Many employers now worry about rising premiums and feel they have lost their say in how claims are handled. Rob Migliore opened the session by introducing Amin Atighpour, Actevate's workers' compensation specialist, who spent years inside the claims system at Employers Mutual and then Qantas. The session focused on the NSW nominal insurer, although many of the principles apply to insurance arrangements nationally.

Tip: Download our free workers' comp premiums glossary to follow along with the terms used in this session.

How the NSW scheme is structured

Before 2015, WorkCover NSW performed the key functions of the scheme. It was then dissolved into SIRA, icare and SafeWork NSW, which created the setup employers deal with today.

• NSW Government: sets the legislative framework.
• SIRA (State Insurance Regulatory Authority): sets the rules and regulations for how that legislation is applied.
• The nominal insurer and icare: the nominal insurer provides cover for the state, and icare manages its policies and claims.
• Scheme agents: providers such as EML, Allianz, GIO, QBE and Gallagher Bassett manage claims on icare's behalf.

The nominal insurer carries roughly 60 to 70% of claims in the scheme. The other arrangements are self-insurers (Qantas is one example), the NSW Government's Treasury Managed Fund, and specialised insurers for certain sectors such as hospitality.

How your premium is calculated

Every premium starts with your average performance premium (APP). This is your total wage bill multiplied by your workers' compensation industry classification rate, which is set by your business's main activity. Higher-risk activities carry a higher rate.

Tip: If your business genuinely has more than one main activity, it may be worth looking at multiple policies with different industry classification codes.

Small employers: APP under $30,000

Small employers sit under the conventional model. Claims costs don't affect their premium and they aren't compared with other employers, so they pay mainly based on APP. The trade-off is that employers in the other models pay a little more to cover those claims costs.

Medium and large employers: APP over $30,000

Most employers sit under the experience-rated model. The key part of the formula is the claims performance adjustment (CPA), which is driven by your own claims performance over the past three years and by the scheme performance measure. In other words, your premium is influenced by how other employers in the scheme perform as well as by your own claims.

Weekly compensation payments (lost time) have the biggest impact under this model. Lump sum payments for permanent impairment or work injury damages also count, but they tend to arrive later in a claim. The longer a claim stays open, the costlier it becomes.

Large employers: the LPR model

Once your APP passes $500,000, you can move to the loss prevention and recovery (LPR) model. Your premium is then based on your APP and your own claims costs rather than the wider scheme. The catch is that far more claims costs count toward your premium, and each dollar can have up to three times the impact.

Rob noted that some Actevate clients have entered the LPR model, with initial premium savings of a third to half. It only works if you have the right resources to stop a lost time injury turning into a protracted recovery.

Note: In a recent review, Actevate found a journey claim that the insurer hadn't coded as a journey claim. Correcting that one code saved the employer $168,000.

Rob explained why errors like this slip through. Before 2015, the same claims team helped calculate the premium. Scheme agents now administer claims on icare's behalf, so the case manager often doesn't know how coding or claim costs will affect your premium.

Reducing your premium impact

Focus on weekly compensation payments

Whichever model you're on, weekly compensation payments make up the largest share of claims costs by a wide margin. Whatever the insurer pays in weekly benefits, you pay for several times over at renewal. Early intervention with suitable duties is the most effective way to bring that exposure down.

Engaging a rehabilitation provider early helps with:

• identifying suitable duties and completing initial assessments
• joining medical case conferences with treating doctors
• proactive return to work planning
• securing capacity upgrades sooner

Tip: You don't need to wait for the insurer's initial liability decision. A rehabilitation provider can be engaged in the first few days to assess the worksite and get the worker back on modified duties.

Get investigations moving early

If the insurer finds a claim isn't compensable, it has no impact on your premium. Review incident reports, check CCTV footage and look for any third party involvement where there may be recovery potential. Details that seem trivial can make a real difference.

Invest before an injury happens

Many employers only react when icare's premium notice arrives around June and July, and by then it's too late. Amin described small, early investments that pay off at renewal:

• Pre-employment checks that look at pre-existing conditions, since one avoided claim can save $50,000 to $70,000 in premium
• Mental health training and EAP to reduce psychosocial hazards, particularly following the psychological injury reforms
• Work health and safety audits to prevent physical injuries in environments like factories and production lines
• A suitable duties register to speed up return to work
• A dedicated return to work coordinator who reviews internal processes and represents you with the insurer
• A preferred rehabilitation provider who works in your interests from the start of a claim

Getting the most from your insurer

Your case manager is your main contact, and their experience, technical knowledge and understanding of premiums can vary a lot. The most reliable approach is to set expectations as soon as a claim starts rather than reacting once something goes wrong.

• Agree on a regular update schedule, whether weekly, fortnightly or monthly.
• Hold regular claims reviews.
• Set clear actions and timeframes for the case manager.
• Understand your escalation pathways.
• Share information early, ask questions and keep following up.

Why claims get approved so quickly

Rob asked Amin, a former case manager, technical specialist and team leader, why claims often seem to be accepted without question. Insurers will usually point to the low liability threshold in NSW legislation. Amin said that doesn't stop them gathering information and pushing back on claims that don't add up, although case managers can develop tunnel vision and move straight to accepting liability.

Interim liability decisions give insurers up to three months, and sometimes longer, to investigate. Yet some employers find that 10 weeks in, no investigations are underway and weekly benefits are simply being paid. Having someone on your side who liaises with the insurer early and holds them to account makes a real difference.

Tip: Collaboration works better than an adversarial approach. The more you understand premium impact and the tools available, the easier it is to ask the case manager for exactly what you need.

Escalating and giving feedback

If expectations aren't being met, escalate from the case manager to the team leader and then the group manager. Keep every escalation objective. Employers with an APP above $100,000 can choose their claims service provider at renewal, and insurers know that affects their bottom line.

Feedback channels carry more weight than most employers realise:

• Post-call surveys: the text message after a call looks like a scam, but it's genuine, and the results are an internal KPI for case managers and their team leaders.
• Periodic surveys from icare and insurers: these are rarely filled out, yet insurers read and act on them because they don't want to lose your business.
• Regular claims reviews: with the case manager and team leader in the room, these are a good forum to raise concerns objectively and reset expectations.

Positive feedback matters as well. When a case manager does a good job, telling them builds the relationship and the attention your claims receive.

Building your own capability

Amin's central message was that your premium isn't just a bill that arrives in the mail. Much of it sits within your control.

• Grow your knowledge of premium models, claims costs, liability and how insurers work.
• Tighten your injury response process. Know who the injury is reported to, who attends first, where the worker sees a GP and what the first certificate of capacity will look like, because the early stages set the tone for the whole claim.
• Look for trends in past claims. Repeated shoulder injuries on a production line, for example, point to processes worth reviewing.
• Act early on psychological risk. These claims usually build over time rather than stemming from one incident, and SIRA reports historically low return to work rates for psychological injuries.
• Monitor premium impact monthly so rising costs can be addressed well before renewal at the end of June.

Key takeaways from Rob

More insurers are now entering the scheme, which adds complexity but also gives employers choice. Rob cautioned that the grass isn't always greener: one Actevate client recently changed insurers and found the service no different. Building good relationships with the people managing your claims often achieves more than switching.

Knowing which costs matter is vital, and wage loss matters most. Depending on your model and claims history, each dollar of wages paid on a claim could cost you $1.50, $2 or $3 in premium, and some Actevate clients pay $4 to $4.50. Rob also suggested picking up the phone rather than relying on email, and asking to speak with a technical specialist when you need more information.

Questions from the audience

Do common law and WPI payments affect premium for three years from the date of injury?

Lump sum payments become premium impacting when they're made, and they can still factor into your premium outside that three-year window. If a claim looks likely to head toward common law or whole person impairment, Amin recommended an in-depth review. Where negligence may be alleged, such as a slip on an unsigned spill, start factual investigations early and document what training was provided.

How do we manage a non-work injury the worker says is work related?

Rob stressed that a claim is simply a claim, and it isn't a foregone conclusion. Employers can ask whether the worker has had these symptoms before, whether anyone witnessed the incident and whether CCTV is available, then send that information to the insurer with the claim. Amin added that an injury happening at work doesn't automatically make work the main contributing factor, which is where clinical records and pre-existing conditions come in.

Tip: Use the incident investigation template in your WHS management system. It prompts the questions an insurer will look at when making a liability decision.

What if we don't have internal resources to review our policy?

Actevate offers a review that looks at your current premium and the two to three years before it, checking whether anything such as claim coding was incorrect. Reach out to the team to find out more.

How do we manage wear and tear in long-serving employees?

Rob recommended periodic medicals every two years for workers in heavy manual handling roles or exposed to industrial noise or hazardous substances. They work much like a pre-employment medical, identifying future injury risk and what can be done now to prevent it.

Can anything be done when a worker falsely declares no previous injuries?

There are implications when a worker chooses not to disclose, but it's a complex area that deserves a longer conversation. Rob invited employers facing this issue to contact Actevate directly.