SIRA reports CTP insurers' claims experience and customer feedback

SIRA reports CTP insurers' claims experience and customer feedback | Insurance Business Australia

SIRA reports CTP insurers' claims experience and customer feedback

The New South Wales (NSW) State Insurance Regulatory Authority (SIRA) has released compulsory third-party (CTP) insurers' claims experience and customer feedback report for March 2021.

SIRA's latest report aims to hold insurers accountable through transparency, enabling scheme stakeholders and the public to have informed discussions about the industry's performance. It also aims to help customers compare insurers when purchasing CTP insurance and to educate people injured in motor accidents about the claims process.

The regulator compared seven key indicators of customer experience across the five CTP insurers in NSW: Australian Associated Motor Insurers Limited (AAMI), Allianz, GIO, NRMA, and QBE. A sixth insurer, Youi, joined the scheme on December 01, 2020, but was not included in the March report due to the lack of claims received.

The report's issue presented data for the first three measures over two time periods: April 01, 2019 to March 31, 2020 (the 2020 year) and April 01, 2020 to March 31, 2021 (the 2021 year). During the 2021 year, insurers accepted 97.9% of claims compared to 98.8% in the 2020 year.

QBE received more claims in the 2021 year than the previous year (99.8% in the 2021 year vs 99.7% in the 2020 year), rejecting 0.3% claims in the 2021 year compared to 0.3% in the previous year.

By contrast, the insurance providers that received fewer claims in the 2021 year than the 2020 year include:

  • AAMI (98.0% in the 2021 year vs 98.4% in the 2020 year), rejecting 2.0% more claims in the 2021 year, compared to 1.6% in the previous year.
  • Allianz (97.0% in the 2021 year vs 98.4% in the 2020 year), rejecting 3.0% of claims in the 2021 year, compared to 1.6% in the 2020 year;
  • GIO (96.9% vs 98.6%), rejecting 3.1% of claims in the 2021 year, compared to 1.4% in the 2020 year; and
  • NRMA (97.3% vs 98.5%), rejecting 2.7% of claims in the 2021 year, compared to 1.5% in the 2020 year.

SIRA used the following indicators to measure insurer performance over the course of a claims process:

  • 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 considered for enforcement and prosecution action; and
  • customer experience and outcomes, as measured by SIRA's independent survey

According to SIRA, the insurers declined claims in certain circumstances under NSW legislation – with the most common reasons for claim denial including:

  • late claim lodgement (more than 90 days after the accident);
  • the claim did not involve a motor vehicle accident; and
  • the claim involved an uninsured, unregistered, or unidentified vehicle.

The report showed that insurers declined 2.1% of claims in the 2021 year compared with 1.2% in the 2020 year. Meanwhile, they accepted 9,884 claims in the 2021 year, down from 11,298 in the 2020 year.