Claims management by the Victorian WorkCover Authority
Overview
In 2002 the Victorian Workcover Authority (VWA) introduced a new claims management model as part of a wider reform program to improve its performance in core business areas. The new model aimed to improve return to work (RTW) outcomes, achieve cost-effective claims management, and to enhance the overall effectiveness of case, injury and medical management. Under the model, claims are triaged and segmented according to risk, where low-risk claims are handled quickly and high-risk claims are actively managed.
The objective of the audit was to assess the effectiveness and efficiency of claims management by VWA. The audit examined the policies, procedures and activities of VWA and its six agents, with a particular emphasis on the arrangements for managing high risk claims, and whether:
- the management of claims is maximising both outcomes for injured workers and the financial sustainability of the scheme
- agents are managing high-risk claims in accordance with VWA’s claims management model
- VWA’s arrangements for monitoring and improving performance of claims management are effective.