Regulatory services and performance
Workers’ Compensation Licensing, Performance and Compliance
The Workers’ Compensation Licensing, Performance and Compliance team (formally known as Insurer Licensing and Performance) have restructured and welcomed additional resources. These changes will strengthen our ability to support and monitor insurers and other duty holders in the scheme.
The restructure includes:
- a Compliance and Enforcement team responsible for the planning, execution and evaluation of workers’ compensation compliance and enforcement activities; and
- a Licensing and Performance team responsible for self-insurance licensing activities and monitoring insurer performance.
If you have any questions, please contact insurerservices@oir.qld.gov.au.
Licensing and performance of Queensland insurers
Out of the 27 Queensland insurers, there are currently 26 self-insurance licences, with 58% holding a four-year licence. From 1 July 2025, Healius Limited returned to WorkCover Queensland. See the complete list of self-insurers.
During 2024-25, no new self-insurance licences were issued. 5 licences were renewed with 2 insurers renewed for 4 years and 3 renewed for 3 years. As of 30 June 2025, there were 12 self-insurers with special licence conditions. Special Licence conditions apply to licence renewals of 3, 2 and 1-year durations, except for new licences that are for 2 years.
Compliance and enforcement activities
In 2024-25 there were 20 audits conducted across scheme insurers including Workcover Queensland.
These comprised of:
- 11 compliance audits
- 1 targeted rehabilitation and return to work audit campaign of all Insurers
- 2 special licence condition audits
- 3 special audits of individual claims
- 3 special audits of individual claims that remain in progress.
Workers Compensation Regulatory Services (WCRS) identified a range of non-compliance and non-conformance following these audits. The top three areas for improvement relate to insurer data submissions, rehabilitation and return to work plans – specifically the review, monitoring and finalisation of the plans and the medical assessment tribunal referral process.
A range of enforcement measures were implemented including 26 improvement action plans, 5 compliance notices, and reduced licence periods for 3 self-insurers.
Rehabilitation and return to work plans (RRTW plans)
As of 30 June 2025, the scheme return to work rate for finalised time lost claims is 90.6%. Further, the rate reduces to 83.2% per cent for workers who have four weeks or more off work.
In March 2025, WCRS published the final audit report of the targeted audit campaign of insurer Rehabilitation and return to work (RRTW) plans, undertaken from 1 March to 13 September 2024. Insurers received their own individual audit reports, and the full report (PDF, 2.48 MB) detailing audit findings and WCRS’s response to ensure the scheme is supporting all scheme stakeholders is published on the WorkSafe website .
The 2024 targeted audit was designed to assess how well Queensland insurers were meeting their obligations in relation to RRTW plans and identify areas of better practice and opportunities to improve return to work outcomes. Overall, the audit revealed opportunities to improve, with only 5 insurers’ meeting minimum requirements for RRTW plans.
The 2024 targeted audit did not audit to the standard of the new laws that commenced on 23 August 2024, requiring a written RRTW plan to be in place within 10 business days of a claim being accepted. Since 1 January 2025, WCRS’s Compliance and Enforcement team have completed 11 insurer compliance audits which included compliance checks against these new laws. The audits revealed considerable improvement in relation to RRTW plans, including developing RRTW plans within 10 business days, and sharing RRTW plans with the worker and stakeholders.
WCRS will continue to monitor and report on performance relating to RRTW plans.
Investigations
In 2024-25, 211 reports of suspected offending under the Workers’ Compensation and Rehabilitation Act 2003 were made to the Regulator. 75% of those reports related to suspected fraud and the provision of false information.
In 2024-25, Workers’ Compensation Investigations and Prosecution Services (WCIPS) actioned and finalised 212 reports of suspected offending. 61 of those were finalised following complex investigations. This resulted in 41 warning letters being issued and 7 matters being referred for legal advice/consideration of prosecution. Over the past 12 months, there has been an uplift in resources with 6 additional investigator positions created to minimise delays resulting from the increase in reports of suspected offending.
WCRS is committed to strengthening the approach taken to workers’ compensation fraud. In 2024-25, WCIPS recovered $253,799.42 that was fraudulently obtained for insurers through the successful prosecution of 9 workers. To preserve the integrity and sustainability of the scheme, investigating serious allegations of fraud will continue to be prioritised in 2025-26.
Notable prosecutions
Track Work Rider sentenced for lying to the insurer about returning to work
On 8 May 2025, a man was sentenced to 6 months imprisonment (suspended for 9 months) for fraud for returning to work as a track work rider but telling his insurer he was unable to work and that he “barely leaves his house.” He was also ordered to repay restitution to the insurer in the amount of nearly $16,000.
Driller sentenced for fraud for working during his claim
On 20 June 2025, a man was sentenced to 12 months' imprisonment (suspended for 3 years) for defrauding an insurer by returning to work as a driller but telling the insurer that “work won’t touch him.” When the insurer found out about the work and asked the man about it, he told the insurer he was only doing administrative work, which was a lie. He was ordered to repay $17,000 in restitution to the insurer.