{"id":65428,"date":"2023-04-18T21:39:49","date_gmt":"2023-04-18T10:39:49","guid":{"rendered":"https:\/\/riskinfo.com.au\/news\/?p=65428"},"modified":"2024-10-30T08:41:00","modified_gmt":"2024-10-29T22:41:00","slug":"successful-claims-more-likely-for-advised-clients-apra","status":"publish","type":"post","link":"https:\/\/riskinfo.com.au\/news\/2023\/04\/18\/successful-claims-more-likely-for-advised-clients-apra\/","title":{"rendered":"Successful Claims More Likely for Advised Clients \u2013 APRA"},"content":{"rendered":"

Latest data confirms life insurance policy holders who have financial advisers are more likely to have their claims accepted than unadvised claimants.<\/p>\n

This affirmation is contained within APRA’s Life Insurance Claims and Disputes Statistics<\/a> for the year ending 31 December 2022, in which data reveals the percentage of individual advised claims for Death, TPD, Trauma, and DII all delivered a higher admitted percentage rate than that of individual non-advised claims.<\/p>\n

\"apra<\/a>
Source: APRA Life Insurance Claims and Statistics for the Year Ending 31 December 2022, Table 1: Claims admittance rate by cover type and distribution channel<\/figcaption><\/figure>\n

The report notes the reason for higher successful claim rates for advised claimants could be due to the policyholder \u201c\u2026having clearer expectations up front of what is covered by the product, or the adviser discouraging the policyholder from lodging a claim that is not covered by the policy.\u201d<\/p>\n

Altogether, more than 15,000 disputes were resolved during the reporting period, with TPD and DII making up the vast majority \u2013 27% and 56% of the total respectively. Three products showed a small number of disputes resolved, namely CCI (199), funeral (665) and accident (218).<\/p>\n

Data shows that admittance rates across all distribution channels have remained stable while claims paid ratios for death and trauma have declined. In contrast, the ratios for TPD and DII peaked in December 2020 \u2013 before returning to a lower level by December.<\/p>\n

Table 6 of the report shows that when it came to death cover claims, 32% of the insurer\u2019s first decisions were incorrect, TPD 39%, DII 33%, and trauma 29%.<\/p>\n

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Source: APRA<\/figcaption><\/figure>\n

For individual products, APRA\u2019s data reveals a sharp increase in the dispute lodgement ratios across all distribution channels since June 2021. It states this has been driven by DII, due to the \u201c\u2026various repricing activities undertaken to address the product\u2019s sustainability issues\u201d.<\/p>\n

The report states a \u2018dispute\u2019 can refer to:<\/p>\n