CTP insurer claims experience and customer feedback comparison - June 2020

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 six key indicators of customer experience 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 and time taken to review claim decisions by insurers through the insurers internal review unit
• the number and outcome of claims referred to the Dispute Resolution Service
• the number and type of compliments and complaints received by SIRA about insurers
• the number and type of issues escalated to SIRA’s Enforcement and Prosecutions team.

This issue of the report presents data for the first 3 measures above, over two time periods: 1 July 2018 to 30 June 2019 and 1 July 2019 to 30 June 2020. The other measures are presented as per the periods described in the respective sections of the report.

The CTP Insurer Claims Experience and Customer Feedback Comparison results are 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?

Insurers accepted most claims from injured people and their families. Over 98% of claims were accepted in both 2019 and 2020. More detail on the rejected claims is provided on the following table.

Table – Chart 1: Claims Acceptance Rates by Insurer, comparing 2019 and 2018 years

Table: Claims rejected due to late lodgement for 2020 versus 2019

Table: Claims declined because insufficient information was provided to the insurer 2020 versus 2019

Table: Claims declined because the claim did not involve a motor vehicle accident

Table: Claims declined because the claim involved an uninsured, unregistered or unidentified vehicle

Table: Number of claims declined because the claim related to a serious driving offence

Table: Claims declined for other reasons (Other includes injury not 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. This is when customers access treatment and care services after notifying the insurer, but before lodging a formal claim.

75% of injured people received ‘pre-claim support’ in 2020, with a further 20% accessing treatment and care services within the first month after lodging a claim. This result is an improvement on 2019, where 72% of customers accessed treatment and care benefits prior to formally lodging a claim.

Table – Chart 3: Time it takes to receive treatment and care benefits (in weeks)

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. All insurers improved the proportion of pre-claim support in 2020.

*Of the total 10,334 accepted statutory benefits claims in 2020, 8,673 had treatment and care services. For 2019, of the total 10,979 accepted statutory benefits claims, 8,612 had treatment and care services.

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. Half 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 payment.

Table – Chart 4: Time it takes to receive income support (in weeks)

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.

Overall, 90% of customers receive income benefits within the first month of having a claim.

*Of the total 10,334 accepted statutory benefits claims in 2020, 3,526 had payments for loss of income. For 2019, of the total 10,979 accepted statutory benefits claims, 3,367 had payments for loss of income.

What happened when customers disagreed with the insurer’s decision?

Table: Percentage of claims withdrawn

Table: 2020 Percentage of claims determined

Table: Percentage of claims in progress

Table: Percentage of claims declined

The number of internal review requests received by insurers depends on how many customers they have. Insurers with more customers are more likely to receive a greater number of internal review requests. By measuring insurer internal reviews per 100,000 Green Slips sold, the regulator can compare insurers’ performance regardless of how many customers they have.

Table: Internal Reviews per 100,000 Green Slips sold

Table: Internal reviews to accepted claims ratio

Outcomes of resolved internal reviews

Of the total 1,788 resolved internal reviews in 2020, 76% had the initial claim decision upheld. In 2019, 75% resolved internal reviews had the decision upheld.

Table – Chart 6: Outcomes of resolved internal review by review type (%)

Note: The figures are rounded to the nearest whole percentage.

Table – Chart 6B: Outcomes of resolved internal review by insurer (%)

Internal review timeframes

The insurers internal review team must assess the claim within legislated timeframes.

The data shows the performance of each insurer in meeting those timeframes.

Chart 7: Internal reviews completed by timeframe %

Allianz and QBE have consistently completed their internal review claims within the allowable timeframes, whilst NRMA have improved their review processing times in 2020. AAMI and GIO review times have increased to June 2020.

Note: The time taken to review an internal review is sourced from data provided by each insurer.

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.

Chart 7B: Internal review duration shown by dispute type and timeframe (days)

Table: Internal review decisions with 14-day timeframes for a decision

Table: Internal review decisions with 21-day timeframe for a decision

Table – Chart 9: Outcomes of resolved DRS reviews*

*Data from 1 Dec 2017 to 30 June 2020.

**The number of dispute resolution cases received by DRS depends on how many customers individual insurers have. Insurers with more customers are more likely to receive a greater number of dispute resolution applications. By measuring dispute resolution cases per 100,000 Green Slips sold, the regulator can compare insurers’ performance regardless of how many customers they have.

***Open in error, invalid or dismissed disputes.

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 more than two working days to close, depending on their complexity. Potential cases of insurer misconduct are escalated to SIRA’s supervision teams for further investigation and possible regulatory action.

How many compliments and complaints did SIRA receive?

Table: Compliments

Compliments per 100,000 Green Slips

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 Green Slips sold, the regulator can compare insurers’ performance regardless of how many customers they have.

Table: Number of compliments per 100,00 Green Slips

Table: Complaints

Table: Complaints per 100,000 Green Slips

This information was collected from 1 July 2019 to 30 June 2020.

*The “Other” category are complaints predominantly by SIRA staff for calls to insurers which for various reasons take an unnecessary long time to action.

What were the complaints about?

Table: AAMI

Table: Allianz

Table: GIO

Table: NRMA

Table: QBE

Table: All insurer related complaints

Enforcement & Prosecutions (E&P)

SIRA has continued to improve its strategies in detecting and responding to breaches of the Motor Accident legislation and guidelines. SIRA works closely with law enforcement agencies and other regulatory bodies to ensure appropriate strategies are in place to minimise risks to the CTP scheme.

The E&P team undertakes a risk-based approach to its investigations by taking into consideration the risk and harm to the scheme, claimants and policy holders and carries out appropriate regulatory enforcement action on a case by case basis.

High level approach is summarised as follows:

Table: Regulatory Action

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.

Dispute Resolution Service (DRS) - A service established under Division 7 of the Act to provide a timely, independent, fair and cost effective system for the resolution of disputes.

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:

• Minor injury - Whether the injury caused by the motor accident is a minor injury for the purposes of the Act.
• Reasonable and necessary treatment and care - Whether any treatment and care provided to the person is reasonable and necessary in the circumstances or relates to the injury caused by the motor accident for the purposes of section 3.24 of the Act (Entitlement to statutory benefits for treatment and care).
• 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
  • 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

Internal reviews to accepted claims ratio - the proportion of internal reviews to accepted statutory benefit claims. This will remove the influence of the insurer market share and give a comparable view across insurers.

Payments - Payment types may include income support payments, treatment, care, home/vehicle modifications or rehabilitation.

Referrals to Enforcements and Prosecutions (E&P) - Where a breach of guidelines or legislation is detected through the management of a complaint or other regulatory activity undertaken by SIRA in accordance with the SIRA compliance and enforcement policy.

Service start date - The date when treatment or care services are accessed for the first time.

Total number of policies - This figure represents the total (annual) number of policies written under the new CTP scheme with a commencement date during the reporting period. The measure represents the count of all policies, across all regions in NSW.

About the data in this publication

For more information about the statistics in this publication, contact [email protected]