According to the Australian Prudential Regulation Authority’s (APRA) latest Life Insurance Claims and Disputes Statistics publication, which covers a rolling 12-month period from 1 January 2025 to 31 December 2025, life insurers received 3,483 TPD claims 2025. Of this, the vast majority came from advised individuals, with 3,350, compared with just 133 non-advised individuals.
Moreover, 70 per cent of those within the individual advised category were paid out their TPD cover, as opposed to only 53 per cent of non-advised individuals, or 70 people.
Advised TPD clients also enjoyed the highest average amount for claims admitted, coming to $785,000, with TAL paying out the highest average at $919,000. Overall, advised client claims enjoyed a strong 82.3 per cent admittance rate. This compared with only 68.8 per cent of non-advised claims admitted, with the average payout being $312,000.
Though death still remains the higher claimed policy (4,462) and enjoys very high admittance rates (97 per cent for advised, 92.2 per cent for non-advised), paid out claim amounts are generally lower, and the difference in outcomes between advised and un-advised are not as stark, highlighting the clear advantage that having a risk adviser in provides in the TPD claim process.
Additional data also pointed to measurable differences in how quickly claims are resolved and how often they progress to dispute.
Within the individual advised channel, 96.8 per cent of death claims are finalised within six months, with 74.2 per cent completed inside two months, and an average duration of 1.6 months.
By comparison, non-advised death claims see 90.5 per cent finalised within six months and 61.3 per cent within two months, with a longer average duration of 2.3 months.
For TPD, timeframes are longer. Among advised clients, 61.7 per cent of claims are finalised within six months and 28.4 per cent within three months, with an average duration of 5.9 months. Non-advised TPD claims lag behind, with 54.1 per cent resolved within six months and just 19.7 per cent within three months, while the average duration stretches to 7.4 months.
Dispute rates also show a clear gap. Advised claims record dispute rates of 6.5 per cent for TPD and 2.1 per cent for death, compared with 11.2 per cent and 3.8 per cent, respectively, for non-advised business.
This should be a lesson to life companies.
There should be no differences in the payout times, or dispute levels between advised or unadvised clients.
The insured is getting the same products, so the same steps and services should be applied in the same fashion to all insured parties in similar fashion. thereby leaving no difference in these numbers.
The life companies need to do better at bringing these numbers closer together until they are the same.
It seems you may not have had to lodge a claim before. There are two sides to every claim: first, supplying the requested documents, forms, and supporting information (handled by the client and/or adviser); and second, assessing and processing the claim (handled by the insurer). For much the same reason a mechanic—who works on cars every day and has the right tools—can service a vehicle faster and to a higher standard than the average person, an adviser-assisted client can generally submit a claim more efficiently and effectively.
Though interestingly the advised channel has a higher “dispute” rate than non-advised when looked at as a percentage of claims received than, though this would be consistent with advisers supporting their clients when most needed.