ADVERTISEMENT

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.

Table 1a: Percentage of claims insurers accepted

  June 2020 June 2019
  Accepted Accepted
AAMI 98.4% 99.3%
Allianz 98.0% 98.3%
GIO 97.5% 99.7%
NRMA 98.4% 96.8%
QBE 99.5% 99.7%
Total 98.4% 98.4%

Table 1b: Main reason why insurer denied claims

  June 2020 June 2019  
  Main reason Main reason  
AAMI Late claim >90 days Late/insufficient information  
Allianz Late claim >90 days Not a car accident  
GIO Late claim >90 days Insufficient information  
NRMA Late claim >90 days Late claim >90 days  
QBE 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

  June 2020 June 2019  
  Pre-claim support Pre-claim support  
AAMI 65% 62%  
Allianz 80% 78%  
GIO 68% 62%  
NRMA 79% 78%  
QBE 75% 71%  
Total 75% 72%  

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 28% 29% 5% 7% 2% 2%
Allianz 17% 18% 3% 4% 0 0
GIO 26% 29% 6% 7% 0 2%
NRMA 17% 17% 4% 4% 0 1%
QBE 19% 22% 4% 5% 2% 2%
Total 20% 22% 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

  June 2020 June 2019
  0-4 weeks 0-4 weeks
AAMI 53% 43%
Allianz 68% 57%
GIO 49% 44%
NRMA 47% 42%
QBE 41% 42%
Total 51% 46%

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 38% 45%   7% 11% 2% 1%
Allianz 26% 35%   6% 6% 0 2%
GIO 41% 47%   9% 8% 1% 1%
NRMA 44% 46%   7% 9% 2% 3%
QBE 46% 45%   10% 11% 3% 2%
Total 40% 44%   8% 9% 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

  June 2020 June 2019
  Per 100,000 green slips Per 100,000 green slips
AAMI 46 41
Allianz 46 32
GIO 55 39
NRMA 28 24
QBE 36 21
Total 39 29

 Customers who request an insurer review may find the outcome is better, the same or lower than before. While around 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 49% 65% 9% 5% 42% 30%
Is injured person mostly at fault? 29% 17% 0 0 71% 82%
Minor injury 9% 13% 0 0 91% 87%
Other 29% 32% 1% 0 70% 68%
Treatment and care 27% 40% 2% 1% 71% 59%
Total 22% 25% 2% 1% 76% 75%

Table 4c: 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.

  June 2020 June 2019 June 2020 June 2019
  Within timeframe
Within timeframe Outside timeframe Outside timeframe
AAMI 19% 52% 81% 48%
Allianz 99% 100% 1% 0
GIO 18% 47% 82% 53%
NRMA 57% 40% 43% 60%
QBE 98% 99% 2% 1%
Total 59% 62% 41%

38%

Table 4d: 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.

  June 2020 June 2019   June 2020 June 2019 June 2020 June 2019
  Medical assess.
Medical assess.    Merit review
Merit review Misc. claims
Misc. claims
AAMI 51 29   47 23 33 40
Allianz 13 11   15 12 15 11
GIO 53 27   51 25 41 22
NRMA 25 30   27 31 19 32
QBE 15 15   17 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 Jun 2020
  Per 100,000 green slips
AAMI 34
Allianz 37
GIO 39
NRMA 24
QBE 22
Total 29

Customers who lodge a DRS dispute may find the outcome is better, the same or lower than the insurer review decision. While 59% 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 Jun 2020
  Better Lower Same
Minor injury 32% 0 68%
Treatment and care 45% 0 55%
Is injured person mostly at fault? 66% 0 34%
Amount of weekly payments 53% 0 47%
Other 45% 7% 48%
Total 39% 2% 59%

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 June 2020
  Per 100,000 green slips
AAMI 14
Allianz 6
GIO 13
NRMA 14
QBE 12
Total 12

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

  Year end 30 June 2020
  Per 100,000 green slips
AAMI 3
Allianz 4
GIO 3
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
Allianz Decisions Management Service
GIO Decisions Delays Service
NRMA Delays Service Decisions/Management
QBE Delays Service Decisions/Management
Total Delays Service Decisions

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

Insurers - more info

Market share >

Market shares for the six CTP insurers in NSW. read more

Comprehensive insurance >

The difference between CTP and comprehensive insurance. read more

AAMI >

Contact details to help you purchase AAMI green slips. read more

Allianz >

Contact details to help you purchase Allianz greenslips. read more

GIO >

Contact details to help you purchase GIO greenslips. read more

NRMA Insurance >

Contact details to help you purchase NRMA Insurance greenslips. read more

QBE >

Contact details to help you purchase a QBE greenslip. read more

Youi >

Contacts to help you buy Youi greenslips. read more

Insurer details >

Contact details for each of the CTP insurers in NSW. read more