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CTP insurer claims experience and customer feedback comparison - March 2020

PDF version of this report is available.

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 of claim decisions reviewed by insurers through the insurer’s 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 April 2018 to 31 March 2019 and 1 April 2019 to 31 March 2020. The report refers to these periods as years 2019 and 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 (statutory benefit 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.

Insurer

Year

Percentage of claims accepted

Percentage of claims rejected

Number of claims accepted

AAMI

2020

98.2%

1.8%

937

AAMI

2019

99.8%

0.2%

888

Allianz

2020

98.2%

1.8%

2,211

Allianz

2019

98.7%

1.3%

2,111

GIO

2020

98.1%

1.9%

1,990

GIO

2019

99.9%

0.1%

2,064

NRMA

2020

98.4%

1.6%

3,566

NRMA

2019

96.1%

3.9%

3,459

QBE

2020

99.2%

0.8%

2,561

QBE

2019

99.7%

0.3%

2,377

Total

2020

98.5%

1.5%

11,265

Total

2019

98.4%

1.6%

10,899

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.

1.5% of claims were declined by insurers in 2020, compared to 1.6% in 2019. There were 11,265 total claims accepted in 2020, up from 10,899 in 2019.

Chart 2: Reasons why claims* were declined

Insurer

Number of claims rejected due to late lodgement (>90 days after accident)

Number of claims rejected due to late lodgement (>90 days after accident)

Insurer

2020 year

2019 year

AAMI

7

1

ALLIANZ

8

11

GIO

16

1

NRMA

34

48

QBE

10

2

Total

75

63

Insurer

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

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

Insurer

2020 year

2019 year

AAMI

0

0

ALLIANZ

0

0

GIO

0

0

NRMA

1

40

QBE

5

0

Total

6

40

Insurer

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

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

Insurer

2020 year

2019 year

AAMI

6

0

ALLIANZ

24

10

GIO

4

0

NRMA

3

13

QBE

1

0

Total

38

23

Insurer

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

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

Insurer

2020 year

2019 year

AAMI

0

0

ALLIANZ

8

3

GIO

1

0

NRMA

8

16

QBE

3

1

Total

20

20

Insurer

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

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

Insurer

2020 year

2019 year

AAMI

0

0

ALLIANZ

0

4

GIO

0

0

NRMA

5

17

QBE

0

0

Total

5

21

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)

Insurer

2020 year

2019 year

AAMI

4

1

ALLIANZ

0

0

GIO

18

2

NRMA

7

7

QBE

1

4

Total

30

14

* Excludes claims which were declined because customers were covered by other scheme/insurer.

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 71% of customers accessed treatment and care benefits prior to formally lodging a claim.

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

66%

28%

5%

1%

782

AAMI

2019

59%

30%

9%

2%

687

Allianz

2020

79%

17%

4%

0%

1,852

Allianz

2019

77%

18%

5%

0%

1,714

GIO

2020

67%

25%

7%

1%

1,589

GIO

2019

60%

30%

8%

2%

1,565

NRMA

2020

78%

16%

5%

1%

2,941

NRMA

2019

77%

18%

5%

0%

2,727

QBE

2020

75%

20%

4%

1%

1,998

QBE

2019

70%

23%

6%

1%

1,855

Total

2020

75%

20%

4%

1%

9,162

Total

2019

71%

22%

6%

1%

8,548

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 11,265 accepted statutory benefits claims in 2020, 9,162 had treatment and care services. For 2020, of the total 10,899 accepted statutory benefits claims, 8,548 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.

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

52%

41%

6%

1%

350

AAMI

2019

39%

47%

13%

1%

278

Allianz

2020

69%

25%

5%

1%

787

Allianz

2019

45%

46%

7%

2%

642

GIO

2020

48%

43%

7%

2%

685

GIO

2019

43%

47%

8%

2%

683

NRMA

2020

45%

45%

9%

1%

1,186

NRMA

2019

40%

47%

11%

2%

1,006

QBE

2020

44%

44%

9%

3%

776

QBE

2019

35%

49%

13%

2%

753

Total

2020

51%

40%

7%

3%

3,784

Total

2019

40%

47%

10%

3%

3,362

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, the rate of claims paid within the first month has improved significantly by 11% from 2019 to 2020.

*Of the total 11,265 accepted statutory benefits claims in 2020, 3,784 had payments for loss of income. For 2019, of the total 10,899 accepted statutory benefits claims, 3,362 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.

Chart 5: Internal reviews by insurers and status (%)

Insurer

Number of internal reviews

Number of internal reviews

Insurer

2020 year

2019 year

AAMI

233

155

ALLIANZ

439

332

GIO

586

383

NRMA

522

544

QBE

442

317

Total

2,222

1,731

Insurer

Percentage of claims withdrawn

Percentage of claims withdrawn

Insurer

2020 year

2019 year

AAMI

11%

6%

ALLIANZ

2%

1%

GIO

8%

8%

NRMA

3%

3%

QBE

9%

18%

Total

6%

7%

Insurer

Percentage of claims determined

Percentage of claims determined

Insurer

2020 year

2019 year

AAMI

62%

52%

ALLIANZ

78%

84%

GIO

63%

61%

NRMA

92%

80%

QBE

74%

70%

Total

75%

72%

Insurer

Percentage of claims in progress

Percentage of claims in progress

Insurer

2020 year

2019 year

AAMI

26%

34%

ALLIANZ

19%

14%

GIO

29%

28%

NRMA

4%

4%

QBE

8%

9%

Total

17%

15%

Insurer

Percentage of claims declined

Percentage of claims declined

Insurer

2020 year

2019 year

AAMI

1%

8%

ALLIANZ

1%

1%

GIO

0%

3%

NRMA

1%

13%

QBE

9%

3%

Total

2%

6%


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.

Internal reviews per 100,000 Green Slips sold

Insurer

2020 year

2019 year

AAMI

48

35

ALLIANZ

45

36

GIO

60

39

NRMA

28

28

QBE

30

22

Internal reviews to accepted claims ratio

Insurer

Internal reviews to accepted claims ratio

Internal reviews to accepted claims ratio

Insurer

2020 year

2019 year

AAMI

25%

17%

ALLIANZ

20%

16%

GIO

29%

19%

NRMA

15%

16%

QBE

17%

13%

Outcomes of resolved internal reviews

Of the total 1658 resolved internal reviews in 2020, 74% had the initial claim decision upheld. In 2019, 76% resolved internal reviews had the decision upheld.

Chart 6: Outcomes of resolved internal reviews (%)

 

Year

Decision overturned – in favour of claimant

Decision overturned – in favour of insurer

Decision upheld

Internal reviews

Amount of weekly payments

2020

43%

9%

48%

149

Amount of weekly payments

2019

60%

7%

33%

86

Is injured person mostly at fault

2020

32%

0%

68%

169

Is injured person mostly at fault

2019

24%

0%

76%

87

Minor Injury

2020

12%

0%

88%

741

Minor Injury

2019

13%

0%

87%

677

Other review types

2020

33%

1%

66%

221

Other review types

2019

30%

0%

70%

202

Treatment and Care R&N

2020

31%

3%

66%

378

Treatment and Care R&N

2019

32%

1%

67%

198

Total

2020

24%

2%

74%

1,658

Total

2019

23%

1%

76%

1,250

The majority of internal reviews result in the original decision being upheld, although there was a decrease (-2%) in this ratio from 2019 to 2020.

Next quarter’s report will be expanded to include an analysis of the average time taken to complete an application for internal review for each insurer.

What if customers still disagree 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.

Chart 7: 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

330

35%

9%

3%

49%

4%

31

ALLIANZ

731

30%

10%

4%

49%

7%

34

GIO

807

38%

11%

4%

42%

5%

36

NRMA

1059

26%

13%

5%

52%

4%

24

QBE

648

39%

10%

3%

45%

3%

19

Total

3575

33%

11%

4%

48%

4%

27

Chart 8: Outcomes of resolved DRS reviews*

 

Insurer decision overturned in favour of claimant

Insurer decision overturned in favour of Insurer

Insurer decision Upheld

Other

Minor Injury

31%

0%

69%

0%

Treatment and care R&N

44%

0%

56%

0%

Is the injured person mostly at fault

71%

0%

28%

1%

Amount of weekly payments

49%

0%

51%

0%

All other dispute types

46%

1%

49%

4%

Total

38%

0%

61%

1%

*Data from 1 Dec 2017 to 31 March 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 700 complaints. 594 complaints were triaged into the non-complex complaints’ category, and 106 were triaged into the complex complaints category.
  • Non-complex complaints are typically resolved within two days. 500 non-complex complaints were resolved.
  • 94 non-complex complaints were escalated to complex.
  • Complex complaints take >2 days on average to resolve. 241 complex complaints were resolved.
  • 112 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 April 2019 to 31 March 2020.

How many compliments and complaints did SIRA receive?

Compliments

Insurer

Number of compliments received

All insurers

156

AAMI

12

ALLIANZ

36

GIO

24

NRMA

56

QBE

28

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.

.

Insurer

Number of compliments received per 100,000 Green Slips

All insurers

3

AAMI

3

ALLIANZ

4

GIO

2

NRMA

3

QBE

2

Complaints

Insurer

Number of complaints received

All Insurers

700

AAMI

72

ALLIANZ

59

GIO

137

NRMA

259

QBE

173


Complaints per 100,000 Green Slips

Insurer

Number of complaints received per 100,000 Green Slips

All insurers

12

AAMI

15

ALLIANZ

6

GIO

14

NRMA

14

QBE

12

Totals

  • Compliments 156
  • Complaints 700
  • Referrals 112

Who complained

  • Person injured 326
  • Lawyer 285
  • Greenslip holder 22
  • Health provider 48
  • Other 19*

This information was collected from 1 April 2019 to 31 March 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?

AAMI

Type of complaint

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

Claims: Decisions

25%

Claims: Delays

24%

Claims: Management

19%

Claims: Service

19%

Claims: Other

0%

Policy: Purchasing

13%

Allianz

Type of complaint

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

Claims: Decisions

36%

Claims: Delays

14%

Claims: Management

19%

Claims: Service

24%

Claims: Other

2%

Policy: Purchasing

5%

GIO

Type of complaint

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

Claims: Decisions

32%

Claims: Delays

26%

Claims: Management

15%

Claims: Service

20%

Claims: Other

3%

Policy: Purchasing

4%

NRMA

Type of complaint

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

Claims: Decisions

26%

Claims: Delays

31%

Claims: Management

13%

Claims: Service

25%

Claims: Other

4%

Policy: Purchasing

1%

QBE

Type of complaint

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

Claims: Decisions

19%

Claims: Delays

34%

Claims: Management

10%

Claims: Service

29%

Claims: Other

5%

Policy: Purchasing

3%

All insurer related complaints

Type of complaint

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

Claims: Decisions

26%

Claims: Delays

28%

Claims: Management

14%

Claims: Service

25%

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
  • Written warnings
  • 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.

From 1 April 2019 to 31 March 2020, 38 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 34 matters were finalised during this period, which includes matters received prior to April 2019.

Completed Investigations

Allianz

3

AAMI

2

GIO

2

NRMA

24

QBE

3

TOTAL

34

Regulatory Action

Allianz

1

Letter of censure

AAMI

1

Letter of censure

GIO

-

 

NRMA

10

Notice of non-compliance

NRMA

1

Letter of censure

QBE

2

Notice of non-compliance

QBE

1

Letter of censure

TOTAL

16

 

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 in accordance with timeframes prescribed by the Act and Guidelines;
  • Failure to respond or late response to a treatment, rehabilitation 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
    • 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 Enforcement and Prosecutions (E&P) - 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.

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 April 2019 to 31 March 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