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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 offenceOther*Total
AAMI512020019
Allianz1201224333
GIO1316060237
NRMA805918212010208
QBE142141123

*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.

Time it takes to receive treatment and care benefits (in weeks)
InsurerPercentage of claims paid as part of the ‘pre-claim support’ categoryPercentage of claims paid from 0-4 weeks after formally lodging a claimPercentage of claims paid from 5-13 weeks after formally lodging a claimPercentage 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.

Time it takes to receive income support (in weeks)
InsurerPercentage of claims which receive income support from 0-4 weeks after lodgementPercentage of claims which receive income support from 5-13 weeks after lodgementPercentage 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
Total41%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.

Internal reviews by insurers and status (%)
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.

Outcomes of resolved internal reviews
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 insurerTotal 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 types68%32%0%368
Total76%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.

SIRA received 361 complaints. 247 complaints were triaged into the non-complex complaints category, and 114 were triaged into the complex complaints category. *Non-complex complaints are typically resolved within two days. 230 non-complex complaints were resolved.  *30 non-complex complaints were escalated to complex. *Complex complaints take >20 days on average to resolve. 97 complex complaints were resolved.  *22 complex complaints were referred to SIRA’s Compliance, Enforcement and Investigation team.

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?

InsurerCompliments 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 complaintNumber 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 typeAllianzAAMIGIONRMAQBETotal
Claims - Decisions38%38%37%37%28%35%
Claims - Delays28%10%22%39%25%30%
Claims - Management3%14%12%7%6%8%
Claims - Service28%34%22%15%28%22%
Claims - Other0%0%3%1%1%1%
Policy - purchasing3%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
  • Amount of weekly payments - Whether the amount of statutory benefits payable under section 3.4 (Statutory benefits for funeral expenses) or under Division 3.3 (Weekly payments of statutory benefits) is reasonable.
  • Was accident the fault of another - Whether the motor accident was caused mostly by the injured person. This influences a person’s entitlement to statutory benefits (sections 3.28 and 3.36 of the Act).
  • Other review types:
    • accident verification
    • earning capacity impairment
    • is death or injury from a NSW accident
    • variation of weekly payments
    • weekly benefits outside Australia
    • recoverable statutory benefits
    • reduction for contribution negligence
    • serious driving offence exclusion
    • permanent impairment
Minor injury - Whether the injury caused by the motor accident is a minor injury for the purposes of the Act.
PaymentsPayment 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 MAIRstakeholder@sira.nsw.gov.au