efficient transfer. It is essential that we maintain continuity of claims management activities and look after our customers.

We have planned - and will implement as needed - a range of strategies to support and monitor the transition process. These strategies include supporting the teams managing claims under the current scheme agents.

We will have icare representatives embedded with the scheme agent teams as a face-to-face support network.

will my workers insurance policy transfer to icare when it’s due for renewal?

Yes. As of 30 April 2017 all workers insurance policies will renew directly with icare, rather than your current insurance agents.

I’m a new business. What does this mean for me?

When you took out your new workers compensation policy you will have nominated an insurance agent to handle your claims. They will manage your claims until 31 December 2017.

EML will be the new claims service agent for all new claims from 1 January 2018.

Do employers need to tell employees about the changes?

Yes. It would be a good idea. If you have workers with active workers insurance claims, icare will contact them from mid June to advise them of the changes.

What happens to current workers insurance claims?

The current scheme agent panel will continue to deliver services to injured workers and employers under the NSW Workers Compensation Scheme until 31 Dec 2017. If your claim is to be moved to another scheme agent, you will be contacted before the transfer occurs.

How will I be kept informed if my workers insurance claims are to be transferred?

If you have an active workers insurance claim, icare will be in contact from mid June to advise you of any changes.

Can I move an existing workers insurance claim to the new agent?

To ensure a smooth transition for our customers, the current scheme agent panel will continue to deliver services to injured workers and employers, under the NSW Workers Compensation Scheme until 31 Dec 2017.

If your claim is to be moved to another scheme agent, you will be contacted before the transfer occurs.

Why can’t I transfer my portfolio to a scheme agent of my choice?

EML will be the new claims service agent for all new claims from 1 January 2018.

We have recommended that portfolios remain with their current scheme agent to ensure employees aren’t making multiple moves with their claims. Our customers will be at the centre of all of icare’s decisions. We want a smooth and efficient transfer. It is essential that we maintain continuity of claims management activities and look after your employees.

My trusted advisor arranges my business insurance. Will they be contacted?

icare has made a general announcement through the media and to external stakeholders. We will also directly contact all of our broker partners, industry groups and other trusted advisor networks.

Will there be any changes to my workers insurance premium?

There will be no changes to your icare workers insurance premium following this change.

Does this affect government agency workers insurance policies?

No. This announcement is for general workers insurance policies, not government workers insurance policies. Call icare self insurance on 02 9216 3829 if you have any further questions.

Additional Employers Q&As

Will there be any changes to my workers insurance premium?

There will be no changes to your icare workers insurance premium following this change.

Can my premium registration and claims be moved to the new claims service agent arrangements now?

From 2017 all workers insurance premiums will be renewed with icare. Existing customers will be notified of the new arrangements when their renewals are due.

EML will be the new claims service agent for all new claims from 1 January 2018.

We have recommended that portfolios remain with their current scheme agent until further notice. Our customers will be at the centre of all icare’s decisions – we want a smooth and efficient transfer. It is essential that we maintain continuity of claims management activities and look after your employees.

Can I select which claims service agent I move to?

We have recommended that portfolios remain with their current scheme agent until further notice. Our customers will be at the centre of all icare’s decisions – we want a smooth and efficient transfer. It is essential that we maintain continuity of claims management activities and look after your employees.

I package up my business insurance and receive discounts. If my icare portfolio is moved, I may not be able to continue to receive discounts.

You will need to discuss the details of your business insurance with your General Insurer or Insurance Broker.

From 2017, all new business workers insurance policies and policy renewals will be with icare workers insurance and not your current insurance agency. Existing customers will be notified of the new details when their renewals are due.

My trusted advisor arranges my business insurance. Will they be contacted?

icare has made a general announcement through the media and to external stakeholders. We will directly contact all of our broker partners, industry groups and other trusted advisor networks.

Do I need to tell my employees about the changes?

Yes. It would be a good idea.

If you have workers with active workers insurance claims, icare will contact them from mid-June to advise them of the changes.

My worker has a conciliation matter in progress. If my policy is transferred will that delay the process?

We do not expect conciliation conferences to be affected by claims, transferring to a different scheme agent.

If you have any questions about a conciliation matter, contact your case manager.

Who do I contact during the transition?

Please continue to contact your current scheme agent or contact icare on 13 44 22.

Additional Workers Q&As

Do I need to do anything if my workers insurance claims are moved to a different scheme agent?

Our icare customers will be at the centreof all decisions; we want a smooth and efficient transfer. It is essential that we maintain continuity of claims management activities and look after our customers.

You don’t need to do anything – icare will be in contact with all of the latest information in regard to any transfers to a different scheme agent.

Will my claim number change?

There will be no change to claim numbers on your existing workers compensation claim.

Will there be a change in how my workers insurance claim is managed?

The new way icare workers insurance manages claims will deliver a better experience for both employers and injured workers, through a transparent service that gives them empowerment and choice. We want it to be a simple, empathetic and consistent, regardless of its complexity.

If your claim is moved, any decisions about your claim will be carried over to your new scheme agent. A normal part of any scheme agent’s role is to regularly review the progress of a claim. Your new claims service agent may therefore make subsequent decisions that adjust how your claim is managed.

Will my case manager change?

There will be no changes to claims managers for EML, GIO and Allianz customers.

If your workers insurance claim with CGU or QBE is transferring to a new claims service agent it is highly likely that you will also have a new case manager.

From mid June, icare will contact all customers who have active claims, to let them know exactly what will happen in their transfer. Our icare customers will be at the centre of all decisions, we want a smooth and efficient transfer. It is essential that we maintain continuity of claims management activities and look after our customers.

Who will pay me weekly payments?

If your employer is currently paying your weekly payments, they will continue to do so. Some workers may be paid directly by their scheme agent. In these cases, if your claim is transferred your current scheme agent will continue to pay you until further notice.

What should I do with my certificates of capacity?

If you currently give your certificates of capacity to your employer, you should continue to do so.

Who will help me return to work?

If you have a workers compensation claim you may have return to work obligations that your scheme agent will help manage. This will be undertaken by your current scheme agent until further notice.

I have a conciliation matter in progress. Will the announcement delay this process?

We do not expect conciliation conferences to be affected by claims that are transferring to a different scheme agent.

If you have any questions about a conciliation matter contact your case manager.

Will my doctor and other healthcare providers know where to send bills?

icare workers insurance has taken a number of steps to ensure all healthcare providers know where to send bills under the new arrangements. For the remainder of 2017 we will work with our scheme agents to transition to the new model. Our customers will be at the centre of all decisions we want a smooth and efficient transfer. It is essential that we maintain continuity of claims management activities and look after our customers.

You can assist in making sure bills are addressed correctly by telling your healthcare provider if your scheme agent has changed and ask them to include the relevant claim number on every invoice.

If you are being transferred to a new claims service agent, your scheme agent will send you a letter with their contact details. You can take this letter to your next appointments.

Can I appeal the decision to move my claim?

Your claim will be transferred to the scheme agent that will be managing your employer’s icare workers insurance; you are unable to appeal this decision.

Will I be sent for a new medical assessment?

You will not be sent for a medical assessment just because your workers insurance claim has moved to a new claims service agent. However, the new scheme agent may need to arrange an assessment to assist in the ongoing management of your claim.

My old scheme agent has already approved or arranged something on my claims (e.g. medical examination, physiotherapy, occupational rehabilitation, surgery, impairment benefits). Do I need to reapply? Do I still have to go?

Any decisions made about your claim will be carried over to your new claims service agent if you are transferred. The new agent will be given information about these decisions. This means you do not need to reapply for anything that has already been approved.

If an appointment has already been made for you (e.g. to attend an independent medical examination or visit an occupational rehabilitation provider) you will need to attend the appointment. If you are unsure about what is expected, you should contact your current scheme agent.

I’ve put in a claim and haven’t heard back. What can I do?

You should continue to contact your current scheme agent.

My scheme agent pays me weekly payments; will the payments be delayed as a result of moving scheme agents?

A change in claims service agent should not delay your weekly payments. icare workers insurance will be monitoring these payments during the transition period to ensure that workers receive their weekly payments on time.

Your current scheme agent will continue to pay you directly, so continue to send your medical certificates to them.

I am challenging my current scheme agent decision in court. Will my claim being transferred to another scheme agent delay this process?

We do not expect that pending court action will be affected by a change in scheme agent.

If you have court action pending and your claim is moving to a different scheme agent, you should discuss this with your legal representative.

What if I have multiple claims?

If you have more than one claim with the same employer, and that employer’s icare workers insurance portfolio is moved to a different scheme agent, all of your claims will move to the same scheme agent.

What if I have claims with more than one employer?

If you have claims with multiple employers, it’s possible that only some of your claims will be moved to a new scheme agent. Your claims will be moved depending on if the employer they are lodged through has its icare workers insurance portfolio moved.

Additional healthcare providers Q&As

Will claim numbers change?

There will be no change to claim numbers on existing workers compensation claim.

Will the scheme agent I send invoices to change?

You may need to send invoices to a different claims service agent depending on whether your patient is moving under a new scheme agent. Please ask your workers if they have been advised that their claim is moving to a different scheme agent. If the scheme agent has changed, send your invoices to the new scheme agent.

We have made arrangements to ensure mail and other communications are redirected if mail is sent to incorrect scheme agents.

Please ensure you include the worker’s claim number on all invoices. Including the worker’s claim number for the injury you are treating, will help ensure the invoice reaches the correct scheme agent as quickly as possible.

Who should I contact if I haven’t been paid?

You should contact the worker’s current scheme agent to follow up any queries.

Who should I contact to discuss a workers treatment during this transition period?

You should continue to contact the worker’s case manager at their current scheme agent to discuss treatment and send reports and invoices to them.

If a worker’s claim is transferring, send reports and invoices to the new scheme agent. The worker should be able to provide you with the new scheme agent’s contact details.

The new scheme agent will receive the worker’s claim files from the previous scheme agent. When the worker is advised of their case manager’s name they will be able to provide you with this information. If you need to speak to the scheme agent sooner, please contact them through the general contact details they have sent to the worker in late June.

Will appointments and services approved by current scheme agents remain valid?

Appointments and services that have been approved by a scheme agent will remain valid even if the claim for the worker you are treating is moved to a different scheme agent.

A normal part of any scheme agent’s role is to regularly review the progress of a claim. The new scheme agent may therefore make subsequent decisions that adjust how the claim is managed.

Further Information

If you have general enquiries about the new icare workers insurance claims service agent arrangements or if you are having difficulty contacting your current or new scheme agent, contact icare on 13 44 22.

CGU's Notice to withdraw from service 31 December 2017

What is the context to CGU making their decision?

icare is developing an improved service delivery model for implementation in early 2018 which will deliver much improved services and outcomes for injured workers and employers.

To support this, icare is undertaking a selection process from the existing pool of scheme agents that will determine those scheme agents that will have the opportunity to provide services under the new service delivery model from 1 January 2018.

CGU has informed icare of its intention to not proceed to submit a proposal to be a service provider after 31 December 2017.

Employers

Will my policy transfer to a new Scheme agent?

Your policy will remain with CGU until it is transferred to be managed directly by icare before 31 December 2017.

Will a change in scheme agent result in a premium change?

No. This decision will not lead to a change in premium.

Which scheme agent will manage my employee’s claims?

CGU is contracted to provide these services to icare until 31 December 2017. Your claims will remain with CGU until icare has determined when the services are to be transferred and to which scheme agent.

Injured Workers

Will moving my claim disadvantage me?

We will make every effort to minimise the disruption to you. Your claim will move to the scheme agent selected to continue providing services on behalf of icare.

I don’t want my claim to move to another scheme agent. What can I do?

CGU is contracted to provide these services to icare until 31 December 2017. Your claims will remain with CGU until icare has determined when the services are to be transferred and to which scheme agent will be managing them. As CGU has elected to withdraw its services from NSW, icare must transfer your claim to a scheme agent that will continue to provide services on behalf of icare.

Will I continue to receive benefits?

Your benefits will continue as usual while your claim is being transferred to a new scheme agent. icare and the new scheme agent will work to ensure that you do not experience deterioration in customer service or claims management.

Will my benefits change?

Your benefits will continue to be calculated in accordance with the legislation. Depending on your eligibility and the status of your claim, you should continue to receive the same weekly benefits. If your circumstances have changed, advise your new scheme agent, when they are appointed, so they can update your claim file. As usual with any change in circumstances a review of your claim will take place, with any changes will be discussed with you.