What Are They Hiding When They Refuse to Review Claims Management?
Nov 20
3 min read
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And Is the Real Fear That Insurers Would Walk?
For years, NSW has danced around one of the most urgent and obvious questions in the workers’ compensation system:
Why won’t the government call a proper, independent review of claims management?
We’ve had inquiries, audits, reports, parliamentary hearings, consultant summaries, and endless “stakeholder engagements.” But when it comes to the core engine of harm — claims management itself — the silence is deafening.
Not hesitation. Not delay. Silence.
Which forces us to ask the real question: What are they protecting?And who are they afraid of?
1. Are They Afraid of What a Real Review Would Reveal?
A genuine review of claims management would have to examine:
denial patterns
systemic delays
psychological injury handling
internal performance targets
surveillance practices
automated decision-making
case manager burnout
inappropriate medical opinions
chaotic file management
and the culture of suspicion that underpins the system
A real review would expose how decisions are made. Who benefits. Who loses. Who gets hurt.
It would shine a light into a part of the system that has operated in the shadows for decades.
And let’s be honest:
No government wants to see that on the public record.
2. Or Is the Fear Even Bigger?
Would the Insurers Walk?
This is the unspoken truth that insiders understand:
If the government forced scheme agents to confront the harm inside their own claims management practices, some insurers might threaten to walk.
Right now, insurers operate with:
limited transparency
limited enforceable accountability
politically convenient contracts
performance indicators that shape behaviour
and a regulator that rarely clamps down
A full, independent review — the kind injured workers and their families deserve would put insurers under a level of scrutiny they have never faced.
If the findings were bad (and they would be), insurers could decide the reputational and operational exposure isn’t worth it.
The whole scheme relies on a delicate reality:
The government needs insurers. Insurers do not need the government.
That imbalance is the real risk no one wants to disrupt.
3. Or Is the System Itself Simply Unmanageable?
Let’s imagine the government does call a review.
What if the findings show:
case managers cannot cope
the system design produces harm
the IT platforms are unfit for purpose and the damage is at scale
psychological claims are structurally mishandled
files are chaotic
public servants are traumatised
internal cultures are breaking
and the operating model makes recovery nearly impossible
What then?
What do you reform when the problem isn’t behaviour —it’s architecture?
A claims management review risks proving that the system is not “failing.”
It is functioning exactly as designed.
And that design harms people.
4. The Hybrid Model Exists for One Reason: So Government Takes No Risk
Here is the core truth sitting beneath all of this:
The NSW workers’ compensation system was deliberately built as a hybrid model so the government carries almost no risk.
Insurers carry the operational risk but the legislation protects them.
Injured workers carry the human risk.
Employers carry the financial risk.
The public carries the social risk.
But the government? They remain insulated.
They outsource the harm. They outsource the claims decisions. They outsource the blame.
If things go wrong?
“Blame the insurer.” “Blame the scheme agent.” “Blame the assessment.” “Blame the worker.”
The hybrid model looks complex, but it has one purpose:
Shield government. Expose everyone else. And ensure the injured remain the only group who cannot walk away.
This is why claims management is never reviewed. Because reviewing it would expose the architecture itself — not just the agents running it.
5. So What Are They Hiding?
Maybe it’s not one thing.
Maybe it’s:
the delays
the denials
the suicides
the pressured staff
the traumatised NGOs
the broken files
the burnout
the culture of suspicion
the political fear of insurers walking
the hybrid structure designed for government protection
the harm that everyone sees but no one is allowed to name
A review of claims management is the one thing government cannot control.
So they avoid it.
Silence becomes strategy.
6. This Could Be YOU or Someone YOU love
If claims management is as safe, fair, and functional as the government and insurers insist it is —why won’t they review it?
Why not examine it? Why not make the process transparent? Why not prove it works?
What are they hiding? What are they afraid of? And why is the truth so dangerous?
Until these questions are answered, the public will draw its own conclusions.
And so will we.
Because the evidence of harm is too great to believe the government rhertoric.
