The claims admittance rates for Individual-Advised Death, TPD, Trauma and DII insurance are in some instances markedly higher than the claims admittance rates for Individual Non-Advised claims, the latest data from APRA shows.
The authority has released its Life Insurance Claims and Disputes Statistics publication, covering a rolling 12-month period from 1 July 2025 to 30 June 2026, which it says presents the key industry and entity-level claims and disputes outcomes for 13 Australian life insurers writing direct business.
APRA’s data shows Individual-Advised Death cover had a claims admittance rate of 97% (91% for Individual Non-Advised) with TPD sitting at 81% for advised claims (71% non-advised) while Trauma cover was 88% for advised compared with 84% for non-advised. Similarly DII sat at 94% advised and 85% non-advised.
APRA notes the claims paid ratio refers to the dollar amount of claims paid out in the reporting period as a percentage of the annual premiums receivable in the same period. As DII has recurring monthly payments; for the purposes of the claims paid ratio, total payments are approximated using an average 24-month payout period.
The data here shows that the claims paid ratio was slightly higher under Individual-Advised for Death, TPD, and Trauma although that was markedly different for DII covers.
The statistics also include a dispute lodgement ratio, which APRA says is the number of disputes lodged during the reporting period per 100,000 lives insured.
For most cover types Individual-Advised covers saw fewer disputes lodged than for Individual Non-Advised covers, except for Trauma covers where the dispute lodgement ratio was 60 per 100,000 lives insured under Individual-Advised, compared with 33 for Individual Non-Advised.
As to dispute outcomes by cover type, the APRA data shows disputes across Death, TPD, Trauma and DII all saw more than 80% resolved. The table below combines all distribution channels.
