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Trauma worst for ‘incorrect outcome’ claim reversals

Trauma claims have the highest proportion of decisions being reversed because of “incorrect outcomes”, according to latest Australian Prudential Regulation Authority life industry data.

Incorrect outcomes led to 67% of changed decisions in trauma, followed by total and permanent disability (47%), disability income insurance (45%) and death (29%).

The prudential authority’s claim and dispute data covers the rolling 12-month period to June 30.

Accident cover disputes have the highest resolution rate at 94%, followed by consumer credit insurance (93%), funeral (89%), DII (86%), death (84%), TPD (83%) and trauma (81%).

TPD claims took about 3.9 months to process on average – the longest among the seven product lines covered in the APRA report.

Trauma and DII shared joined second (1.4 months), followed by CCI (1.3 months), death (one month), accident (0.8 months) and funeral (0.6 months).

TPD and trauma claim dispute duration averaged 1.8 months, with death second at 1.4 months.

For individual-advised policies, death claims averaged $619,000; TPD $896,000; trauma $267,000; DII $9000 (expressed as a monthly benefit); and accident $241,000.

For group super covers, death claims averaged $144,000; TPD $155,000; and DII $5000 (monthly benefit).