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.