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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

Insurer

Year

Percentage of claims accepted

Percentage of claims rejected

Number of claims accepted

AAMI

2020

98.4%

1.6%

856

AAMI

2019

99.3%

0.7%

911

ALLIANZ

2020

98.0%

2%

2,026

ALLIANZ

2019

98.3%

1.7%

2,051

GIO

2020

97.5%

2.5%

1,774

GIO

2019

99.7%

0.3%

2,018

NRMA

2020

98.4%

1.6%

3,233

NRMA

2019

96.8%

3.2%

3,536

QBE

2020

99.5%

0.5%

2,445

QBE

2019

99.7%

0.3%

2,463

Total

2020

98.4%

1.6%

10,334

Total

2019

98.4%

1.6%

10,979

Why were claims declined?

Insurers decline claims in certain circumstances under NSW legislation.

The most common reasons for claim denial included:

  • late claim lodgement (more than 90 days after their accident),
  • insufficient information provided to the insurer,
  • the claim did not involve a motor vehicle accident.

1.6% of claims were declined by insurers in 2020, which was consistent with the 2019 year. There were 10,334 total claims accepted in 2020, down from 10,979 in 2019.

  • Figures exclude claims which were declined because customers were covered by another scheme/insurer.

Table: Total Claims rejected in 2020 and 2019

Insurer

Number of claims rejected claims

Number of claims rejected claims

AAMI

14

6

ALLIANZ

42

36

GIO

45

7

NRMA

52

118

QBE

13

8

Total

166

175

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

Insurer

2020 Number of claims rejected due to late lodgement (more than 90 days after accident)

2019 Number of claims rejected due to late lodgement (more than 90 days after accident)

AAMI

5

3

ALLIANZ

18

12

GIO

20

3

NRMA

25

52

QBE

10

2

Total

78

72

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

Insurer

2020 Number of claims declined because insufficient information was provided to the insurer

2019 Number of claims declined because insufficient information was provided to the insurer

AAMI

4

3

ALLIANZ

0

0

GIO

12

4

NRMA

0

29

QBE

1

0

Total

17

36

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

Insurer

2020 Number of claims declined because the claim did not involve a motor vehicle accident

2019 Number of claims declined because the claim did not involve a motor vehicle accident

AAMI

3

0

ALLIANZ

17

15

GIO

6

0

NRMA

3

7

QBE

0

1

Total

29

23

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

Insurer

2020 Number of claims declined because the claim involved an uninsured, unregistered or unidentified vehicle

2019 Number of claims declined because the claim involved an uninsured, unregistered or unidentified vehicle

AAMI

0

0

ALLIANZ

5

5

GIO

0

0

NRMA

8

8

QBE

1

1

Total

14

14

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

Insurer

2020 Number of claims declined because the claim related to a serious driving offence

2019 Number of claims declined because the claim related to a serious driving offence

AAMI

0

0

ALLIANZ

2

4

GIO

2

0

NRMA

14

14

QBE

0

0

Total

18

18

Table: Claims declined for other reasons (Other includes injury not existent, or not covered under the legislation)

Insurer

Number of claims declined for other reasons (Other includes injury not existent, or not covered under the legislation)

Number of claims declined for other reasons (Other includes injury not existent, or not covered under the legislation)

AAMI

2

0

ALLIANZ

0

0

GIO

5

0

NRMA

2

8

QBE

1

4

Total

10

12

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)

Insurer

Year

Before Lodgement

0 to 4 weeks

5 to 13 weeks

14 to 26 weeks

Number of claims

AAMI

2020

65%

28%

5%

2%

731

AAMI

2019

62%

29%

7%

2%

710

ALLIANZ

2020

80%

17%

3%

0%

1,746

ALLIANZ

2019

78%

18%

4%

0%

1,672

GIO

2020

68%

26%

6%

0%

1,511

GIO

2019

62%

29%

7%

2%

1,508

NRMA

2020

79%

17%

4%

0%

2,738

NRMA

2019

78%

17%

4%

1%

2,805

QBE

2020

75%

19%

4%

2%

1,947

QBE

2019

71%

22%

5%

2%

1,917

Total

2020

75%

20%

4%

1%

8,673

Total

2019

72%

22%

5%

1%

8,612

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)

Insurer

Year

0 to 4 weeks

5 to 13 weeks

14 to 26 weeks

27 to 52 weeks

Number of claims

AAMI

2020

53%

38%

7%

2%

327

AAMI

2019

43%

45%

11%

1%

267

Allianz

2020

68%

26%

6%

0%

742

Allianz

2019

57%

35%

6%

2%

652

GIO

2020

49%

41%

9%

1%

643

GIO

2019

44%

47%

8%

1%

655

NRMA

2020

47%

44%

7%

2%

1,084

NRMA

2019

42%

46%

9%

3%

1,020

QBE

2020

41%

46%

10%

3%

730

QBE

2019

42%

45%

11%

2%

773

Total

2020

51%

40%

8%

1%

3,526

Total

2019

46%

44%

9%

1%

3,367

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?

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 did not take part in making the original decision. 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, or
  • 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.

Table – Chart 5: Internal reviews by insurers and status (percentage)

Insurer

2020 Number of internal reviews

2019 Number of internal reviews

AAMI

233

185

ALLIANZ

453

297

GIO

534

388

NRMA

524

463

QBE

539

307

Total

2,283

1,640

Table: Percentage of claims withdrawn

Insurer

2020 Percentage of claims withdrawn

2019 Percentage of claims withdrawn

AAMI

8%

8%

ALLIANZ

3%

1%

GIO

9%

5%

NRMA

4%

7%

QBE

7%

18%

Total

6%

8%

Table: 2020 Percentage of claims determined

Insurer

2020 Percentage of claims determined

2019 Percentage of claims determined

AAMI

78%

62%

ALLIANZ

79%

84%

GIO

77%

67%

NRMA

86%

79%

QBE

72%

68%

Total

78%

73%

Table: Percentage of claims in progress

Insurer

2020 Percentage of claims in progress

2019 Percentage of claims in progress

AAMI

13%

26%

ALLIANZ

18%

14%

GIO

13%

27%

NRMA

7%

7%

QBE

9%

13%

Total

12%

16%

Table: Percentage of claims declined

Insurer

2020 Percentage of claims declined

2019 Percentage of claims declined

AAMI

1%

4%

ALLIANZ

0%

1%

GIO

1%

1%

NRMA

3%

7%

QBE

12%

1%

Total

4%

3%

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

Insurer

2020 year

2019 year

AAMI

46

41

ALLIANZ

46

32

GIO

55

39

NRMA

28

24

QBE

36

21

Total

39

29

Table: Internal reviews to accepted claims ratio

Insurer

2020 Internal reviews to accepted claims ratio

2019 Internal reviews to accepted claims ratio

AAMI

27%

20%

ALLIANZ

22%

14.5%

GIO

30%

19%

NRMA

16%

13%

QBE

22%

12.5%

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 (%)

-

Year

Decision overturned – in favour of claimant

Decision overturned – in favour of insurer

Decision upheld

Internal reviews

Amount of weekly payments

2020

49%

9%

42%

154

Amount of weekly payments

2019

65%

5%

30%

80

Is injured person mostly at fault

2020

29%

0%

71%

172

Is injured person mostly at fault

2019

17%

0%

83%

78

Minor Injury

2020

9%

0%

91%

723

Minor Injury

2019

13%

0%

87%

617

Other review types

2020

29%

1%

70%

314

Other review types

2019

32%

0%

68%

201

Treatment and Care R&N

2020

27%

2%

71%

425

Treatment and Care R&N

2019

40%

1%

59%

221

Total

2020

22%

2%

76%

1,788

Total

2019

25%

1%

75%

1,197

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

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

-

Year

Decision overturned – in favour of claimant

Decision overturned – in favour of insurer

Decision upheld

Internal reviews

AAMI

2020

18%

3%

79%

182

AAMI

2019

24%

1%

75%

115

ALLIANZ

2020

27%

0%

73%

358

ALLIANZ

2019

25%

1%

74%

250

GIO

2020

20%

1%

79%

411

GIO

2019

25%

1%

74%

259

NRMA

2020

28%

2%

70%

450

NRMA

2019

24%

0%

76%

365

QBE

2020

16%

1%

83%

387

QBE

2019

25%

0%

75%

208

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 %

-

Year

Within timeframe

Outside timeframe

AAMI

2020

19%

81%

AAMI

2019

52%

48%

ALLIANZ

2020

99%

1%

ALLIANZ

2019

100%

0%

GIO

2020

18%

82%

GIO

2019

47%

53%

NRMA

2020

57%

43%

NRMA

2019

40%

60%

QBE

2020

98%

2%

QBE

2019

99%

1%

Total

2020

59%

41%

Total

2019

62%

38%

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

-

Year

Medical Assessment (days taken)

Merit review (days taken)

Miscellaneous claims assessment (days taken)

Timeframe for decision

AAMI

2020

51

47

33

14

AAMI

2019

29

23

40

14

ALLIANZ

2020

13

15

15

14

ALLIANZ

2019

11

12

11

14

GIO

2020

53

51

41

14

GIO

2019

27

25

22

14

NRMA

2020

25

27

19

14

NRMA

2019

30

31

32

14

QBE

2020

15

17

16

14

QBE

2019

15

15

16

14

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

-

Year

Medical Assessment (days taken)

Miscellaneous claims assessment (days taken)

Timeframe for decision (days taken)

AAMI

2020

46

48

21

AAMI

2019

32

32

21

ALLIANZ

2020

22

20

21

ALLIANZ

2019

10

17

21

GIO

2020

50

44

21

GIO

2019

36

32

21

NRMA

2020

30

28

21

NRMA

2019

32

32

21

QBE

2020

23

22

21

QBE

2019

22

21

21

What if customers still disagreed with the reviewed decision by the insurer?

If the customer continues to disagree with the insurer about their claim after the insurer internal review, customers may apply to the Dispute Resolution Service (DRS) for an independent determination of the dispute. Most applications require an internal review by the insurer prior to applying to DRS.

DRS can assist in resolving disputes in one of two ways:

  • Facilitate the formal resolution of issues in dispute between insurer and customer
  • Arrange an independent and binding decision by an expert decision-maker.

Sometimes DRS applications can be:

  • Declined by DRS if they are submitted outside the timeframes set by the legislation or the matter is outside the jurisdiction of DRS,
  • Withdrawn by the customer, or
  • Settled between the customer and insurer outside the DRS formal process.

Table – Chart 8: Dispute Resolution Cases by Insurer and Status (%)*

Insurer

Number of DRS reviews

Percentage of DRS Reviews in Progress

Percentage of Withdrawn DRS reviews

Percentage of declined DRS reviews

Percentage of Determined DRS reviews

Percentage of Other *** DRS reviews

DRS Disputes per 100,000 Green Slips sold**

AAMI

407

36%

9%

4%

46%

5%

34

ALLIANZ

896

33%

10%

4%

46%

7%

37

GIO

980

41%

10%

3%

41%

5%

39

NRMA

1195

26%

14%

6%

50%

4%

24

QBE

819

39%

11%

3%

42%

5%

22

Total

4297

34%

12%

4%

45%

5%

29

Table – Chart 9: Outcomes of resolved DRS reviews*

-

Insurer decision overturned

Insurer decision Upheld

Other

Minor Injury

32%

68%

0%

Treatment and care R&N

45%

55%

0%

Is the injured person mostly at fault

66%

34%

0%

Amount of weekly payments

53%

47%

0%

All other dispute types

45%

48%

7%

Total

39%

59%

2%

*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.

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 NSW Ombudsman for assistance.

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 707 complaints. 604 complaints were triaged into the non-complex complaints’ category, and 103 were triaged into the complex complaint category
  • Non-complex complaints are typically resolved within two days. 512 non-complex complaints were resolved
  • 92 non-complex complaints were escalated to complex
  • Complex complaints take >2 days on average to resolve. 220 complex complaints were resolved
  • 104 complex complaints were referred to SIRA’s supervision teams

Any customers dissatisfied with SIRA’s handling of their complaint can contact the NSW Ombudsman.

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

How many compliments and complaints did SIRA receive?

Table: Compliments

Insurer

Number of compliments received

ALL INSURERS

168

AAMI

14

ALLIANZ

36

GIO

27

NRMA

60

QBE

31

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

Insurer

Number of compliments received per 100,000 Green Slips

ALL INSURERS

3

AAMI

3

ALLIANZ

4

GIO

3

NRMA

3

QBE

2

Table: Complaints

Insurer

Number of complaints received

ALL INSURERS

707

AAMI

71

ALLIANZ

62

GIO

130

NRMA

266

QBE

178

Table: Complaints per 100,000 Green Slips

Insurer

Number of complaints received per 100,000 Green Slips

ALL INSURERS

12

AAMI

14

ALLIANZ

6

GIO

13

NRMA

14

QBE

12

Totals

  • Compliments 168
  • Complaints 707
  • Referrals 38

Who made the complaint

  • Person injured 338
  • Lawyer 274
  • Green Slip holder 22
  • Health provider 50
  • Other 23*

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

Type of complaint

Portion of total complaints received by AAMI which related to that type of complaint

Claims: Decisions

23%

Claims: Delays

22%

Claims: Management

24%

Claims: Service

18%

Claims: Other

0%

Policy: Purchasing

13%

Table: Allianz

Type of complaint

Portion of total complaints received by Allianz which related to that type of complaint

Claims: Decisions

30%

Claims: Delays

18%

Claims: Management

23%

Claims: Service

21%

Claims: Other

3%

Policy: Purchasing

5%

Table: GIO

Type of complaint

Portion of total complaints received by GIO which related to that type of complaint

Claims: Decisions

29%

Claims: Delays

28%

Claims: Management

16%

Claims: Service

18%

Claims: Other

5%

Policy: Purchasing

4%

Table: NRMA

Type of complaint

Portion of total complaints received by NRMA which related to that type of complaint

Claims: Decisions

20%

Claims: Delays

28%

Claims: Management

20%

Claims: Service

26%

Claims: Other

3%

Policy: Purchasing

3%

Table: QBE

Type of complaint

Portion of total complaints received by QBE which related to that type of complaint

Claims: Decisions

16%

Claims: Delays

33%

Claims: Management

16%

Claims: Service

28%

Claims: Other

5%

Policy: Purchasing

2%

Table: All insurer related complaints

Type of complaint

Portion of total complaints received by Insurers which related to that type of complaint

Claims: Decisions

22%

Claims: Delays

28%

Claims: Management

19%

Claims: Service

24%

Claims: Other

3%

Policy: Purchasing

4%

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:

SIRA receives:

  • Internal SIRA referrals
  • External referrals
  • Risk-based compliance audits

Referrals received go to the E&P team. When the matter is finalised, the following options are available to E&P:

  • Education
  • Notification of breach
  • Letter of censure
  • Penalty provisions
  • Criminal prosecution and licencing withdrawal
  • Media releases

For more information about how SIRA approaches its compliance and enforcement activities, please refer to SIRA’s Compliance and Enforcement Policy - PDF (345.4 KB).

From 1 July 2019 to 30 June 2020, 28 matters were referred to the CE&I team for investigation into alleged insurer breaches of their obligations under the legislation and guidelines. A total of 40 matters were finalised during this period, which includes matters received prior to July 2019.

Table: Completed Investigations

Insurer

Number

Allianz

3

AAMI

2

GIO

4

NRMA

28

QBE

3

Table: Regulatory Action

Insurer

Number

Type of Regulatory Action

Allianz

1

Letter of censure

AAMI

1

Letter of censure

GIO

1

Letter of censure

NRMA

10

Notice of non-compliance

NRMA

1

Letter of censure

QBE

1

Notice of non-compliance

QBE

2

Letter of censure

TOTAL

17

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Of those matters where an insurer breach was substantiated, the following issues were identified, and insurers subsequently notified:

  • Failure to determine or late determination of liability within timeframes stipulated under the Act and Guidelines;
  • Failure to conduct internal reviews within timeframes stipulated under the Act and Guidelines;
  • Failure to respond or late response to a treatment and care request by the claimant or their representative;
  • Inappropriate management of CTP claims.

The other matters finalised during this period were determined to be insurer practice issues of a minor nature and they have been referred to SIRA’s insurer supervision unit for education and continued monitoring.

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.

Determined DRS dispute - A dispute which has been through the DRS process and of which a decision has been made.

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

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 July 2019 to 30 June 2020 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