Recent data from the Australian Prudential Regulation Authority (APRA), current as of June 30, 2024, has revealed notable trends in claims and disputes across various insurance cover types.
Funeral insurance leads the report with a 100% claims admittance rate for individual non-advised policies, meaning that all claims filed in this category were approved. Meanwhile, death insurance achieved a 99% claims admittance rate in group ordinary plans. Other notable figures include trauma insurance, which recorded an 86% admittance rate for group ordinary, and DII (disability income insurance), showing a 95% admittance rate for individual advised policies.
In terms of claims paid ratios, total permanent disability (TPD) insurance stands out with 100% claims paid ratio for group super policies, indicating that all claims in this category were settled. Conversely, death insurance had a paid ratio of 45% for individual advised and 81% for group super. The DII paid ratio was 68% for individual advised and 99% for group super, suggesting that while many claims are approved, not all are paid out, particularly in individual non-advised scenarios.
The report also indicated concerns in relation to disputes, particularly in the DII category, which recorded the highest dispute lodgement ratios. Individual advised DII saw 334 disputes per 100,000 lives insured, while individual non-advised DII had an even higher ratio of 425 disputes. The TPD category also showed significant dispute rates, with 93 disputes for individual advised policies and 47 disputes for individual non-advised.
Trauma insurance had a dispute lodgement ratio of 51 for individual advised policies, indicating some contention among policyholders, while accident insurance had a lower ratio of 83 disputes for individual advised policies. Additionally, critical illness insurance (CCI) saw a lower dispute lodgement ratio of 9 for individual non-advised policies.
Dispute outcomes were varied across categories. For example, death insurance disputes were resolved 86% of the time, with 32% of decisions maintained and 5% reversed. In contrast, TPD disputes were resolved 81% of the time, with 26% of decisions upheld and 8% reversed.
The data serves as a comprehensive overview of claims acceptance and disputes across multiple insurance cover types. To view the complete data, visit the APRA site.
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