Insurance, Workers’ Compensation & Injury Schemes – Governance Five™ © Non-Clinical Governance Guide

Governance Five™ © is applied as a repeatable, staged decision-to-delivery flow for non-clinical governance topics where clarity, participation, traceability or public accountability are needed – for example scheme design, access and eligibility rules, employer programs, injury-management models, provider networks, social-value claims or community-impact narratives.

In insurance and schemes, it is typically used around but not inside core legal, actuarial, claims and clinical functions. It focuses on how decisions are structured, who is engaged, what evidence is aggregated, how delivery aligns with promises, and how learning feeds back into governance.

• Govern: Define the non-clinical, non-actuarial intent and fairness principles – for example around access, early support, return-to-work, worker voice, employer obligations, local capability, mental health, vulnerable cohorts or public-value commitments. Clarify non-clinical decision rights, guardrails and what must always defer to statutory or professional authority.
• Engage: Identify the required voices – workers, claimants, families, unions, employer groups, clinicians, allied-health providers, lawyers, advocates, regulators, communities and scheme partners – and document how and when they contribute to program or model design.
• Aggregate: Bring together data, risk analysis, lived experience, financial modelling, complaints, investigations, audit findings, qualitative feedback and external evidence into a shared basis for non-clinical decisions about programs and models.
• Deliver: Align contracts, panel arrangements, employer programs, communications, digital tools, incentives and reporting with what was authorised at governance level, so there is a visible line from non-clinical decision to front-line experience.
• Evolve: Use claims trends, disputes, ombudsman outcomes, royal commissions, inquiries, regulator findings, reviews and audits to update upstream governance settings – not just local procedures – so that learning becomes structural, not episodic.

This flow does not alter legal, actuarial, regulatory or clinical obligations. Those remain with the appropriate qualified professionals and authorities. Governance Five™ © focuses on how non-clinical decision structure, participation and documentation are organised around those obligations.

Governance Five™ © is concerned with how non-clinical, non-actuarial decisions that affect people, employers and communities are structured and traced, especially when work involves:

• Multiple actors – insurers, scheme owners, TPAs, employers, unions, clinicians, allied-health providers, lawyers and regulators.
• Multiple schemes or products – workers’ compensation, CTP, personal injury, income protection, disability, life and group products.
• Blended objectives – financial sustainability plus safe work, fair outcomes, mental health, early support, local jobs or public trust.
• Complex funding, incentives and risk-sharing – experience rating, premium discounts, outcome-based payments, shared-risk agreements.
• Public narrative and scrutiny – where communities, media or inquiries ask “why is the scheme like this and who decided?”.

Governance Five™ © provides a single non-clinical governance flow that makes decision paths visible, auditable and explainable, without changing statutory, prudential or professional frameworks.

Statutory schemes operate under legislation and regulation. Within those boundaries, non-clinical governance questions may include:

• How early intervention, case management and return-to-work programs are designed and reviewed.
• How provider panels and pricing frameworks are structured and adjusted.
• How worker voice, employer voice and union input are incorporated into scheme design.
• How community impact, mental health and vulnerable cohorts are considered.

Governance Five™ © can help scheme owners:

• Govern: Make scheme-wide non-clinical principles, objectives and guardrails explicit.
• Engage: Structure participation of workers, employers, unions, advocates, clinicians, providers and communities.
• Aggregate: Bring together financials, outcomes, experience data, research and lived experience before reforms.
• Deliver: Align agent contracts, provider agreements and communications with what was authorised.
• Evolve: Turn inquiries, audits and ombudsman findings into governance updates, not only operational fixes.

Legislation and regulators still set the rules. Governance Five™ © focuses on how non-clinical scheme decisions are structured within those rules.

Private insurers balance prudential obligations, shareholder expectations and customer outcomes. Non-clinical governance topics may include:

• How support programs, rehabilitation offerings and mental-health initiatives are designed and offered.
• How vulnerable customers, hardship and accessibility are considered in non-clinical design.
• How marketing, sales and public statements about wellbeing or social impact align with real governance.
• How employer, fund, adviser and member voices are incorporated.

Governance Five™ © can help insurers:

• Set non-clinical principles for fairness, transparency, accessibility and trust (Govern).
• Structure engagement with customers, advisers, funds, employer groups and advocates (Engage).
• Aggregate data, complaints, surveys, claims trends and external evidence before changing programs (Aggregate).
• Ensure implementation, partner contracts and communications match what was authorised (Deliver).
• Feed review findings into governance-level improvements (Evolve).

Governance Five™ © does not replace prudential standards or financial advice. It focuses on how non-clinical decisions about support and programs are structured.

Employers, especially large or high-risk ones, run WHS, wellbeing and RTW programs that interact with schemes and insurers. Non-clinical governance questions may include:

• How programs are offered, targeted and evaluated across locations and job types.
• How unions, HSRs, workers and leaders participate in design and review.
• How alliances with providers and insurers are set up and governed.
• How claims and safety data are used to improve culture and practice, not only metrics.

Governance Five™ © can help employers:

• Clarify non-clinical principles and decision rights for WHS and RTW programs (Govern).
• Engage workers, HSRs, unions, leaders and providers in a structured way (Engage).
• Aggregate data, stories and risk analysis before major program decisions (Aggregate).
• Align internal roles, supplier contracts and communications with authorised intent (Deliver).
• Use reviews and investigations to evolve governance, not just processes (Evolve).

WHS law and industrial instruments remain primary. Governance Five™ © focuses on the non-clinical structuring of programs within that framework.

Third-party administrators and provider networks link insurers, schemes, employers and clinicians. Non-clinical governance questions may include:

• How service models, triage approaches and care pathways are set up.
• How fairness, transparency and choice are considered for injured people.
• How data, incentives and KPIs are aligned with declared objectives.
• How communities and sectors understand why the system works this way.

Governance Five™ © can help these networks:

• Make non-clinical governance logic visible across insurers, providers and employers (Govern).
• Engage workers, unions, providers, advocates and customers in program design (Engage).
• Aggregate experience, outcomes and risk before model changes (Aggregate).
• Ensure contracts and operations reflect authorised decisions (Deliver).
• Turn systemic issues into governance revisions, not just performance management (Evolve).

Clinical decisions remain with qualified practitioners; legal and regulatory decisions remain with authorised bodies. Governance Five™ © addresses the non-clinical structuring of the ecosystem.

The statements below are examples only. They should be reviewed by your own legal, financial, actuarial, regulatory and clinical-governance advisors before any external use.

About its role

• “We use Governance Five™ © as a non-clinical governance framework to organise how decisions, participation and documentation are structured around our existing legal, prudential and regulatory obligations.”
• “Governance Five™ © helps us show the path from mandate to engagement, aggregation, delivery and learning for programs that affect injured people, employers and communities.”
• “It is a licensed governance system, not a legal, financial or clinical tool. It complements, but does not replace, specialist frameworks.”

About potential non-clinical benefits

• “Using Governance Five™ © may improve visibility and traceability across multi-organisation insurance and injury schemes.”
• “It can reduce ambiguity about who is involved, when and under what rules in non-clinical decisions about programs and models.”
• “It helps align engagement, evidence and implementation so that non-clinical decisions are easier to explain to customers, claimants, employers, regulators and communities.”

About boundaries

• “Governance Five™ © does not provide legal, financial, actuarial or clinical advice and does not alter statutory or regulatory obligations.”
• “Claims decisions, underwriting, pricing, legal interpretations and clinical assessments remain the responsibility of the appropriate professionals and authorities.”

These examples are for informational purposes. They do not create or remove any obligations. Always confirm wording locally.

Leaders may wish to consider these non-clinical governance questions when exploring Governance Five™ ©:

• Can we clearly describe the governance flow behind major non-clinical decisions that shape access, support models and public-value claims in our schemes or portfolios?
• Do our current frameworks make it easy to show who was engaged, what was considered and how trade-offs were decided across legal, actuarial, commercial, clinical and community perspectives?
• When we make ESG, social-value, wellbeing or trust claims, can we trace them back to a documented method origin?
• Across products, schemes, TPAs and regions, are we implicitly relying on a single staged method without having named it or checked its authorship and licensing status?
• Would a single licensed non-clinical governance flow make it easier to respond to regulators, inquiries, investors, ombudsman matters and community questions?

These prompts do not judge current practice. They simply help identify whether method origin, provenance and licensing should be part of your governance and risk conversations.

Governance Five™ © / Power Group Purchasing™ © is a documented, authored system whose five-stage flow Govern → Engage → Aggregate → Deliver → Evolve™ © has been on public record since 2010.

Insurers, statutory schemes, TPAs, large employers, injury-management providers, superannuation funds and sector partners may wish to consider licensing or alignment discussions where their non-clinical frameworks:

• Use a similar five-stage governance flow to justify scheme design, social impact, early support, mental-health outcomes, safe work or sovereign capability.
• Are promoted as a single, proprietary system for cross-organisation public-value or community-value decision-making.
• Underpin tenders, reforms, ESG reports, sustainability reports, social-bond structures or large national initiatives in ways that resemble Governance Five™ © public examples.

In such cases, organisations may decide – with their own legal, IP, regulatory and financial advisors – to:

• Confirm that their method is independently founded with dated pre-2010 provenance, or
• Explore licensing or attribution where there is substantive structural overlap with Governance Five™ ©.

Nothing in this section is a legal finding or allegation. It is a governance-awareness prompt only. Any decision about licensing, alignment or attribution remains the responsibility of each organisation and its professional advisors.