Life insurance claims comparison tool

There are different types of life insurance available. These include:

• Death cover - pays a set amount of money when you die. The money will go to the people you nominate as beneficiaries on your policy.
• Total and permanent disability (TPD) cover - pays a lump sum to help with rehabilitation and living costs if you are totally and permanently disabled. TPD is often sold with life cover.
• Income protection cover - replaces some of your income if you are unable to work because of injury or illness.
• Trauma cover - pays a lump sum if you are diagnosed with a critical illness or serious injury such as cancer, heart attack or stroke.
• Consumer credit insurance (CCI) - pays a lump sum to cover repayments on your loan that you can't pay when you lose your job, you are sick or injured or you die.
• Funeral insurance - pays a lump sum to help your family cover funeral and related expenses when you die.
• Accidental death and injury cover - pays a lump sum for when a person accidentally dies or is injured. Most accidental death policies include a long list of exclusions, like death from hazardous activities, drugs, alcohol and self-harm.

This tool allows you to compares life insurance claims where the policy has been obtained:

• Through a superannuation fund - this is when default life insurance cover is provided through a superannuation fund or the amount of cover is increased. See Life insurance through your super fund.
• Through a financial adviser - this is when a financial adviser recommends a life insurance product that may or may not be offered within a superannuation fund. See Financial advice.
• Directly through an insurer - this is when a life insurance policy is bought directly from the insurer, generally with no personal financial advice or general advice.

These are the three most common ways life insurance is sold in Australia. Some employers also offer group life insurance to their employees where a single contract covers all employees. See Life insurance claims and disputes statistics for more information on group life insurance.

This tool reports data for all policies sold by an insurer for the type of life insurance cover and the sales channel selected. You can contact an insurer to understand the differences between individual insurance policies they offer.

Data in this tool is reported by life insurers and friendly societies to the Australian Prudential Regulation Authority (APRA). For more life insurance claims data see Life insurance claims and disputes statistics.

APRA licences insurers to operate in Australia and monitors them using a number of rules. These rules are designed to ensure that they remain financially stable and are able to keep the financial promises they make to their policyholders.

The data in this tool includes:

1. Claims accepted rate - the percentage of claims an insurer accepted for payment out of all claims that went to a final decision during the period. Reasons why an insurer may not accept a claim include:

• an exclusion clause applies. For example, the person claiming had a pre-existing condition that is excluded under the policy.
• a person making a claim forgot or chose not to tell the insurer information that was required when signing up to the insurance policy.
• the claim does not meet a definition in the insurance contract. For example, a person claiming does not meet the requirements for the definition of a heart attack.

2. Average claim time (months) - the average amount of time it took for an insurer to decide whether to accept or decline a claim for payment during the period. Under the Financial Services Council's Life Insurance Code of Practice an insurer should let claimants know about the initial decision within 2 months for income protection insurance and within 6 months for all other types of life insurance.

Reasons why a claim can take longer to finalise include:

• it takes a long time for an insurer to obtain evidence needed to assess a claim from doctors, government agencies or third parties.
• the insurer is having difficulties contacting the claimant.
• the claim is fraudulent, the insurer suspects fraud or the claimant did not provide all required information to the insurer, and further investigation is required.

3. Disputes per 100,000 lives insured - the number of claims related disputes lodged during the period for every 100,000 people insured. Disputes about a claim may be lodged with the insurer, an external dispute resolution scheme, a Court or Tribunal. Disputes can occur for many reasons including disagreement or dissatisfaction with:

• the claims decision
• the amount received for a claim
• the claims process

4. Policy cancellation rate - the percentage of policies that were cancelled by the insurer or the person insured during the period. An insurer can cancel a life insurance policy if:

• the insurer can prove a claim is fraudulent
• the insured person does not pay their insurance premiums and they have been told in writing by the insurer this may lead to cancellation of the policy

An insured person can cancel a policy for many reasons including:

• they no longer need or can't afford a policy
• they change their mind and cancel during the cooling-off period
• they purchase a new policy and cancel their old policy