The Australian Prudential Regulation Authority (APRA) and the Australian Securities and Investments Commission (ASIC) have released new data on life insurance claims and dispute outcomes for the 12 months to Dec. 31, 2025, covering 13 direct life insurers. The results are set out in APRA’s Life Insurance Claims and Disputes Statistics and are also used in ASIC’s MoneySmart Life insurance claims comparison tool, which compares insurers by product type, distribution channel, and four measures: claims acceptance rates, claims duration, number of disputes, and policy cancellation rates.
According to APRA’s data, death cover recorded the highest claims admittance rates across the main channels. Over the period, life insurers admitted 97% of individual advised death claims, 92% of individual non‑advised claims, and 98% of claims in both group superannuation and group ordinary business. For total and permanent disability (TPD) cover, admittance rates varied by channel. Individual advised TPD business recorded an 82% admittance rate, compared with 69% for individual non‑advised policies. Group business showed higher rates, with 90% of group super and 89% of group ordinary TPD claims admitted.
Trauma insurance admittance rates were 88% for individual advised and 84% for individual non‑advised policies, while group ordinary trauma claims were admitted at 95%. Disability income insurance (DII) admittance rates were 94% for advised individual cover, 86% for non‑advised, 96% for group super, and 98% for group ordinary arrangements. Consumer credit insurance (CCI), funeral, and accident products showed more variation by channel, with some categories not reported for all distribution types and smaller overall volumes.
The publication also provides claims paid ratios, comparing claims payments made over the period with premiums. For death cover, individual advised and non‑advised business recorded claims paid ratios of 43% and 44%, respectively. Group super death cover reported a claims paid ratio of 75%, while group ordinary business reported 50%. TPD followed a similar pattern of differences between retail and group segments. Claims paid ratios were 70% for individual advised TPD, 53% for individual non‑advised, 99% for group super, and 53% for group ordinary. For trauma cover, individual advised business recorded a 58% claims paid ratio, non‑advised 44%, and group ordinary 68%. For DII, APRA estimated claims paid ratios using a 24‑month payment period to reflect the ongoing nature of income benefits. On this basis, individual advised DII recorded a 60% claims paid ratio, non‑advised 140%, group super 110%, and group ordinary 50%.
The statistics also report the time taken to finalise claims. When data is combined across channels, 76% of death claims were finalised within two weeks and 93% within two months, with an estimated average duration of 1.0 month. TPD assessments tended to run longer than other benefit types. Over the period, 22% of TPD claims were completed within two weeks and 50% within two months. A further 34% took more than two months up to six months, 12% took more than six months up to 12 months, and 4% extended beyond 12 months. The estimated average duration for TPD claims was 3.8 months.
For trauma cover, 56% of claims were completed within two weeks and 87% within two months, with an average duration of 1.4 months. DII claims showed similar timing, with 52% finalised in two weeks, 89% within two months and an estimated average duration of 1.4 months. CCI claims were finalised within two weeks in 61% of cases and within two months in 92% of cases, with an average duration of 1.2 months. Funeral insurance claims were finalised fastest on average: 93% were resolved within two weeks, 99% within two months, and the average duration was 0.6 months. Accident claims were resolved within two weeks in 84% of cases and had an average duration of 0.9 months.
Dispute lodgement ratios, measured as disputes per 100,000 lives insured, differed by product and channel. Ratios for DII were the highest of all cover types reported: 315 for individual advised business, 446 for individual non‑advised, 74 for group super, and 48 for group ordinary. For TPD, dispute lodgement ratios were 106 for individual advised, 67 for non‑advised, 35 for group super, and 9 for group ordinary. Death cover reported lower dispute ratios, at 14 for individual advised, 28 for individual non‑advised, 1 for group super, and 4 for group ordinary. For trauma cover, dispute lodgements reached 61 per 100,000 lives in the individual advised segment and 32 in the non‑advised segment, with no trauma disputes reported for group ordinary. Accident cover recorded dispute ratios of 77 for individual advised and 18 for individual non‑advised policies.
Across all cover types, a high proportion of disputes lodged during the period were resolved by year‑end. Resolution rates ranged from 82% of disputes for TPD to 95% for funeral insurance. In most resolved disputes, insurers kept their original decision. In trauma insurance, 47% of resolved disputes resulted in the original decision being maintained and 4% in a reversal, while 49% were classified as other outcomes, such as negotiated changes. For death cover, 35% of resolved disputes resulted in the original decision being maintained and 3% in a reversal, with 62% recorded as other outcomes.
Reasons for overturning original claim decisions were broken down by product. For death claims where the original outcome was reversed, 50% were attributed to the original outcome being incorrect, 33% to additional information received, and 17% to other reasons. In TPD, 31% of reversals were recorded as original outcome incorrect and 58% as resulting from additional information. For trauma, 71% of reversals were attributed to the original outcome being incorrect and 18% to additional information. Dispute processing times were mainly within a three‑month period. For DII, 93% of disputes were finalised within 45 days and 5% extended beyond 90 days, with an estimated average duration of 1.3 months. For death cover, 90% of disputes were completed within 45 days, 7% went beyond 90 days, and the average duration was 1.4 months.
The statistics also include in‑force business by insurer, showing lives insured, annual premium, sum insured, new business, and lapse rates across individual advised, individual non‑advised, group super, and group ordinary segments. In individual advised death cover, there were about 1.27 million lives insured as of Dec. 31, 2025, with annual premiums of around $3.06 billion. By share of annual premium, TAL held 27.5%, Zurich 23.5%, Acenda Life 16.0%, and AIAA 15.6%, with the remainder spread across smaller participants. In group super death cover, 9.24 million lives were insured with annual premiums totalling $2.25 billion. TAL accounted for 46.4% of annual premium in this segment, AIAA 26.1%, and MetLife 13.9%. Other insurers, including Acenda Life, ART Life, and Zurich, wrote smaller portions of the market. APRA publishes the Life Insurance Claims and Disputes Statistics twice a year. A subset of the data is presented by ASIC through the MoneySmart Life insurance claims comparison tool for use by consumers and other stakeholders.
