Investigation into icares processing of actual wage declarations and hindsight adjustments to workers compensation premiums report
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This report has identified failures within Insurance and iCare NSW’s (icare’s) management of workers compensation premiums between 2017 and 2023.
The report found that icare engaged in unreasonable conduct by failing to exercise its statutory functions within a reasonable timeframe.
One of the functions of Insurance and Care NSW (icare) is to provide workers compensation insurance to more than 338,000 public and private sector employers in NSW and their almost 4 million employees.
In order to ensure that an employer has sufficient workers compensation insurance cover for its employees, the Workers Compensation Act 1987 requires an employer to pay a premium at the beginning of the period of cover, based on the amount of wages the employer projects it will pay. This premium is later adjusted, either up or down, after the employer retrospectively reports to icare the actual wages that were paid during the relevant period. Any consequent change to the premium is known as a ‘hindsight adjustment’.
Between October 2024 and February 2025, we received complaints from six employers who held workers compensation insurance with icare.
The six complaints all related to significant delays in icare’s processing of hindsight adjustments for their businesses. In each case the complainants told us they had lodged declarations with icare of actual wages they paid during the year and that their declarations were lodged within the required legislative timeframes. The employers complained that icare failed to adjust their workers compensation premiums based on their actual declared wages in a timely manner and in some cases that this did not occur until over 3 years later. The employers told us that the situation was causing them financial hardship and that icare was not taking their concerns sufficiently into account.
The delays affecting the individual complainants led us to have concerns about the implications of potentially widespread delays processing actual wage declarations on the viability of the Workers Compensation scheme in circumstances where employers may have spent a significant period of time being either under or over insured.
Our investigation therefore looked into the systems, processes and procedures used by icare in the processing and collection of adjustments to workers compensation premiums between 2017 and 2023.
We identified that in 2017, legislative and systemic changes meant that icare became responsible for all underwriting, policy and billing functions across the workers compensation scheme that had previously been performed by scheme agents. icare became responsible for approximately 55,000 legacy hindsight adjustments as a result of this change. At this time, icare’s Guidewire Policy Centre (GWPC) software which was rolled out based on its capability to do so, was not configured to process hindsight adjustments automatically. Administrative oversights, including the erroneous closure of files, further worsened delays.
We found that, despite the significant influx of hindsight adjustments requiring processing in 2017, the required software fixes to enable automatic processing in straightforward cases were not implemented until 2023. Further, icare did not have any timeliness measures in place to evaluate its progress against its backlog until 2023. Although icare has now identified and processed all outstanding actual wage declarations made for active policies between 2019 and 2024, it did not systematically address the backlog of unprocessed wage declarations until 2025, when it implemented a remediation plan to identify and process outstanding hindsight adjustments.
We made findings that the conduct of icare was unreasonable within the meaning of s 26(1) (b) of the Ombudsman Act 1974 in so far as icare failed to:
icare has advised us that since our investigation commenced, it has implemented a remediation plan to identify and process all outstanding wage declarations. icare’s assurance team is reviewing the remediation plan. icare has also engaged with State Insurance Regulatory Authority (SIRA) on waiving late payment fees applied to hindsight adjustments when those adjustments were delayed by icare.
icare also told us that it has it has apologised to 5 of the 6 complainants verbally or via email and offered extended payment arrangements to remediate the impact on all 6 employers. Two employers accepted the payment plans and have paid their adjustments in full. The remaining employers still have outstanding hindsight adjustments.
We recommended that icare should:
Within 1 month following finalisation of the investigation:
1. formally apologise to the 5 employers with active policies (excluding AB), who complained to the Ombudsman for the delays in processing their actual wage declarations.
2. offer and negotiate appropriate payment plans with the remaining 3 active employers (MP, DG and PE), relative to their financial circumstances.
Within 3 months following finalisation of the investigation:
3. provide the Ombudsman with a written report that details the outcome of the review by icare’s line 2 assurance team concerning the remediation plan as described in icare’s response to our statement of provisional findings and recommendations. This report should include details of any apologies that have been offered by icare and any payment plans that have been negotiated with affected employers.
Within 12 months following finalisation of the investigation:
4. provide the Ombudsman with copies of any further internal or external audits that icare conducts to assure itself that hindsight adjustments are now being processed in accordance with the timeliness metrics and controls identified in its remediation plan.
We have asked icare to provide us with regular progress updates on its implementation of the recommendations.
In the following sections, we provide a detailed explanation of the reasons for our findings.
Chantal Snell
Acting NSW Ombudsman
The investigation, conducted under s 13 (1) of the Ombudsman Act 1974 (Ombudsman Act), concerns ‘the systems, processes and procedures used by icare in the processing and collection of adjustments to workers compensation premiums’.
The Workers Compensation Act 1987 (WC Act) and the Workers Compensation Regulation 2016
(WC Regulation) require employers to submit their actual wage declaration to icare within 4 months of the expiry of their workers compensation policy. The purpose of this process is to ensure that workers compensation premiums have been calculated accurately. This process is crucial for maintaining the transparency, fairness and viability of the workers compensation scheme.
The investigation was prompted by the receipt of complaints between 25 October 2024 and 2 June 2025 from 6 insured employers. In each case the employers told us they had lodged declarations with icare of actual wages they paid during the year and that their declarations were lodged within the required legislative timeframes. The employers complained that icare failed to adjust their workers compensation premiums based on their actual declared wages until much later, in some cases over 3 years later. The delays resulted in two of the employers receiving invoices for large premium adjustments for multiple prior years and being given short payment plans of 3 months to pay off the debts. In some instances, late payment fees were also applied to these hindsight adjustments when they were not paid within one month of the invoice being issued. The employers told us that the situation was causing them financial hardship and that icare was not taking their concerns sufficiently into account.
In addition to the impact of the delays on the individual complainants, we had concerns about the broader implications of potentially widespread delays processing hindsight adjustments on the viability of the Workers Compensation scheme in circumstances where employers may have spent a significant period of time being either under or over insured.
This investigation has been finalised, and our investigation report has been sent to icare and the Minister for Industrial Relations and Minister for Work Health and Safety. The complainants have received the outcome of their individual matters.
The below table summarises the 6 complaints received by the Ombudsman between 25 October 2024 and 2 June 2025. Additional details of individual cases are included as case studies throughout the report.
Table 1: Summary of the complaints
Employer / Policy holder | Period(s) of unprocessed wage statement(s) | Date actual wage statement(s) submitted | Date hindsight adjustment issued | Delay in months[1] | Amount invoiced |
PL | 2021/22 | 26 July 2022 | 21 October 2024 | 26 | $17,819.36 |
SH | 2022/23 | 1 August 2023 | 1 October 2024 | 15 | $579,188.08 |
AB | 2021/22 | August 2022 | 27 September 2023 | 12 | $62,564.96 |
MP | 2019/20; 2020/21; 2021/22; 2022/23 | July 2020 and July 2021 | 10 November 2024 | 40 | $53,780.57 |
DG | 2021/22; 2022/23; 2023/24 | Unknown, 18 May 2023 and 30 August 2024 | 11 February 2025 | 30 | $84,008.25 |
PE | 2021/22 | 13 February 2023 | 25 March 2025 | 13 | $7,594.95 |
icare is constituted under the State Insurance and Care Governance Act 2015 (SICG Act). One of the functions of icare, as relevant to this matter, is to act for the Nominal Insurer in accordance with the WC Act.
icare operates as a Public Financial Corporation and is governed by an independent Board of Directors. The Board is accountable to the Minister for Industrial Relations and Minister for Work Health and Safety.
The State Insurance Regulatory Authority (SIRA) is likewise constituted under the SICG Act. SIRA is the insurance regulator. As part of its regulatory role, SIRA accepts and deals with complaints about icare and requests for reviews of decisions by icare.
The WC Act establishes a scheme of compulsory workers compensation insurance. An employer must have an insurance policy, from a licensed insurer, for all workers employed.[2] Policies must be issued for a period of 12 months (this is also referred to as the ‘injury year’)[3], unless otherwise approved by SIRA.[4]
The premium for the insurance policy is calculated in accordance with the Workers Compensation Market Practice and Premiums Guidelines.[5] The WC Act and the WC Regulations require employers to keep records of, and provide to insurers, information relevant to the calculation of premiums throughout the life cycle of a policy.
An employer must:
Once icare has received the report of the actual wages from the insured employer, it compares them against the estimated wages for that insurance period.[10] The premium is then adjusted, and this adjustment is colloquially referred to as a "hindsight adjustment".
The hindsight adjustment mechanism is a compliance mechanism that ensures the premium accurately reflects the employer's wage expenditure and risk exposure. The hindsight adjustment may result in the employer receiving a refund if actual wages were lower than estimated or being required to pay an additional premium if they were higher. While the legislation allows icare to charge interest on premium adjustments, icare’s position is that it does not do so. However, where an employer fails to pay an adjustment by the invoice due date[11] icare must apply a late payment fee.[12] Late payment fees continue to accrue on all overdue hindsight adjustment amounts at an applicable statutory rate compounded monthly.
While there is no discretion under the legislation for either icare or SIRA to waive premium adjustments, the late payment fee may be waived by icare, but only with the approval of SIRA.[13]
While there is a clear obligation placed on employers to declare their actual wages within a 4-month period, the WC Act does not prescribe a timeframe within which icare must process actual wage declarations and issue hindsight adjustments. However, as a general principle, all statutory functions must be exercised reasonably, and this includes in respect of timeframes.
The ‘ordinary’ rule, where a statute does not provide a timeframe within which a statutory function is to be done, is that it is implied that it is required to be done within a reasonable time: Koon Wing Lau v Calwell (1949) 80 CLR 533, 573–4; Minister for Immigration and Citizenship v Li [2013] HCA 18; (2013) 249 CLR 332 (Li) at [102].
Among the group of 6 employers that complained to our Office, the actual wage statements were declared to icare in accordance with the legislated timeframe of within 4 months following the end of the injury year on at least 7 out of 9 occasions[14] between 2020 - 2025. In each case, icare did not make the hindsight adjustment for over a year after the actual wage statements were lodged. The shortest processing time was approximately 12 months, and the longest time was 3 years and 4 months.
It would have been a reasonable expectation by the employers that icare would complete adjustments promptly and at the very latest prior to the conclusion of each annual cycle so that both parties (employers and icare) are able to finalise their accounts in preparation for the next annual cycle. Such an expectation is reinforced by the design of the Workers Compensation system that relies on an annual cycle of declaration, reassessment and renewal to monitor and enforce employer and insurer compliance. A lack of communication with employers about the relevant actual timeframes for processing hindsight adjustments, particularly in an environment where software limitations increased the potential for what icare describes as ‘administrative oversight’ and backlogs were known to exist, only served to exacerbate the significant impact on employers when their adjustments were ultimately identified and processed.
In standard circumstances, hindsight adjustments to premiums are routine activities given that the formula for calculating workers compensation insurance premiums is predetermined. Despite this, icare advised that its Guidewire Policy Centre (GWPC) software was not coded to automatically calculate an employer’s final premium when actual wages are inputted until 2023. Where an employer has reasonably straightforward circumstances, an automated outcome is now typically able to be produced and sent to the employer in 48 hours. icare informed us that timeliness measures were not instituted until 2023 and that its current target is that all hindsight adjustments should be completed within 45 days, with a stretch target of 30 days. icare also advised that since it resolved issues with its GWPC software in 2023 (see further discussion below), approximately 90% of actual wage declarations submitted by employers have been processed automatically.
In cases where an employer’s circumstances are more complex,[15] however, the premium still has to be calculated manually. icare advised that this was the case for 5 of the 6 complainants identified in our investigation.
Case Study 1 PE
These complainants owned a small sporting equipment business and contacted icare in May 2025 to complain that they had just received a premium adjustment for a wage declaration relating to 2021/22 financial year. icare apologised for the delay but stated that it was unable to hold the premium adjustment as it is payable based on the declared wages for the relevant policy period. icare also advised that the “21/22 hindsight adjustment for $7,594.95 has been set up on six instalments” and attached a copy of the invoice.
The complainants submitted a complaint to our office on 30 May 2025, stating:
We shouldn’t have to pay for something that far back. They have made an error and why should we
now retrospectively pay for that error 3 years later.
icare advised that it only identified the outstanding hindsight adjustment when the employer contacted icare about its 2023/24 premium. icare also confirmed:
This particular hindsight adjustment was not processed when the employer’s wage declaration was received from the employer on 13 February 2023 due to an administrative oversight. The employer’s wage declaration was not eligible for automatic processing of the 2021/22 hindsight adjustment as an underwriting exception applied. Instead, as the employer premium was moving from a small to an experience-rated premium model, an Underwriter was required to contact the employer to gather the required information to determine the applicable hindsight adjustment. However, due to an administrative oversight within icare the transaction was not assigned to an Underwriter to process.
The complainant informed us that:
we are a small business and times are tough, and we shouldn’t be penalized for an error they have made….that financial year is well and truly over; we can’t go back an changed (sic) our companies (sic) lodged tax returns and make any adjustment…icare were completely rigid in their response claiming they can retrospectively go back any length of time and issue hindsight adjustments, when the email we received after submitting our declared wages clearly says it will be processed within 5 days…There surely must be a timeframe of when they can request this from customers.
Case Study 2 SH
The complainant in this matter was one of the founders of a hospitality business. On 1 August 2023 she lodged a declaration of actual wages for the 2023 financial year. On 1 October 2024, icare issued an adjustment of premium invoice for $597,188.08.
The complainant raised the issue with icare on 21 November 2024, advising that she considered the “invoice adjustment raised to be invalid” due to icare’s 15 month delay in issuing the hindsight adjustment, stating that the invoice can neither be processed nor paid as the financial reports for financial years 2023 and 2024 had been closed. She also stated that as far as the company was concerned, its icare premiums were in order, given that no adjustment invoice was issued at the time the declaration of wages was lodged.
In an email with an icare representative, she further advised that she had followed up with icare numerous times after submitting her actual wage declaration in order to confirm closure of the policy for the 2023 financial year but received no response. She interpreted the lack of response from icare as sufficient confirmation that the 2023 financial year policy was closed and settled with icare and that no adjustments were required.
In response to her complaint, icare informed her that it was only able to offer a payment plan whereby the invoice could be paid in instalments. The reason it provided for the delay in issuing the hindsight adjustment was due to:
a backlog of adjustments which was triggered by the restructure that occurred from 2015 whereby 300,000+ employers were transferred from their previous insurer, to icare.
icare acknowledged that the backlog caused the actual wage declaration which was submitted on time to be overlooked but advised that the hindsight adjustment was valid and could not be waived, stating that it had:
reviewed your policy and can appreciate that the delay in processing the 22/23 adjustments has caused frustration and concerns regarding payment. However, late payment fees continue to accrue on all overdue amounts at the applicable statutory rate per month compounded monthly in accordance with S172 of the 1987 Act. These cannot be held or reversed, the best option to avoid them being charged is to pay the overdue amount.
The complainant told icare that:
The delay in raising this premium adjustment invoice 15 months late has a significant impact on our financials and statutory reporting, over what is now three financial years.
On 11 December 2024, the complainant submitted a complaint to SIRA via its online web portal, requesting that SIRA “Govern icare on their obligations” and “Direct icare to resolution.” On 19 December 2024, the complainant submitted a complaint to our office requesting that icare either raise a credit to cancel the invoice or else agree to a 15-month payment plan with no interest or fees incurred.
On 8 January 2025 SIRA responded to the complainant and advised that SIRA:
do not hold the correct legislative power to compel the insurer to waive a validly calculated premium.
However, SIRA advised that it would review icare’s service failures. We do not know if this occurred.
In response to our notice to produce information in this investigation, icare acknowledged that between 2018 and 2023 there were significant challenges in processing the volume of actual wage declarations in a timely manner. However, little action was taken during this time to identify the extent of the problem or rectify the causes.
A range of factors were identified by icare as the reasons why delays to making hindsight adjustments were so significant and widespread.
In 2017, legislative and systemic changes meant that icare became responsible for all underwriting, policy and billing functions across the workers compensation scheme that had previously been performed by scheme agents. icare informed us that ‘as part of this change, approximately 55,000 legacy hindsight adjustments were inherited [from scheme agents] into icare’. At the same time, icare adopted the GWPC software platform as an ‘out of the box’ software platform to manage all policy and billing workflows so it would be ready for immediate deployment. However, rather than providing a ready software solution, icare told us that it became apparent that “the preset parameters and functionalities of the GWPC platform did not align with the required workflow.” Furthermore, the system did not flag when actual wage statements were received, documents were indexed, or activities had been closed. Therefore, “they were not visible to the Underwriters and consequently not processed…”.
icare informed us that between 2017-2023 the GWPC platform caused the closure of matters and documents to be saved to the incorrect case files. It is not clear when icare became aware of the issues with GWPC, but enhancements were not introduced until 2023 – some 5 years after the software was first deployed. This inaction allowed the continued accumulation of instances where actual wage declarations were received by icare but remained unprocessed on file.
Other factors identified by icare as contributing to delays processing hindsight adjustments included the busy periods within icare’s cyclical work, limited resourcing, and competing priorities.
Inherent in the annual declarations cycle are peaks and troughs in icare’s workload. As icare told us, “29% of icare’s portfolio (over 99,000 policies) renew on either 30 June or 1 July; and over 63% of experience-rated employers[16] typically renew their policies in late-June or early-July which generally requires more manual intervention by an Underwriter due to their complexity.” icare advised that prior to changes to the GWPC software, this increased the number of underwriting exceptions requiring underwriter review and placed increased pressure on processing timeframes.
Furthermore, icare says that it operates a ‘breakeven premium model’ to keep premiums lower for employers. In icare’s view, this means icare’s budget is constrained and increased resourcing was not an option. In addition, icare told us that staff usually responsible for processing actual wage declarations were redeployed on at least two occasions between 2018 and 2022 to support other “organisation prioritised” work.
As the cases of the 6 employers show, rather than designing a systemic organisational response, the outstanding actual wage declarations were often being processed only if and when underwriters came across them. Sometimes this was because underwriters were performing other tasks on a matter. In other cases, the outstanding actual wage statement came to light because the policy holder or their representative made (sometimes unrelated) enquiries with icare.
Case Study 3 MP
The complainant in this matter operated a professional painting business for residential, commercial and retail projects. She complained about receiving substantially delayed hindsight adjustment invoices for actual wage declarations that were only identified by icare after she sought premium relief following an increase to her premiums due to a workers compensation claim.
Following her application for premium relief, on 9 and 10 November 2023, she received several emails from icare advising that icare had not processed the declarations of actual wages submitted by the company in July 2020 for the period from 1 July 2019 to 30 June 2020, and in July 2021 for the period from 1 July 2020 until 30 June 2021. icare invoiced the company the amounts of $25,621.83 and $34,976.94 for the 2019-20 and 2020-21 periods respectively.
The complainant contacted icare by email on 27 November 2023. On 19 December 2023, icare advised her that it was unable to waive the adjustment invoices.
icare advised that it had:
identified the outstanding hindsight adjustment payments…when an Underwriter was processing a separate activity for this employer.
icare stated that the reason for the delay was because:
the relevant adjustments were indexed incorrectly and recognised by an Underwriter during their daily processing activities.
The complainant submitted a complaint to our office on 20 December 2023, stating that receiving hindsight adjustments so long after submitting her actual wage declarations was:
simply unconscionable. The delay by icare in issuing these ‘hindsight adjustments’ is unreasonable. icare certainly only seemed to discover their oversight and their failure to issue the adjusted premiums in a timely manner because we asked for the policy relief. We believe that these ‘hindsight adjustments’ should be waived due to the completely unreasonable delay by icare in actioning our declarations of actual wages.
The financial impacts of receiving delayed and multiple hindsight adjustments were significant and unreasonable on employers. The delays were particularly problematic for the smaller businesses that had finalised their accounts for previous financial years and had forecasted budgets that were unable to sustain significant amendments. icare did not sufficiently consider the impact of the delay on these businesses.
Case Study 4 DG
This complainant is the Chief Operating Officer of a home improvement business. On 31 August 2021 icare advised her that it had not received the actual wages declaration for the policy period
8 May 2020 – 30 April 2021. The business emailed icare on 2 September 2021, attaching the declaration that was submitted in April 2021 and requesting that icare acknowledge receipt of
the email.
On 11 and 12 February 2025, the complainant received three emails from icare regarding final premium adjustments covering the policy periods of 30 April 2021 – 30 April 2022, 30 April 2022 – 30 April 2023, and 30 April 2023 – 30 April 2024 with a total amount owing of $84,008.25 for premium hindsight adjustments.
We received the complaint on 20 February 2025, including that due to a system failure on icare’s end, the premium adjustments for all three policy years had only been processed on 11 February 2025. The business complained that it was expected to pay the debt despite the 30-month delay in icare’s processing.
icare acknowledged to our office that the outstanding hindsight adjustment payments were identified “when icare was processing the actual wages for 2023/24 and conducted a policy review.” icare also confirmed that:
On 18 May 2023, the actual wages for 2021/22 and 2022/23 were submitted by the employer via CSS [Customer Self Service portal]. This activity was closed in error on 18 August 2023 by an icare staff member without processing or issuing the hindsight adjustment. On 30 August 2024, the employer submitted their actual wages for 2023/24 via CSS. Similarly, this activity was closed in error by an icare staff member. In each instance, this resulted in the loss of visibility of the activity in icare’s system.
The complainant stated:
I was told that due to a system failure on their end, the adjustments for all three years had only just been processed on February 11, 2025. And now, we were expected to simply absorb this massive debt—all because of their own administrative failure. As a small business, we simply cannot afford to be hit with an unexpected $84,000 bill for something we had no idea existed.
She also told us that the business would require:
a minimum five-year payment plan to manage the remaining balance…we are a small business with our budget already forecasted for the year—being blindsided by this kind of debt will have a severe financial impact on us.
However, the complainant was only offered a payment arrangement over a 12 month period.
Despite knowing at least as early as 2023, when software enhancements were introduced, that matters had been erroneously closed without the actual wage declarations having been processed, icare did not act to systematically identify all affected policies until June 2025. This was despite the fact icare was also on notice through a May 2024 report by SIRA, Workers Compensation under insurance review: Underwriting file audit Nominal Insurer that under-insurance from outstanding actual wage declarations posed a material risk to the workers compensation scheme. SIRA audited 155 employer underwriting files over three policy renewals from 30 June 2020 to 30 June 2023 and found that, ‘of the 125 wage declarations processed (136 lodged, 11 not processed) across the three policy periods audited, 32 (26%) final premiums were processed outside of the NI’s [Nominal Insurer] timeframe of 60[17] days’.[18] There were 11 instances where the processing time was longer than 12 months with the longest time being 854 days (close to 2.5 years).[19]
icare told us that:
as of 21 May 2025, there were approximately 3,680 policies (7,051 transactions) that had unprocessed hindsight adjustments beyond its 45-day target for manual processing. However, icare does not consider [these] to be a backlog because they relate to policies where icare has not received all requested information from the employer.
icare was aware of issues with the processing of hindsight adjustments as early as 2017, including the need to actively manage backlogs and ensure appropriate resourcing. However, aside from implementing the Customer Self Service (CSS) portal and enhancing the GWPC software in 2023, icare took limited action to systematically identify and address the historical unprocessed actual wage statements until 2025.
The continued accumulation of unprocessed actual wage statements not only negatively impacted policy holders but also had a negative financial impact on the Workers Compensation Insurance Fund (WCIF)[20] more broadly.
The significant delays in processing some actual wage declarations between 2017 and 2023 mean that icare may not have become aware of under-insurance until much later and could not produce accurate statements about the financial status of the WCIF. More widespread delays may have resulted in reduced trust in icare and incentive to comply with legislative requirements to submit actual wage declarations within the legislated timeframe.
Whilst the operational circumstances of icare during the period under investigation were not all of icare’s making, there was nevertheless a responsibility for icare to take active steps to manage the inherited backlog, including by ensuring appropriate systems were in place both from a technological and staffing perspective. It is of particular concern that occasions of administrative error in closing files were not identified by icare but rather brought to its attention by affected employers or their advisors.
It was not until 2025 - some 7 years after the software was first deployed and at least 2 years after it was known that matters had been erroneously closed – that icare conducted a small-scale pilot to trial a method for identifying unprocessed statements. The pilot looked at 200 randomly selected policies where the employer had failed to submit a wage declaration. From this group, 3 policies were identified that had unprocessed wages declarations on file.
In August 2025, icare advised that it was still considering whether this pilot program might be applied more broadly. Somewhat inconsistently and belatedly, in its submissions to our statement of provisional findings and recommendations, in February 2026, icare advised that in June 2025, it engaged an external specialist to commence its remediation plan to:
icare informed us that it has now identified and processed all outstanding actual wage declarations made for active policies between 2019 and 2024, which included 789 policies that had not been processed (representing an approximate missed file rate of 0.06% of all active policies).
icare also told us that its line 2 assurance team is reviewing the remediation plan to ensure that it was appropriately designed, executed, and completed, and that the issue of wage declarations not being processed in a timely manner has been effectively resolved for the future.
Based on the facts and conclusions reached on the key issues raised by the investigation, I find that the conduct of icare was unreasonable within the meaning of s 26(1) (b) of the Ombudsman Act in so far as icare failed to:
We recommend that icare should:
Within 1 month following finalisation of the investigation:
1. formally apologise to the 5 employers with active policies (excluding AB), who complained to the Ombudsman for the delays in processing their actual wage declarations.
2. offer and negotiate appropriate payment plans with the remaining 3 active employers (MP, DG and PE), relative to their financial circumstances.
Within 3 months following finalisation of the investigation:
3. provide the Ombudsman with a written report that details the outcome of the review by icare’s line 2 assurance team concerning the remediation plan as described in icare’s response to our statement of provisional findings and recommendations. This report should include details of any apologies that have been offered by icare and any payment plans that have been negotiated with affected employers.
Within 12 months following finalisation of the investigation:
4. provide the Ombudsman with copies of any further internal or external audits that icare conducts to assure itself that hindsight adjustments are now being processed in accordance with the timeliness metrics and controls identified in its remediation plan.
Footnotes
Only the longest delay has been included where wage declarations for multiple years were processed for an employer at once.
s155 Workers Compensation Act 1987.
s136 of the Workers Compensation Regulation 2016.
s155A Workers Compensation Act 1987.
SIRA, Workers Compensation Market Practice and Premiums Guidelines, 30 June 2022. URL: 2022 Workers Compensation Market Practice and Premiums Guidelines - SIRA.
s173 Workers Compensation Act 1987.
s173 Workers Compensation Act 1987 and s138 Workers Compensation Regulation 2016.
s174 Workers Compensation Act 1987.
s174 Workers Compensation Act 1987.
ss 138(1) and 138(3) Workers Compensation Regulation 2016.
Late fees can be applied where an employer has failed to pay an adjustment of premium (hindsight adjustment) within one month after service on the employer a notice that the hindsight adjustment payment is due.
s172 Workers Compensation Act 1987.
S172(2) Workers Compensation Act 1987. We note that on 14 February 2025, icare contacted SIRA regarding waiving late payment fees where icare has contributed to the delay in processing actual wage statements. At the time of responding to us in May 2025, icare was still waiting for a response from SIRA on this point. In its submission to our provisional findings and recommendations, icare advised that on 1 September 2025 it had established an agreed process with SIRA to seek approval for the waiver of late payment fees in defined circumstances. These circumstances include where icare has contributed to the delay in hindsight processing.
Some complaints related to multiple annual wage declarations for the same employer.
Circumstances which may lengthen processing times include changes in employer category, having more than 20 different Workers Compensation Industry Classifications (WICs), or where premiums are calculated by reference to what is known as ‘per capita rates’ (for example the number of taxi plates a company has).
Experience-rated employers are larger businesses whose Average Performance Premium (APP) is over $30,000, distinguishing them from smaller businesses whose premium rates are fixed by industry. Experience-rated employers’ insurance premiums are directly affected by their claims history.
We note 60 days is different from icare’s current KPIs but could not identify where SIRA sourced this timeframe from.
SIRA, Workers Compensation under insurance review: Underwriting file audit Nominal Insurer, May 2024, 6.
SIRA, Workers Compensation under insurance review: Underwriting file audit Nominal Insurer, May 2024, 6.
The Workers Compensation Insurance Fund (WCIF) is established under s154D of the Workers Compensation Act 1987. It is managed by icare and primarily funded through workers compensation premiums paid by employers. The WCIF supports the payment of insurance claims.
We acknowledge the traditional custodians of the land on which we work and pay our respects to all Elders past and present, and to the children of today who are the Elders of the future.
Artist: Jasmine Sarin, a proud Kamilaroi and Jerrinja woman.