Claims paid statistics, and what they leave out

Search for claims-paid statistics for New Zealand life insurers and you will find scattered figures published by individual companies and distributors, each on its own definitions and periods, covering its own product mix. What you will not find is a regulator-published dataset letting you compare insurers on a common basis.

Australia has one. The Australian Prudential Regulation Authority publishes life insurance claims and disputes statistics showing, per insurer and product type, how many claims were admitted, declined and withdrawn, and how long they took. It is regularly misread, but it exists and it is comparable.

New Zealand has no equivalent. Saying so plainly is more useful than assembling a table out of mismatched voluntary disclosures and calling it a comparison. If a site shows you a league table of New Zealand insurers by claims paid, ask where the data came from and whether the definitions were the same for every row.

Some figures do exist and are worth knowing, provided they are read for what they are.

What a claims-paid ratio does not tell you

Even where a percentage is published, it carries less information than it appears to.

• It does not distinguish product types. Life claims are paid at much higher rates than income protection or trauma claims, because death is easier to establish than disability. A life-heavy book shows a better ratio than a disability-heavy one, with no difference in behaviour.
• It does not count claims that were never made. A policyholder told informally that a claim will not succeed never appears in the denominator.
• It does not show withdrawn claims, which sit between paid and declined and are counted differently by different companies.
• It says nothing about how long claims took, how much evidence was demanded, or how many were paid only after a complaint.

These are the details that decide whether the cover does what you expected. Read them before you compare on price.

• Any per-insurer claims league table for New Zealand — ask what the data source is before you believe it.
• Figures quoted without a period or a definition of what counts as a claim.
• The difference between claims paid by number and by value, which can point in different directions.
• Whether the figure comes from the insurer, a distributor or an independent source, and what each has to gain.
• That a declined claim is not necessarily a wrongly declined claim, and a paid claim is not necessarily a well-handled one.

Every New Zealand insurer writes life and living cover to its own wording, and the words are where the money is. Two policies that look identical on price can pay very differently when it matters. Closing that gap is the entire job of an adviser.

• Most declined life claims trace back to something not disclosed at application. An adviser’s job at that stage is to make sure the disclosure is complete.
• An adviser knows which definitions are hardest to meet in practice and will steer you away from wordings that will not respond to your likely risk.
• At claim, an adviser assembles medical evidence and presents it against the definition, which materially affects outcomes.
• Where a claim is declined, an adviser knows the internal review process and the dispute scheme escalation route.
• An adviser can tell you which insurers have been straightforward to deal with in their own claims experience — anecdotal, but more honest than a manufactured ratio.

There are three ways to buy life cover in New Zealand, and they are not equivalent. You can buy direct from one insurer, which means you see one product range and one underwriting appetite. You can buy through your bank, which usually means a single insurer’s product sold under the bank’s brand, often with narrower definitions. Or you can go through an adviser, who quotes several insurers at once and is required to put your interests first.

The premium you pay is the same either way. Insurers build adviser commission into their pricing whether or not an adviser is involved, so going direct does not get you a discount — it just removes the person whose job is to argue your corner at application and at claim time.

• An adviser can see which insurer is currently taking your health history on standard terms, and which one will load or exclude it.
• An adviser can structure cover across two insurers if that produces a better outcome than putting everything with one.
• An adviser handles the underwriting back-and-forth, and is the person who chases the claim when a family is least able to.
• An adviser has to document why the recommendation suits you, which is a written record you can hold them to.

We are a referral service, not an insurer. We do not quote premiums and we do not sell policies. What we do is put you in front of one licensed New Zealand adviser who can compare the market properly.

1. 1

   You tell us what you are looking at

   The form takes about a minute. Nobody asks for your medical history on a web form — that conversation happens with the adviser, properly, and only once you have decided to proceed.

2. 2

   An adviser calls you

   A licensed New Zealand adviser talks through your situation: who depends on you, what you owe, what you already have in place, and what you are actually worried about.

3. 3

   They compare the market

   The adviser quotes across the major insurers, checks which of them will take your health history on the best terms, and puts the options side by side in writing.

4. 4

   You decide, in your own time

   There is no obligation and no cost to you. If the answer is that you already have enough cover, a good adviser will tell you that.