Regulatory services and performance

Insurer licencing and performance

During 2023-24, one new self-insurance licence was granted to Collins Foods Limited. Redland City Council returned to WorkCover Queensland from 1 July 2024. See the complete list of self-insurers.

There are currently 28 self-insurance licences, with 53 per cent of insurers holding a four year licence. Across the year, 14 self-insurance licences were renewed with nine insurers renewed for four years, three insurers renewed for three years and two insurers renewed for two years.

There were 35 audits conducted across all insurers (including WorkCover Queensland and self-insured employers). This includes Compliance, Targeted, Licence Condition and Special audits.

Scheme data told us that as of 30 June 2024, the scheme return to work rate for finalised time lost claims is 90.5 per cent. Further, the rate reduces to 82.6 per cent for workers who have four weeks or more off work.

In 2023-24, a Targeted Audit of all insurers commenced on rehabilitation and return to work plans. The audit is now complete with an update on results expected to be shared with scheme stakeholders by the end of November 2024.

At the end of 2023-24, there were 12 self-insured employers that had a special licence condition and 25 active improvement action plans across all insurers.

Investigations

Over the past five years, the number of reports of suspected fraud and other offending made to the Regulator has increased by 275 per cent.

It is important that investigation resources are directed towards investigating the most serious, blatant or prolific offending in a timely manner.

An Investigations Priority Policy was implemented from 5 December 2023 to ensure a transparent, consistent and risk-based approach to triaging reports of suspected non-compliance. This policy is being supported by additional resources in 2024-2025.

In 2023-24, there were 78 investigations undertaken and 16 prosecutions commenced as a result of those investigations. Ninety-three per cent of prosecutions resulted in a successful outcome.

Notable prosecutions

WorkCover fraud leads to five months’ imprisonment for worker

A Queensland man was imprisoned for five months for defrauding WorkCover Queensland and was ordered to repay $78,000. Read more

Company’s ‘failure to provide’ results in $24,000 workers’ comp fine

A Southeast Queensland audio visual business was fined $24,000 after failing to comply with an investigator’s (authorised person) requirement to provide documents. Read more

Dispute resolution services

Medical Assessment Tribunals

The Medical Assessment Tribunals continued to experience increases in tribunal referrals in 2023-24 (11.4 per cent) with a 53 per cent increase in referrals since 2018-19.

The average duration from date of registration until a tribunal hearing reduced from 61 days in 2022-23 to 42 business days in 2023-24.

Strategies being implemented to manage increased tribunal referrals and reduce delays and impacts for workers, insurers and the scheme include additional resources, intensive hearings, maximising internal resources, educating insurers on quality referrals along with triaging and weekly monitoring of timeframes.

Tribunal Services also continues to engage with insurers in meeting the requirements of the Medical Assessment Tribunal - Referral Guidelines to expedite the validation process, reduce delays and prevent referrals from being returned.

Contact the team on mat@oir.qld.gov.au or 1300 738 197 if a matter requires prioritising due to a risk of potential psychological harm or financial welfare concerns for the worker.

Review and Appeals

Initiatives during 2022-23 and 2023-24 have increased Review Unit productivity with finalised reviews 26.6 per cent above 2022-23. Open reviews have reduced from 974 in October 2023 to 867 as at 30 June 2024.

Reviews continue to be managed efficiently with the average duration to decide reviews once allocated to a review officer being 14.9 days in 2023-24. This is an improvement from 16.2 days in 2022-23.

The Review Unit continued to experience higher than expected review applications in 2023-24 (22.7 per cent above 2022-23) contributing to ongoing delays in allocating and finalising reviews within the 25 business-day legislative timeframe.

Strategies being implemented to maximise Review Unit productivity include:

• business process improvements
• additional resources and maximising internal and outsourced legal services
• establishing a project team to implement recommendations from an independent review of the Review Unit’s operating model and support the implementation of the relevant findings and recommendations of the 2023 five-year review
• regular engagement with insurers to support improved quality in decision making and to understand disputation rate trends.

Contact the team on 1300 738 197 if a matter requires prioritising due to a risk of potential psychological harm or financial welfare concerns for the worker.