Ombudsman investigation into WorkCover Self-Insurers
In Victoria most employers engage an insurance company ("authorised agents”) to manage their WorkCover liabilities. There is however an ability for employers to self-insure, that is manage their liabilities internally. Practically this option is used almost exclusively by large employers with the benefit of scale. Currently there are 34 self-insurers operating in Victoria, representing about 5% of total scheme remuneration.
In 2016 and 2019 the Ombudsman conducted an investigation into the claims management practices and oversight of authorised agents but self insurers slipped under the radar. These investigations resulted in an Independent Review and the Government committing to reform.
Last week the Ombudsman announced an investigation into the claims process conducted by self-insurers, and WorkSafe’s oversight role of them. This investigation was launched after the Ombudsman received multiple complaints and submissions from injured workers spotlighting concerns with the way self-insurers claims are being managed and lack of access to independent review of decision making when compared to decisions made by authorised agents. Other complaints were made about WorkSafe’s weak supervision of self-insurers.
The announcement stated that the investigation will consider:
- If the self-insurers’ management of claims are fair and provide just outcomes for their injured workers.
- Whether or not WorkSafe's oversight processes help provide fair and just outcomes for injured workers under the self-insurer scheme.
The Ombudsman is also interested in self-insurers best practices in managing injured workers claims. They would like to hear different experiences from injured workers, former workers of self-insurers or anyone that provides aid to injured workers including unions, lawyers and doctors.