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.