CTP insurer claims experience and customer feedback comparison - March 2020

A 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.

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

* 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)

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)

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 (%)

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

Internal reviews to accepted claims ratio

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 (%)

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 (%)*

Chart 8: Outcomes of resolved DRS reviews*

*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

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.

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Complaints