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Insurer Claims Performance

What to expect from insurers when making a claim

The greenslips.com.au calculator helps vehicle owners find the cheapest price for all six CTP insurers. These are AAMI, Allianz, GIO, NRMA Insurance, QBE and, since 1 December 2020, Youi. State Insurance Regulatory Authority (SIRA) provides quarterly data on insurer performance to help people make more informed comparisons and know what to expect if they make a CTP claim.

Each report answers these questions:

1. What are the chances of having my claim accepted? ›

2. How long will I wait for treatment and care benefits? ›

3. How long will it take to get income support if I take time off work? ›

4. What happens if I disagree with the insurer? ›

5. Can I complain about or compliment insurers? ›

1. What are the chances of having my claim accepted?

The new scheme since 1 December 2017 made benefits available to all injured parties in the first 6 months after a car accident. Benefits include payments for loss of income, medical and rehabilitation costs.

Most insurers accept 98% of claims and, if they deny any claims, must explain why. The main reason has changed from late claims (by more than 90 days) to non-existent injury or not under legislation.

Table 1a: Percentage of claims insurers accepted

  September 2021 September 2020
  Accepted Accepted
AAMI 98.7% 98.5%
Allianz 97.1% 97.8%
GIO 98.6% 98.3%
NRMA 97.1% 97.8%
QBE 99.6% 99.8%
Total 98.1% 98.4%

Table 1b: Main reason why insurer denied claims

  September 2021 September 2020  
  Main reason Main reason  
AAMI Insufficient info/Late claim >90 days Late claim >90 days/Insufficient info  
Allianz Late claim >90 days Late claim >90 days/Not a vehicle accident  
GIO No injury/Not under legislation Late claim >90 days  
NRMA No injury/Not under legislation Late claim >90 days  
QBE Late claim/No injury/Not under legislation Late claim/No injury/Not under legislation  
Total No injury/Not under legislation Late claim >90 days  

2. How long will I wait for treatment and care benefits?

How quickly insurers pay benefits is important for helping injured people make a full recovery after an accident. That is why insurers also pay pre-claim support before someone lodges a formal claim. In 2021, 72% of injured people received pre-claim support.

Table 2a: Percentage of claimants with pre-claim support

  September 2021 September 2020  
  Pre-claim support Pre-claim support  
AAMI 67% 66%  
Allianz 75% 79%  
GIO 67% 67%  
NRMA 72% 76%  
QBE 73% 76%  
Total 72% 74%  

Table 2b: Percentage with benefits in first 4 weeks and after

  2021 2020 2021 2020 2021 2020
  0-4 weeks 0-4 weeks  5-13 weeks 5-13 weeks 14-26 weeks 14-26 weeks
AAMI 20% 28% 4% 5% 1% 1%
Allianz 19% 17% 4% 4% 0 0
GIO 26% 26% 5% 6% 1% 1%
NRMA 22% 19% 4% 4% 1% 1%
QBE 22% 19% 4% 4% 1% 1%
Total 23% 21% 4% 4% 1% 1%

3. How long will it take to get income support if I take time off work?

The sooner claimants send required information to the insurer, the faster they can receive income support. Some 91% of customers received income benefits within the first 13 weeks of making a claim.

Table 3a: Percentage of claimants with income support in first 4 weeks

  September 2021 September 2020
  0-4 weeks 0-4 weeks
AAMI 48% 58%
Allianz 63% 68%
GIO 48% 53%
NRMA 59% 50%
QBE 55% 42%
Total 56% 53%

Table 3b: Percentage of claimants with income support after first 4 weeks

  2021 2020   2021 2020 2021 2020
  5-13 weeks 5-13 weeks    14-26 weeks 14-26 weeks 27-52 weeks 27-52 weeks
AAMI 42% 35%   9% 6% 1% 1%
Allianz 31% 26%   5% 5% 1% 1%
GIO 41% 40%   9% 7% 2% 0
NRMA 32% 42%   8% 6% 1% 2%
QBE 35% 47%   7% 9% 3% 2%
Total 35% 39%   7% 7% 2% 1%

4. What happens if I disagree with the insurer?

When customers disagree with the insurer’s decision, they can request a review by the insurer. Types of decisions include minor injury, treatment and care, weekly payments, or who was at fault in the accident. Insurers accept most requests for review, unless they are late or the insurer lacked jurisdiction.

Table 4a: Number of insurer reviews per 100 claims

  September 2021 September 2020
  Per 100 claims
Per 100 claims
AAMI 43 42
Allianz 39 29
GIO 46 42
NRMA 32 25
QBE 43 35
Total 39 33

 Customers who request an insurer review may find the outcome is better, the same or lower than before. While about three quarters stay the same, it depends on the subject under review.

Table 4b: Type of outcome after each insurer review subject

  2021 2020 2021 2020 2021 2020
  Better Better Lower Lower Same Same
Amount of weekly payments 48% 46% 6% 8% 46% 46%
Is injured person mostly at fault? 18% 28% 0 0 82% 72%
Minor injury 13% 10% 0 0 87% 90%
Other 17% 20% 0 2% 83% 78%
Treatment and care 27% 25% 1% 2% 72% 73%
Total 20% 21% 1% 1% 79% 78%

Table 4c: Outcome of resolved internal review by insurer

  2021 2020 2021 2020 2021 2020
  Better Better Lower Lower Same Same
AAMI 19% 15% 1% 2% 80% 83%
Allianz 22% 21% 1% 1% 77% 78%
GIO 18% 19% 1% 1% 81% 80%
NRMA 20% 27% 1% 3% 79% 70%
QBE 21% 19% 0 0 79% 81%

Table 4d: Internal reviews completed within timeframes

Insurers should provide most internal review decisions within 14 days up to a maximum of 28 days. In response to regulatory action, AAMI, GIO and NRMA have vastly improved their timeliness.

  Sept 2021 Sept 2020 Sept 2021 Sept 2020
  Within timeframe
Within timeframe Outside timeframe Outside timeframe
AAMI 99.5% 41.2% 0.5% 58.8%
Allianz 98.9% 99.4% 1.1% 0.6%
GIO 99.5% 35.3% 0.5% 64.7%
NRMA 96.0% 82.1% 4.0% 17.9%
QBE 98.5% 98.1% 1.5% 1.9%
Total 98.2% 73.5% 1.8%

26.5%

Table 4e: Type of internal review completed in number of days

There are three types of internal review: merit review, medical assessment and miscellaneous claims. Insurers should provide most internal review decisions within 14 days. Timeliness improved dramatically in the past year.

  Sept 2021 Sept 2020   Sept 2021 Sept 2020 Sept 2021 Sept 2020
  Medical assess.
Medical assess.    Merit review
Merit review Misc. claims
Misc. claims
AAMI 11 40   11 34 9 31
Allianz 15 13   16 14 13 14
GIO 11 43   9 42 9 33
NRMA 17 19   13 17 13 12
QBE 13 13   12 14 13 14
Timeframe (days) 14 14   14 14 14 14

5. Can I complain about or compliment insurers?

Since 1 March 2021, injured people can complain about insurers to the Independent Review Office. SIRA continues to manage complaints about all other aspects of the scheme. Complaints usually outweigh compliments per 100,000 green slips.

Table 5a: Number of complaints per 100,000 green slips

  Year end 30 September 2021
  Per 100,000 green slips
AAMI 16
Allianz 10
GIO 17
NRMA 19
QBE 17
Total 16

Table 5b: Number of compliments per 100,000 green slips

  Year end 30 September 2021
  Per 100,000 green slips
AAMI 2
Allianz 3
GIO 5
NRMA 3
QBE 2
Total 3

 

Sources: State Insurance Regulatory Authority (SIRA) CTP Insurer Claims Experience and Customer Feedback Comparison, 30 September 2021. In these tables, 2021 is 1 Oct 2020 to 30 Sep 2021 and 2020 is 1 Oct 2019 to 30 Sep 2020, unless stated otherwise.

Compliments and complaints data are collected by SIRA and do not include those directed to insurers.

Claims information is not yet available for Youi because of its recent NSW CTP market entry on 1 December 2020.

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