CTP Insurer Claims Experience and Customer Feedback Comparison
A PDF version of this report is available.
1 December 2017 to 30 June 2019
Why does SIRA publish insurer data?
As part of its regulatory oversight, SIRA monitors insurers’ performance through data-gathering and analysis. SIRA helps to hold insurers accountable by being transparent with this data, enabling scheme stakeholders and the wider public to have informed discussions about the performance of the industry.
Additionally, access to insurers’ data will help customers make meaningful comparisons between insurers when purchasing CTP insurance. People injured in motor accidents may also benefit from knowing what to expect from the insurer managing their claim.
In this report, SIRA compares four key indicators of customer experience from 1 Dec 2017 to 30 June 2019 across the five CTP insurers in NSW: AAMI, Allianz, GIO, NRMA and QBE.
The following evidence-based indicators measure insurer performance over the course of a claim journey:
- the number of statutory benefits claims accepted by insurers
- how quickly insurers pay statutory benefits
- the outcome of claim decisions reviewed by insurers through the insurer’s internal review unit, and
- the number and type of compliments and complaints received by SIRA about insurers.
The CTP Insurer Claims Experience and Customer Feedback Comparison results will be published each quarter. Future publications will benefit as SIRA continues to improve and expand its data collection and reporting capability.
How many claims* did insurers accept?
*Statutory benefits claims.
Insurers accepted most claims from injured people and their families.
Total claims accepted 98% (16,022)
| Insurer | Number of claims | Percentage of claims accepted |
|---|---|---|
| AAMI | 1,336 | 98.6% |
| Allianz | 3,053 | 98.9% |
| GIO | 3,161 | 98.8% |
| NRMA | 5,260 | 96% |
| QBE | 3,532 | 99.3% |
| Total | 16,342 | 98% |
Why were claims declined?
Insurers decline claims in certain circumstances under NSW legislation. To date, 2% of the 16,342 claims have been declined by insurers. 16,022 statutory benefits claims have been accepted. The most common reasons for claim denial included:
- late claim lodgement (more than 90 days after the accident), and
- provision of insufficient information to the insurer.
Reasons why claims were declined*
*Excludes claims which were declined where customers are covered by other scheme/insurer.
| Insurer | Late claim (lodged >90 days after accident) | Insufficient information provided to insurer | Claim did not involve a motor vehicle accident | Claim involved an uninsured, unregistered or unidentified vehicle | Claim related to a serious driving offence | Other* | Total |
|---|---|---|---|---|---|---|---|
| AAMI | 5 | 12 | 0 | 2 | 0 | 0 | 19 |
| Allianz | 12 | 0 | 12 | 2 | 4 | 3 | 33 |
| GIO | 13 | 16 | 0 | 6 | 0 | 2 | 37 |
| NRMA | 80 | 59 | 18 | 21 | 20 | 10 | 208 |
| QBE | 14 | 2 | 1 | 4 | 1 | 1 | 23 |
*Other reasons include: Injury non-existent or not covered under the legislation.
How long did it take to receive treatment and care benefits?
Receiving treatment immediately after an accident is critical for making a full recovery. That is why insurers cover initial medical expenses for most people before they lodge a formal claim. 71% of injured people received ‘pre-claim support’, with a further 22% accessing treatment and care services within the first month after lodging a claim.
| Insurer | Percentage of claims paid as part of the ‘pre-claim support’ category | Percentage of claims paid from 0-4 weeks after formally lodging a claim | Percentage of claims paid from 5-13 weeks after formally lodging a claim | Percentage of claims paid from 14-26 weeks after formally lodging a claim | Percentage of claims paid more than 26 weeks after formally lodging a claim | Number of claims |
|---|---|---|---|---|---|---|
| AAMI | 59% | 30% | 9% | 2% | 0% | 1,061 |
| Allianz | 78% | 17% | 4% | 1% | 0% | 2,539 |
| GIO | 60% | 30% | 8% | 2% | 0% | 2,477 |
| NRMA | 78% | 17% | 4% | 1% | 0% | 4,161 |
| QBE | 71% | 22% | 6% | 1% | 0% | 2,825 |
| Total | 71% | 22% | 6% | 1% | 0% | 13,063 |
Some insurers cover expenses faster than others. Among the five insurers, Allianz and NRMA had the highest proportion of pre-claim treatment and care support. This is when customers access treatment and care services after notifying the insurer, but before lodging a formal claim.
How quickly have insurers paid income support to customers after motor accidents?
Some people need to take time off work after an accident. That is why it’s important for insurers to provide income support in the form of weekly payments to people while they are away from work. 41% of customers entitled to income support payments received it within the first month of lodging a claim, with the vast majority receiving the income support payments within 13 weeks.
The sooner the insurer receives the relevant information from the customer, the sooner the insurer can begin to pay income support payments.
| Insurer | Percentage of claims which receive income support from 0-4 weeks after lodgement | Percentage of claims which receive income support from 5-13 weeks after lodgement | Percentage of claims which receive income support from 14-26 weeks after lodgement | Percentage of claims which receive income support more than 26 weeks after lodging a claim | Number of claims |
|---|---|---|---|---|---|
| AAMI | 39% | 46% | 13% | 2% | 418 |
| Allianz | 44% | 44% | 8% | 4% | 1,036 |
| GIO | 41% | 47% | 9% | 3% | 1,122 |
| NRMA | 39% | 47% | 11% | 3% | 1,558 |
| QBE | 34% | 48% | 13% | 5% | 1,178 |
| Total | 41% | 46% | 10% | 3% | 5,312* |
*To date, of the 16,022 total statutory benefit claims, 5,312 had payments for loss of income.
Some insurers begin paying income support faster than others. Among the five insurers, Allianz had the highest proportion of customers who received income support within the first month of lodging a claim.
What happened when customers disagreed with the insurer’s decision?
Customers who disagree with the insurer’s decision can ask for a review. The decision will be reconsidered by the insurer’s internal review team, who are independent from the original decision makers.
Insurers accepted most applications for internal reviews. However, some applications were declined because:
- the request was submitted late and the customer did not respond to requests for reasons why it was submitted late, and
- the insurer determined it did not have the jurisdiction to conduct an internal review of that decision.
Customers sometimes also withdraw their application for an internal review.
| Insurer | Number of internal reviews | Percentage of determined internal reviews | Percentage of in progress internal reviews | Percentage of declined internal reviews | Percentage of withdrawn internal reviews | Internal reviews per 100,000 greenslips* |
|---|---|---|---|---|---|---|
| AAMI | 316 | 65% | 23% | 5% | 7% | 74 |
| Allianz | 581 | 87% | 10% | 2% | 1% | 66 |
| GIO | 682 | 68% | 20% | 3% | 9% | 74 |
| NRMA | 919 | 79% | 4% | 12% | 5% | 49 |
| QBE | 564 | 70% | 8% | 4% | 18% | 41 |
| Total | 3,062 | 75% | 11% | 6% | 8% | 56 |
*The number of internal review requests received by insurers depends on how many customers they have. Insurers with more customers will receive more requests for internal reviews, and vice versa. By measuring insurer internal reviews per 100,000 greenslips sold, the regulator can compare insurers’ performance regardless of how many customers they have.
| Type of internal review | Percentage of decisions upheld | Percentage of decisions changed in favour of the person | Percentage of decisions changed in favour of the insurer | Total number of resolved internal reviews |
|---|---|---|---|---|
| Minor injury | 87% | 13% | 0% | 1,190 |
| Treatment and care | 65% | 34% | 1% | 419 |
| Amount of weekly payments | 34% | 59% | 7% | 155 |
| Accident the fault of another | 81% | 19% | 0% | 165 |
| Other review types | 68% | 32% | 0% | 368 |
| Total | 76% | 23% | 1% | 2,297 |
If customers are dissatisfied with the outcome of the internal review, they can submit their claim to SIRA’s Dispute Resolution Services (DRS) via SIRA’s website. An independent DRS decision maker will reconsider the internal reviewer’s determination.
Compliments and complaints
SIRA closely monitors the compliments and complaints it receives about insurers. Compliments help identify best practice in how insurers manage claims, while complaints may highlight problems with insurers’ conduct which could require further investigation.
How SIRA handles complaints
Customers can lodge complaints through any of SIRA’s channels. Non-complex complaints are handled by SIRA’s CTP Assist service and usually take less than two working days to close*. Complex complaints are referred to SIRA’s complaints handling experts and take on average 21 working days to close, depending on their complexity. Potential cases of insurer misconduct are escalated to SIRA’s Compliance, Enforcement and Investigation team for further investigation and possible regulatory action.
Customers who are unhappy with the outcome of SIRA’s review can resubmit their complaint for further consideration. If customers disagree with how SIRA handled their complaint, they can contact the Ombudsman of NSW for assistance.
*Where SIRA reviews a complaint and provides an outcome
Snapshot of resolved complaints process
Customers are encouraged to talk to their insurer in the first instance; insurers have their own complaints handling process.
Any customers dissatisfied with SIRA’s handling of their complaint can contact the NSW Ombudsman.
This information was collected from 1 January 2019 to 30 June 2019.
How many compliments and complaints about insurers did SIRA receive?
| Insurer | Compliments | Compliments per 100,000 greenslips* | Complaints | Complaints per 100,000 greenslips* |
|---|---|---|---|---|
| Allianz | 14 | 2 | 32 | 4 |
| AAMI | 8 | 2 | 29 | 7 |
| GIO | 10 | 1 | 76 | 8 |
| NRMA | 24 | 1 | 153 | 8 |
| QBE | 11 | 1 | 71 | 5 |
| Total | 67 | 1 | 361 | 7 |
There were 22 referrals to compliance, enforcement and investigation.
*The number of compliments and complaints insurers receive depends on how many customers they have. Insurers with more customers will receive more compliments and complaints, and vice versa. Therefore, by measuring compliments and complaints per 100,000 greenslips sold, the regulator can compare insurers’ performance regardless of how many customers they have.
| Who made the complaint | Number of complaints |
|---|---|
| Person injured | 173 |
| Lawyer | 161 |
| Greenslip holder | 14 |
| Health provider | 12 |
| Other | 1 |
This information was collected from 1 January 2019 to 30 June 2019.
What were the complaints about?
| Complaint type | Allianz | AAMI | GIO | NRMA | QBE | Total |
|---|---|---|---|---|---|---|
| Claims - Decisions | 38% | 38% | 37% | 37% | 28% | 35% |
| Claims - Delays | 28% | 10% | 22% | 39% | 25% | 30% |
| Claims - Management | 3% | 14% | 12% | 7% | 6% | 8% |
| Claims - Service | 28% | 34% | 22% | 15% | 28% | 22% |
| Claims - Other | 0% | 0% | 3% | 1% | 1% | 1% |
| Policy - purchasing | 3% | 4% | 4% | 1% | 12% | 4% |
This information was collected from 1 January 2019 to 30 June 2019.
Glossary
| Accepted claims | The total number of statutory benefit claims where liability was not declined during the first 26 weeks of the benefit entitlement period. |
| Acceptance rate | The percentage of statutory benefit claims where liability was not declined during the first 26 weeks of the benefit entitlement period. It is the total count of statutory benefit claims lodged, less declined claims, divided by total statutory benefit claims. |
| Claim | A claim for treatment and care or loss of income regardless of fault under the Act. It excludes early notifications (before a full claim is lodged), as well as interstate, workers compensation and compensation to relatives claims. |
| Complaint | An expression of dissatisfaction made to or about an organisation and related to its products, services, staff or the handling of a complaint, where a response or resolution is explicitly or implicitly expected or legally required. |
| Complaints received | The number of complaints that have been received in the time period. |
| Compliment | An expression of praise. |
| Declined claims | The total number of statutory benefit claims where the liability is rejected during the first 26 weeks of the benefit entitlement period. |
| Income support payments | Weekly payments to an earner who is injured as a result of a motor accident, and sustains a total or partial loss of earnings as a result of the injury. |
| Insurer | An insurer holding an in-force licence granted under Division 9.1 of the Act. |
| Internal review | When requested by a person, the insurer conducts an internal review of decisions made and notifies the person of the result of the review, usually within 14 days of the request. |
| Internal review types |
|
| Payments | Payment types may include income support payments, treatment, care, home/vehicle modifications or rehabilitation. |
| Referrals to Compliance, Enforcement and Investigation (CE&I) | Where a potential breach of guidelines or legislation is detected through the management of a complaint in accordance with the SIRA compliance and enforcement policy. |
About the data in this publication
Claims data is primarily sourced from the Universal Claims Database (UCD) which contains information on all claims received under the NSW Motor Accidents CTP scheme, which commenced on 1 December 2017, as provided by individual licensed insurers.
SIRA uses validated data for reporting purposes. Differences to insurers’ own systems can be caused by:
- a delay between claim records being captured in insurer system and data being submitted and processed in the UCD
- claim records submitted by the insurer being blocked by data validation rules in the UCD because of data quality issues.
All CTP compliments and complaints data from 1 January 2019 to 30 June 2019 was collected through SIRA’s complaints and operational systems. Compliments and complaints received directly by the insurers were not included.
For more information about the statistics in this publication, contact [email protected]
The full report and a summary is published on the SIRA website.