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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, from 1 December 2020, Youi. State Insurance Regulatory Authority (SIRA) now provides quarterly data on insurer performance to help people make more informed comparisons and know what to expect if they make a claim.

Each report answers these types of 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. What happens if get into a dispute about this? ›

6. 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 includes payments for loss of income, medical and rehabilitation costs.

Most insurers accept over 98% of claims and, if they deny any claims, must explain why. The main reason is currently late claims (by more than 90 days). It is important for claimants to submit their documents on time.

Table 1a: Percentage of claims insurers accepted

  September 2020 September 2019
  Accepted Accepted
AAMI 98.0% 99.4%
Allianz 97.5% 98.2%
GIO 97.7% 99.4%
NRMA 98.0% 97.4%
QBE 99.7% 99.8%
Total 98.3% 98.6%

Table 1b: Main reason why insurer denied claims

  September 2020 September 2019  
  Main reason Main reason  
AAMI Late claim >90 days Late claim >90 days  
Allianz Late claim >90 days Not a car accident  
GIO Late claim >90 days Late claim >90 days  
NRMA Late claim >90 days Late claim >90 days  
QBE Late claim >90 days Late claim >90 days/Other  
Total Late claim >90 days 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.

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

  September 2020 September 2019  
  Pre-claim support Pre-claim support  
AAMI 66% 65%  
Allianz 79% 78%  
GIO 67% 64%  
NRMA 76% 78%  
QBE 76% 72%  
Total 74% 73%  

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

  2020 2019 2020 2019 2020 2019
  0-4 weeks 0-4 weeks  5-13 weeks 5-13 weeks 14-26 weeks 14-26 weeks
AAMI 29% 27% 5% 7% 0 1%
Allianz 17% 18% 4% 4% 0 0
GIO 27% 27% 5% 8% 1% 1%
NRMA 19% 17% 4% 4% 1% 1%
QBE 19% 23% 4% 4% 1% 1%
Total 21% 21% 4% 5% 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. A full 90% of customers receive income benefits within the first month of making a claim.

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

  September 2020 September 2019
  0-4 weeks 0-4 weeks
AAMI 58% 41%
Allianz 68% 63%
GIO 53% 42%
NRMA 50% 44%
QBE 42% 45%
Total 53% 48%

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

  2020 2019   2020 2019 2020 2019
  5-13 weeks 5-13 weeks    14-26 weeks 14-26 weeks 27-52 weeks 27-52 weeks
AAMI 35% 49%   6% 9% 1% 2%
Allianz 26% 30%   5% 5% 1% 2%
GIO 40% 51%   7% 6% 0 1%
NRMA 42% 46%   6% 9% 2% 2%
QBE 47% 44%   9% 10% 2% 1%
Total 39% 43%   7% 8% 1% 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, no reasons are given for being late, or the insurer lacked jurisdiction.

Table 4a: Number of insurer reviews per 100,000 green slips

  September 2020 September 2019
  Per 100,000 green slips Per 100,000 green slips
AAMI 51 51
Allianz 45 36
GIO 50 46
NRMA 27 29
QBE 38 23
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

  2020 2019 2020 2019 2020 2019
  Better Better Lower Lower Same Same
Amount of weekly payments 46% 52% 11% 8% 43% 40%
Is injured person mostly at fault? 28% 24% 0 0 72% 76%
Minor injury 9% 13% 0 0 91% 85%
Other 27% 32% 1% 1% 72% 60%
Treatment and care 29% 40% 2% 1% 69% 57%
Total 22% 25% 2% 1% 76% 71%

Table 4c: Outcome of resolved internal review by insurer

  2020 2019 2020 2019 2020 2019
  Better Better Lower Lower Same Same
AAMI 17% 23% 3% 1% 80% 76%
Allianz 25% 29% 1% 1% 74% 70%
GIO 18% 23% 2% 1% 80% 76%
NRMA 27% 32% 2% 1% 71% 67%
QBE 19% 28% 0 0 81% 72%

Table 4d: Internal reviews completed within timeframes

Insurers should provide most internal review decisions within 14 days up to a maximum of 28 days. SIRA investigates why some insurers are completing reviews by the timeframe and some are not.

  September 2020 September 2019 September 2020 September 2019
  Within timeframe
Within timeframe Outside timeframe Outside timeframe
AAMI 43% 34% 57% 66%
Allianz 99% 100% 1% 0
GIO 36% 30% 64% 70%
NRMA 75% 29% 25% 71%
QBE 98% 99% 2% 1%
Total 72% 54% 28%

46%

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 but most insurers have not done so.

  Sept 2020 Sept 2019   Sept 2020 Sept 2019 Sept 2020 Sept 2019
  Medical assess.
Medical assess.    Merit review
Merit review Misc. claims
Misc. claims
AAMI 44 34   37 27 29 37
Allianz 14 12   15 12 15 12
GIO 45 33   42 32 40 32
NRMA 19 33   17 38 12 42
QBE 15 15   16 15 16 16
Timeframe (days) 14 14   14 14 14 14

5. What happens if get into a dispute about this?

If claimants are dissatisfied with the result of the insurer review, they can lodge a dispute with SIRA’s Dispute Resolution Services (DRS). The DRS helps clarify the issues in dispute between insurer and customer then arranges for an independent and binding decision.

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

  1 Dec 2017 – 30 Sept 2020
  Per 100,000 green slips
AAMI 39
Allianz 40
GIO 44
NRMA 26
QBE 25
Total 32

Customers who lodge a DRS dispute may find the outcome is better, the same or lower than the insurer review decision. While 58% currently stay the same, it depends on the subject under review.

Table 5b: Type of outcome after each DRS dispute subject

  1 Dec 2017 – 30 Sept 2020
  Better Lower Same
Minor injury 33% 0 67%
Treatment and care 46% 0 54%
Is injured person mostly at fault? 67% 0 33%
Amount of weekly payments 51% 0 49%
Other 45% 8% 47%
Total 41% 1% 58%

6. Can I complain about or compliment insurers?

Customers can complain about or give compliments to insurers. CTP Assist handles non-complex complaints within two working days. SIRA complaints handling experts deal with more complex complaints.

Table 6a: Number of complaints per 100,000 green slips

  Year end 30 Sept 2020
  Per 100,000 green slips
AAMI 13
Allianz 7
GIO 14
NRMA 11
QBE 11
Total 11

Table 6b: Number of compliments per 100,000 green slips

  Year end 30 Sept 2020
  Per 100,000 green slips
AAMI 3
Allianz 5
GIO 3
NRMA 2
QBE 2
Total 3

SIRA publishes only types of complaints, not types of compliments.

Table 6c: Top three types of complaint about each insurer

  1st 2nd 3rd
AAMI Management Decisions Service
Allianz Management Decisions Service/Delays
GIO Delays Management Service/Decisions
NRMA Service Management Delays
QBE Management Delays Service
Total Management Service Delays

 
Sources: State Insurance Regulatory Authority (SIRA) CTP Insurer Claims Experience and Customer Feedback Comparison, 30 September 2020. In these tables, 2020 is 1 October 2019 to 30 September 2020 and 2019 is 1 October 2018 to 30 September 2019 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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