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SIRA Return to Work Roadmap 2026-28: What it means for claims teams
SIRA's three-year plan to lift declining return-to-work rates puts person-centred early intervention, complex claim management and stronger insurer oversight at the centre of the NSW Workers Compensation Scheme. Here is what claims managers, case coordinators and insurers should be doing now.
The first sustained RTW reversal since the early 2010s
The NSW Workers Compensation Scheme covers 4.9 million jobs and 349,000 employers. 13-week return-to-work rates have decreased from 88% in 2016-17 to 79% in 2024-25 — equating to an estimated 45,680 additional people experiencing avoidable work disability over that period. SIRA's Roadmap responds to that decline with a coordinated, evidence-based plan focused on early intervention and work participation across the Scheme.
The decline is sustained
13-week RTW rates have fallen 9 percentage points since 2016-17. The decline is broad-based across employer size and insurer type, but most pronounced in psychological injury and the public sector.
Complexity is concentrating
Psychological injury claims now make up 10% of claims but 26% of total Scheme cost. Three large NSW government agencies account for 95% of TMF claims. Complex claims are getting longer and more expensive.
Early intervention is the lever
The first four weeks of a claim are highly predictive of overall RTW outcomes. SIRA's analysis found less than 25% of insurers are effectively assessing risks of delayed recovery and RTW.
The decline at a glance
The data SIRA used to anchor the Roadmap. Numbers are drawn from SIRA Open Data as at November 2024-25 and the Roadmap's appendix.
RTW rates by insurer type (FY 2024-25)
| Insurer type | Market share (claims) | 13-week RTW (overall) | Non-psych / Psych RTW | Claims cost |
|---|---|---|---|---|
| Nominal insurer (NI) | 62% (70,954) | 78% | 82% / 34% | $2.76B (64%) |
| Government self-insurers (TMF) | 20% (22,846) | 78% | 89% / 43% | $1.15B (27%) |
| Self-insurers | 11% (13,115) | 82% | 86% / 55% | $239M (6%) |
| Specialised insurers | 7% (7,619) | 88% | 92% / 49% | $143M (3%) |
| Total Scheme | 114,534 | 79% | 85% / 40% | $4.29B |
RTW rates by employer size (FY 2024-25)
| Employer size | Market share (claims) | 13-week RTW (overall) | Non-psych / Psych RTW |
|---|---|---|---|
| Large (>200 employees) | 60% (66,219) | 82% | 89% / 44% |
| Medium (20-200) | 24% (26,696) | 80% | 85% / 33% |
| Small (1-19) | 16% (17,597) | 69% | 72% / 25% |
| Total Scheme | 110,512 | 79% | 85% / 40% |
SIRA's evidence base reaffirms the 20-day rule: after 20 days off work, the chance of returning drops to 70%. By 45 days (9 weeks) it drops to 50%. The Roadmap's emphasis on the first four weeks is grounded in this trajectory.
The 4 key challenges SIRA identified
Comprehensive analysis across legislation, claims data, regulatory reviews, independent inquiries, lived experience reference groups and stakeholder engagement converged on four challenge areas. Each is the root for an action area in the Roadmap.
- Reduced focus on recovery at work and work participation
- Insurer remuneration not aligned with RTW performance
- High insurer staff turnover impacting capability
- Administrative inefficiencies in certification and information flow
- Psych claims = 10% of claims, 26% of cost (2024-25)
- 70% of psych claims linked to preventable factors (work pressure, bullying, harassment)
- Government sector accounts for 49% of psych claims
- 13-week RTW for psych is 40% — less than half non-psych (84%)
- Three occupations make up two-thirds of job-detached people: labourers, community/personal service workers, machine operators and drivers
- Increasing share of claimants no longer employed at notification
- More roles associated with work pressure and interpersonal interaction
- NSW public sector = ~8% of claimants but 20% of claims
- Three large government agencies account for 95% of TMF claims
- TMF psych claims have doubled over six years
- 1,397 government sector people had capacity but had not worked in the preceding 13 weeks (Jan-Mar 2025)
- Five concern areas: structural complexity, financial performance, employer compliance, RTW challenges, claims management practice
Two of the four challenges — complex claims and the public sector — concentrate the cohort where medication regimens drive RTW outcomes. Opioids, benzodiazepines, antidepressants and medicinal cannabis directly influence cognition, fatigue, sleep and capacity. Independent pharmacy review is one of the lowest-cost, highest-leverage interventions available to claims teams managing this cohort.
The 4 Roadmap action areas
SIRA has prioritised four whole-of-Scheme action areas. The initiatives within each are designed to deliver meaningful improvements in RTW outcomes in the short to medium term.
- 1.1 Establish collaborative partnerships with insurers to shift Scheme culture
- 1.2 Implement government legislative reforms — strengthening early intervention and intensive RTW supports for psychological injury
- 1.3 Progress actions from SIRA's Claims Management Review Report 2025: review the policy framework (guidelines and standards of practice), review the regulatory approach, strengthen SIRA's supervision of insurer compliance, align insurer practices
- 2.1 Review the Certificate of Capacity to better support recovery at work
- 2.2 Review injury notification requirements and injury management planning
- 2.3 Leverage emerging artificial intelligence tools to enhance injury management efficiency and effectiveness
- 3.1 Support implementation of the NSW Government RTW Strategy 2025-2028
- 3.2 Expand SIRA Workers Compensation Assist service (outbound calls to at-risk employers)
- 3.3 Partner with priority industries and unions on industry-specific initiatives
- 3.4 Revise and publish amended SIRA Guidelines for workplace RTW programs
- 4.1 Simplify and streamline existing SIRA-funded programs to improve access and utilisation
- 4.2 Strengthen supervision so programs are used as part of an effective early-intervention strategy
- 4.3 Clarify scope of workplace rehabilitation services and foster collaborative partnerships
- 4.4 Review service range and funding models for complex claims and people seeking new employment
- 4.5 Design a work participation partnership framework for industry-led pilots
- 4.6 Review SIRA's Workplace Rehabilitation provider approval framework
What this means for claims teams in practice
Translating the Roadmap into the operational changes claims managers, technical specialists and case coordinators should expect — and prepare for — over the next 12 to 24 months.
Five operational shifts to expect
The Roadmap doesn't name pharmacy review specifically — but four of the five operational shifts above point at the cohort where medication oversight materially changes outcomes. Complex claims, psychological injury, public sector files, and "high medical intervention without objective improvement" (a recognised modifiable factor in the SIRA evidence base) are exactly where IMM's independent reviews accelerate decision-making. Average 8-day turnaround. 81% prescriber implementation rate. Trusted by GIO/Suncorp, EML, QBE, Allianz and TMF agencies.
The 4 domains of RTW outcomes
SIRA grounds the Roadmap in evidence on the modifiable factors driving RTW outcomes. The Roadmap directs action across all four — most can be addressed within the first four weeks of a claim if engaged early.
How SIRA will measure progress
Performance will be tracked through both lead indicators (early signals of improvement) and lag indicators (cumulative RTW outcomes). Annual progress reports will be published.
Lead indicators
| Indicator | Definition |
|---|---|
| Delay in notification | Delays in notifying employer and insurer that lead to delayed access to treatment and supports |
| Time lost | Average days off in the first 6 months from date of injury |
| RTW planning & plan | Whether a written RTW plan exists and parties are coordinated (employer experience) |
| Early contact and support | Workplace engages the person immediately following injury notification (employer experience) |
| Suitable work provision | Recovery at work and early RTW to good work (employer experience) |
| People take active role | Insurer equipped/supported the person to take an active role in recovery |
| Timely decisions and approvals | Decisions and approvals made without delay |
| Encouraged RTW / SAW | Insurer encouraged safe and timely RTW or stay-at-work |
Lag indicators
| Indicator | Definition |
|---|---|
| Stay-at-work rate at 13 weeks | % of people who made a claim and did not cease working as a result of their injury |
| RTW rate at 13 weeks | % of people who had at least one day off work and returned at full or current work capacity |
| Working rate at 13 weeks | Combined SAW + RTW measure |
| Job detached (with capacity) rate | People with a claim not working because of injury, illness or work disability over the preceding 13 weeks |
Common questions
Quick answers to the questions claims teams are asking us.
What is the SIRA Return to Work Roadmap 2026-28?
It is the State Insurance Regulatory Authority's three-year strategic plan to lift return-to-work outcomes in the NSW Workers Compensation Scheme. It centres on person-centred early intervention and work participation, with four action areas: Scheme focus and culture, Scheme efficiencies, Employer initiatives, and RTW services and supports.
Why has SIRA released the Roadmap now?
13-week RTW rates have declined from 88% in 2016-17 to 79% in 2024-25 — an estimated 45,680 additional people experiencing avoidable work disability. SIRA has also identified deteriorating early intervention, growth in complex psychological injury claims, and worsening NSW public sector performance as compounding pressures.
What does the Roadmap change for insurers and claims teams?
Insurers can expect strengthened SIRA supervision of obligations, a Certificate of Capacity and injury notification review, more risk-based and outcomes-focused regulation, and explicit expectations to apply person-centred early intervention within the first four weeks. Insurer remuneration is flagged for re-alignment with RTW performance.
How are psychological injury claims treated under the Roadmap?
Psychological injury claims represent 10% of claims but 26% of total claim cost in 2024-25, with a 13-week RTW rate of just 40% (compared with 84% non-psychological). The Roadmap directs intensive RTW supports for these claims and aligns with the government's legislative reforms targeting early intervention for psychological injury.
What is the role of medication oversight in supporting RTW outcomes?
Medication regimens — particularly opioids, benzodiazepines, antidepressants and medicinal cannabis — directly affect cognition, fatigue, sleep, and functional capacity, which determine whether a person can stay at work or return safely. SIRA's evidence base specifically flags "high medical intervention without objective improvement" as a modifiable factor associated with poorer outcomes. Independent pharmacy review is one of the lowest-cost, highest-leverage interventions for complex and medication-heavy claims.
When will the changes take effect?
The Roadmap covers 2026-2028. SIRA will publish annual progress reports. Some changes — such as Certificate of Capacity revisions and SIRA Guideline updates for workplace RTW programs — are likely within the first 12 months. Strengthened supervision of insurer obligations and remuneration realignment are likely to phase in across the period.
Where can I read the full Roadmap?
The complete document is available on the SIRA website: SIRA Return to Work Roadmap 2026-28 (PDF).
Strengthening early intervention for complex claims
If medication is a factor in a complex claim — opioids, benzodiazepines, antidepressants, medicinal cannabis, or polypharmacy — IMM's independent pharmacists provide a fast, evidence-based clinical opinion that aligns directly with the Roadmap's early-intervention focus. Average 8-day turnaround. 81% prescriber implementation rate.
