Background

CGU Workers compensation would like to thank the Legislative Council Standing Committee

on Law and Justice for the opportunity to address key issues raised at the recent public

hearings during the first review of the Workers Compensation scheme in New South Wales.

and international competitiveness through a workforce that is productive and operating at the

highest level of participation.

CGU is one of five scheme agents in the New South Wales workers compensation scheme

charged with administering workers compensation insurance policies and managing claims

on behalf of icare. In that capacity, CGU responds to the following issues identified by the

Committee;

• Covert surveillance;

• Consistency in case management and case management turnover;

• Qualifications and training of case managers;

At IAG, our objective is to improve our customers’ experiences, and everything we do is

designed with them in mind. This year, we found new ways to bring customers into our

conversations, and include them in how we are shaping our business.

In June 2016, we established the IAG Consumer Advisory Board to bring together a number

of Australia’s leading consumer representatives and IAG management to discuss key

CGU SUBMISSION TO THE FIRST

REVIEW OF THE WORKERS

As a scheme agent, CGU has an obligation to the scheme, injured workers, employers and

the community to pay valid claims in a timely and effective manner.

where there is an indication of potential fraud or exaggerated claims. The ability to conduct

legitimate surveillance is an essential part of the process to deter and uncover fraudulent

behaviour within the scheme.

CGU only undertakes surveillance in a small number of claims. As evidence of this, in the

period July 2015 to June 2016, surveillance only occurred in 2% of workers compensation

From November 2016, referrals of this kind require authorization by a Claims Branch

manager at a minimum.

In July 2016 CGU commenced a review of its surveillance and investigation procedures. As

a consequence of this review a more robust framework for referrals to investigation providers

was introduced. It is important to note that there are specific guidelines relating to

surveillance and investigation providers that ensure the protection of third parties, including

minors. At all times CGU is committed to following these guidelines to supplement any

guidance provided by icare.

turnover

IAG which includes CGU, supports the scheme prioritising return to health and activity for

injured workers.

As a scheme agent, CGU is committed to delivering best practice claims management and

our strategy starts with ‘getting the basics right’ in order to deliver excellent customer service

to key stakeholders including; injured workers, employers, the scheme and broader

community. Our claims management practices strive to achieve; clarity, consistency,

CGU undertakes a range of initiatives to build the capability and competence of staff to

deliver consistency in case management. Capability measures include a comprehensive

induction program for new case managers and the development of skills matrices for key

roles. In situations where the CGU staff member responsible for an injured worker changes,

process.

There is a focus on continuous improvement for all staff across the business through forums

such as; internal reviews, monthly meetings, seminars and case management planning

sessions. This investment in our people has resulted in an improved staff retention rate in

IAG established an Ethics Committee and reviewed our Code of Ethics and Conduct to

confirm they remain relevant and appropriate.

Qualifications and training of case managers

CGU through its human resources, culture and learning and development strategies aims to

attract, retain and develop a highly engaged and capable workforce.

Across our business, the training scheduling for operational claims staff has three tiers with

set objectives to ensure that training adds value to our people, the scheme and translates in

Consistent with the evidence given by icare and the Insurance Council of Australia, there is

no single course which an individual can attain to qualify them to work as a case manager in

the NSW workers compensation scheme.

There are broader personal injury courses and certifications that can be completed. For the

benefit of the committee we have listed a few of them below.

• Masters in Personal Injury Management through Griffith University;

• Certificates in Personal Injury Management through the Personal Injury Education of

which IAG is a member;

• Diploma of personal injury and disability insurance management.

mentoring and support with all facets of their role.

CGU recognises that no two claims are the same. For that reason, when a claim is made,

several criteria are considered to ensure the claim is managed appropriately. These criteria

include an assessment of the injury, claim and employer type. Thereafter claims are

reviewed regularly to ensure appropriate management with the goal of returning the worker

to optimum health. In order to assess the injured worker’s capacity, there may be a need for

a professional assessment by independent medical examiners.

CGU as a scheme agent, acknowledges that we can always do better when dealing with the

most vulnerable of those making claims. For this reason, we would welcome the opportunity