The State Insurance Regulatory Authority (SIRA) has released the results of its latest research on the experience of CTP insurance customers in New South Wales.

These five insurers studied for this report were in NSW: AAMI, Allianz, GIO, NRMA and QBE.

The report titled CTP insurer claims and experience and customer feedback comparison, looks at data from 1 December 2017 through until 30 September 2019 and looks at indicators of the insurance industries performance, including:

Number of statutory benefits claims accepted by insurers:

Of the 19,382 claims submitted to the five insurers over this period, the vast majority (98%) were accepted. 351 claims were denied, with the main reasons being a late claim lodgement or insufficient information given. NRMA showed the lowest claim acceptance at 96.7%, with the other companies all over 98%.

How quickly insurers pay statutory benefits:

After an incident, some insurers cover expenses faster than others. Among the five insurers, Allianz and NRMA had the highest proportion of pre-claim support, where customers can access treatment after notifying the insurer, but before lodging a formal claim. Overall, 72% of injured insurance customers studied received support, such as covering initial medical expenses.

An accident will often mean time off work, and insurance company payments to cover this are important for many customers. Of those studied, 41% of those eligible received income support payments within the first month. Some customers had to wait a lot longer, with between 11% and 18% not receiving income support until 14 weeks or more after the lodgement of a claim.

Outcome of claim decisions reviewed by insurers through the insurer’s internal review unit, and the outcome and number of claims referred to the Dispute Resolution Service.

When a customer disagreed with the insurer’s decision, they can ask for a review. This will then be looked at by the insurer’s internal review team, independent from those at the insurance company that made the original decision.

Of these reviews, 63% to 86% were determined. Following this, the outcome for the customer was determined to be the same or better in most cases. Between all insurer’s 3,203 cases were reviewed and this resulted in the same outcome for the customer in 74% of cases, a better outcome in 25% of cases and a lower outcome in 1% of cases. A notable exception is 8% of internal reviews looking at weekly payments resulted in a lower outcome for the customer.

 

Following the outcome of an internal review, and sometimes regardless, the customer can submit their claim to SIRA’s Dispute Resolution Service (DRS), where an independent decision is made after considering the internal reviewer’s determination. From here 64% of the DRS reviews ended with the same outcome for the customer, 34% with a better result for the customer, 1% with a lower outcome for the customer and 1% of claims were exempt from claim assessment.  

The number and type of compliments and complaints received by SIRA about insurers.

The amount of compliments and complaints per 100 000 green slips is a measure used by the regulator to compare insurers performance. By this measure, the insurance companies ranged from 5 to 14 complaints per 100 000.

Most complaints were about claims decisions (31% overall), followed by claims delays (390%) and claims management (11%)

 

The number and types of issues escalated to SIRA’s Compliance, Experience and Investigations.

The Compliance, Enforcement and Investigations (CE&I) team at Sira carries out enforcement action on a case by case basis to minimise risks to the CTP scheme. The CE&I team completed 22 investigations, and from these took regulatory action in 4 cases against insurance companies. These were a letter of censure for Allianz, 2 notices of non-compliance for NRMA and another for QBE.

More on the SIRA data can be found here:

https://www.sira.nsw.gov.au/resources-library/green-slip-resources/publications/ctp-insurer-claims-experience-and-customer-feedback-comparison-Sept-19