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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 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 98% of claims and, if they deny any claims, must explain why. The main reason is late claims (by more than 90 days). This means it is important for claimants to submit their documents on time.

Table 1a: Percentage of claims insurers accepted

  March 2021 March 2020
  Accepted Accepted
AAMI 98.0% 98.4%
Allianz 97.0% 98.4%
GIO 96.9% 98.6%
NRMA 97.3% 98.5%
QBE 99.8% 99.7%
Total 97.9% 98.8%

Table 1b: Main reason why insurer denied claims

  March 2021 March 2020  
  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/Insufficient info Late claim >90 days  
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

  March 2021 March 2020  
  Pre-claim support Pre-claim support  
AAMI 66% 66%  
Allianz 78% 80%  
GIO 65% 67%  
NRMA 73% 78%  
QBE 75% 75%  
Total 72% 75%  

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 28% 28% 5% 5% 1% 1%
Allianz 18% 17% 4% 3% 0 0
GIO 28% 25% 6% 7% 1% 1%
NRMA 23% 16% 3% 5% 1% 1%
QBE 29% 20% 4% 4% 1% 1%
Total 23% 20% 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 93% 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

  March 2021 March 2020
  0-4 weeks 0-4 weeks
AAMI 53% 52%
Allianz 67% 69%
GIO 48% 47%
NRMA 55% 45%
QBE 43% 44%
Total 53% 51%

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 43% 41%   3% 6% 1% 1%
Allianz 29% 25%   3% 5% 1% 1%
GIO 43% 43%   8% 7% 1% 3%
NRMA 37% 44%   6% 9% 2% 2%
QBE 48% 44%   8% 9% 1% 3%
Total 40% 40%   6% 7% 1% 2%

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 claims

  March 2021 March 2020
  Per 100 claims
Per 100 claims
AAMI 25 23
Allianz 22 18
GIO 24 27
NRMA 15 14
QBE 23 16
Total 21 18

 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 43% 43% 9% 9% 48% 48%
Is injured person mostly at fault? 14% 32% 0 0 86% 68%
Minor injury 12% 12% 0 0 88% 88%
Other 30% 34% 2% 1% 68% 65%
Treatment and care 31% 31% 0 3% 69% 66%
Total 23% 24% 1% 2% 76% 74%

Table 4c: Outcome of resolved internal review by insurer

  2021 2020 2021 2020 2021 2020
  Better Better Lower Lower Same Same
AAMI 24% 23% 1% 3% 75% 74%
Allianz 26% 26% 2% 1% 72% 73%
GIO 21% 20% 2% 2% 77% 78%
NRMA 24% 29% 0 3% 76% 68%
QBE 20% 20% 0 0 80% 80%

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.

  March 2021 March 2020 March 2021 March 2020
  Within timeframe
Within timeframe Outside timeframe Outside timeframe
AAMI 80% 18% 20% 83%
Allianz 100% 99% 0 1%
GIO 75% 17% 25% 83%
NRMA 93% 56% 7% 44%
QBE 98% 98% 2% 2%
Total 90% 60% 10%

40%

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. Most insurers did not achieve this at all.

  March 2021 March 2020   March 2021 March 2020 March 2021 March 2020
  Medical assess.
Medical assess.    Merit review
Merit review Misc. claims
Misc. claims
AAMI 26 53   17 44 26 44
Allianz 20 19   16 14 21 20
GIO 21 56   22 54 31 40
NRMA 20 26   15 30 14 21
QBE 15 15   14 17 21 21
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 the new Personal Injury Commission. The PIC helps clarify the issues in dispute between insurer and customer then arranges for an independent and binding decision. Before 1 March 2021, they had to apply to SIRA’s Dispute Resolution Services (DRS).

Table 5a: Number of disputes per 100 claims

  1 Dec 2017 – 28 Feb 2021
  Per 100 claims
AAMI 22
Allianz 20
GIO 23
NRMA 15
QBE 18
Total 19

Customers who lodge a dispute may find the outcome is better, the same or lower than the insurer review decision. While 55% currently stay the same, it depends on the subject under review.

Table 5b: Type of outcome after each dispute subject

  1 Dec 2017 – 28 Feb 2021
  Better Lower Same
Minor injury 34% 0 66%
Treatment and care 46% 0 54%
Is injured person mostly at fault? 64% 0 36%
Amount of weekly payments 55% 0 45%
Other 42% 19% 39%
Total 41% 4% 55%

6. Can I complain about or compliment insurers?

Injured people can complain about or give compliments to insurers. SIRA used to handle this kind of complaint. Since 1 March 2021, the Independent Review Office hears complaints about insurers.

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

  Year end 31 March 2021
  Per 100,000 green slips
AAMI 12
Allianz 7
GIO 13
NRMA 11
QBE 11
Total 11

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

  Year end 31 March 2021
  Per 100,000 green slips
AAMI 2
Allianz 4
GIO 4
NRMA 3
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/Delays Service
Allianz Management Decisions Service
GIO Management Decisions Delays
NRMA Management Service Delays
QBE Management Service Decisions
Total Management Service Decisions

 
Sources: State Insurance Regulatory Authority (SIRA) CTP Insurer Claims Experience and Customer Feedback Comparison, 31 March 2021. In these tables, 2021 is 1 April 2020 to 31 March 2021 and 2020 is 1 April 2019 to 31 March 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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