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CTP Insurer Claims Experience and Customer Feedback Comparison - December 2022

Chapters

Chapters

  1. Insurer comparison
  2. Why does SIRA publish insurer data
  3. How many claims did insurers accept?
  4. Why were claims declined?
  5. How long did it take to receive treatment and care benefits?
  6. How quickly have insurers paid income support to customers after motor accidents?
  7. What happened when customers disagreed with the insurer’s decision?
  8. Outcomes of determined internal reviews
  9. Internal review timeframes
  10. Internal review timeframes by dispute type
  11. Recovery through work measures
  12. Complaints
  13. Enforcement and Prosecutions (E&P)
  14. Glossary

10. Internal review timeframes by dispute type

There are three types of internal reviews:

  1. Merit review (e.g. the amount of weekly benefits)
  2. Medical assessment (e.g. permanent impairment, minor injury or treatment and care)
  3. Miscellaneous claims assessment (e.g. whether the claimant was mostly at fault).

For most internal reviews, the insurer must provide their internal review decision within 14 days of receiving the request for internal review. However, there are some medical assessment and miscellaneous claims assessment matters where this timeframe is extended to 21 days. The maximum timeframe for all internal reviews is 28 days if further information is required.

Internal review duration shown by dispute type and timeframe (days)