🇦🇺Australia

Delayed Claim Decisions

3 verified sources

Definition

Failure to provide complete documentation in the initial loss assessment phase leads to insurers requesting additional information, extending the decision timeline beyond the 10 business day mandate under the General Insurance Code.

Key Findings

  • Financial Impact: AUD 5,000-20,000 per delayed claim in holding costs (e.g., business interruption at AUD 1,000/day for 10-20 extra days)
  • Frequency: Per claim, especially complex business claims
  • Root Cause: Manual documentation gaps in initial assessment

Why This Matters

Claims adjusting firms in Australia waste 10-30 business days per claim on documentation delays. Automation of initial loss assessment eliminates this risk.

Affected Stakeholders

Claims Adjusters, Loss Assessors, Business Policyholders

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Financial Impact

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Current Workarounds

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Methodology & Sources

Data collected via OSINT from regulatory filings, industry audits, and verified case studies.

Evidence Sources:

Related Business Risks

Idle Adjuster Capacity from Rework

AUD 2,000-4,000 per claim in labour (20-40 hours at AUD 100/hour adjuster rate)

Under-Settlement from Poor Documentation

AUD 5,000-50,000 per claim in reduced settlements (e.g., depreciation, betterment deductions without counter-evidence)

Fehlentscheidungen bei Tarifindikation durch unzureichende, nicht standardisierte Aktuariatsdokumentation

Quantified (logic-based): Bei einem Portfolio mit AUD 200 Mio. Jahresprämie führt eine 1–3 % systematische Unterpreisung oder nicht realisierte Erhöhung zu 2–6 Mio. AUD jährlichem Ergebnisverlust; skaliert auf mehrere Linien kann dies 5–15 Mio. AUD p.a. übersteigen.

Überhöhter manueller Aufwand bei der Erstellung von Aktuariatsunterlagen für Tarifgenehmigungen

Quantified (logic-based): Typisch 100–200 Aktuarsstunden pro Filing à ca. AUD 250–350/Stunde = AUD 25.000–70.000 direkter Aufwand je Tarifrunde; bei 6–10 Filings pro Jahr entstehen 150.000–700.000 AUD jährliche Personalkosten, wovon 40–60 % (60.000–420.000 AUD) durch Automatisierung und Standardisierung reduzierbar sind.

Decision Errors in Catastrophe Modelling

AUD 10-50M+ in unreserved losses per major event due to model discrepancies; global AAL $152B with Australia exposed to cyclone/earthquake/bushfire[1][4]

Cost Overrun from Loss Adjustment Expenses

AUD 10-30% overrun on gross losses from unmodelled LAE and demand surge; contributes to $145B insured losses in 2024[1][8]

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