SIRA Calls for Person-Centred Approach in NSW Workers Compensation Claims Management

The State Insurance Regulatory Authority (SIRA) has released its Claims Management Review Report, calling for a cultural shift towards a person-centred approach in workers compensation claims management across New South Wales.

The review was undertaken in response to Recommendation 18 of the 2023 NSW Parliamentary Law and Justice Committee’s Review of the Workers Compensation Scheme. It assessed whether the current system meets the needs of injured workers and employers, with a particular focus on the rising complexity of psychological injuries.

Drawing on claims data, audits, literature reviews, and stakeholder consultations, SIRA identified four key findings and made 14 recommendations to guide systemic reform.

Cultural shift needed

The report found that lasting improvements require a system-wide move away from transactional, process-driven cultures to person-centred, relational models. This shift, SIRA argues, should underpin future scheme design, performance measures, and regulatory frameworks.

Embedding person-centred practices

To improve claims outcomes, SIRA recommends embedding person-centred practices into insurer operations. This includes proactive early intervention, tailored injury management planning, plain English (or culturally appropriate) explanations of key claims decisions, accurate and timely decision-making (including correct weekly payments), and robust case handover protocols to ensure continuity. Claims managers play a critical role and will need strengthened training and capability-building to support recovery and return-to-work outcomes, especially for workers with psychological injuries.

Better support for workers and employers

The review found that both workers and employers often lack understanding of the workers compensation system, which can impede recovery. SIRA recommends insurers adopt tailored cohort management models for psychological injury claims, while also building workers’ compensation literacy and providing clearer education and active support for employers to engage positively with injured workers.

Reducing administrative burden

The report also highlights the need to streamline prescriptive regulation and reduce red tape. SIRA will review and simplify its guidelines, standards of practice, injury notification requirements, and the certificate of capacity so that insurers and regulators can redirect resources toward meaningful, person-centred case management.

SIRA Chief Executive Mandy Young said the findings reinforced the importance of putting people at the centre of the claims process.

“By shifting to a more empathetic, people-first claims model, which operates within the legislative parameters of the Workers Compensation system, we can better support recovery and return to work for people injured at work,” Ms Young said.

Read the full Claims Management Review Report here.