Advisers help clients increase success of claims on personal insurances
Updated: 4 days ago
Written by Christopher Hall, AdvDipFP | Authorised Representative, AFSL 526688 | Updated October 2026
Clients often ask what the difference is between getting a policy though an Adviser or directly from an insurer or phone-sales desk. Recently the governing body (APRA) reported that personal insurance holders with an Adviser are more likely to receive pay-outs than non-advised policyholders.
Below, Table 1, shows that in most cases, Advisers have been able to help their clients through traumatic times and the client has received a better outcome:
Table 1:
Note - DII is Disability Income Insurance; sometimes called Income Protection
In APRA's June 2020 release, advised individual policies were admitted at 96% for death cover against 89% non-advised, 81% against 61% for TPD, and 94% against 85% for disability income (income protection). Trauma was the exception, with 85% admitted for advised policies against 87% for non-advised (APRA, 2020).
Cover type | Individual advised, % admitted (2020) | Individual non-advised, % admitted (2020) |
Death | 96% | 89% |
TPD | 81% | 61% |
Trauma | 85% | 87% |
Disability income (DII) | 94% | 85% |
Source: APRA, Life Insurance Claims and Disputes Statistics, June 2020 (released 20 October 2020). The 2026 figures below are from APRA's later release.
The key takeaway for many clients is the important role Advisers play in supporting clients through disability claims like TPD/Income Protection (DII). APRA points to the likelihood that advised clients have clearer expectations regarding what their policies cover, and may also be discouraged from lodging claims that are not covered by their policies. Importantly, not lodging a claim can save unnecessary angst, stress and time, especially at a time when clients should be focusing on their health, or loved ones.
What does APRA's 2026 claims data show about adviser-placed cover?
In Australia, APRA's 2026 claims data show that adviser-placed personal insurance is admitted at higher rates than direct or online cover for every cover type, with the widest gap in TPD. Adviser-placed claims were admitted at 97% for death cover against 92% direct, 94% against 86% for income protection, 88% against 84% for trauma and 82% against 69% for TPD (APRA, 2026). The TPD gap is more than 13 percentage points.
Cover type | Adviser-placed admitted | Direct or online admitted |
Death (life cover) | 97% | 92% |
Income protection | 94% | 86% |
Trauma | 88% | 84% |
Total and permanent disability (TPD) | 82% | 69% |
Source: APRA, Life Insurance Claims and Disputes Statistics, 2026. Retail channels industry-wide; not specific to any one insurer.
The comparison covers retail cover only. Christopher Hall, AdvDipFP, Authorised Representative, AFSL 526688, reads the gap as a placement effect: cover that is matched to circumstances and disclosed correctly at application is more likely to be admitted. It is not a measure of insurer quality. The full breakdown is in APRA's adviser-placed and direct admitted-claim rates.
How does this compare with claims on group cover through a super fund?
Group cover is a separate channel and is not covered by the adviser-versus-direct comparison above. APRA reports group super claims admitted at higher overall rates, 98% in the 12 months to December 2025, because group cover is generally accepted without individual underwriting. The hurdles for claims on group cover through a super fund sit in the amount of cover, the definitions and the process of lodging a claim, which is where support matters most.
Are claims more likely to be paid if cover is placed through an adviser?
On APRA's 2026 retail data, yes for every cover type. Adviser-placed claims were admitted at 97% for death, 94% for income protection, 88% for trauma and 82% for TPD, against 92%, 86%, 84% and 69% for direct or online cover (APRA, 2026). The figures describe retail channels industry-wide, not any single insurer.
Which type of cover shows the biggest difference between adviser-placed and direct claims?
TPD. APRA's 2026 data show 82% of adviser-placed TPD claims admitted against 69% for direct or online TPD, a gap of more than 13 percentage points (APRA, 2026).
Why might adviser-placed claims be admitted more often?
APRA points to the likelihood that advised clients have clearer expectations about what is covered, and Christopher Hall reads the gap as a placement effect: cover matched to circumstances and disclosed correctly at application. The data do not measure insurer quality.
Does this mean adviser-placed cover pays better than group cover through super?
No. The adviser-versus-direct comparison applies to retail cover only. APRA reports group super claims admitted at 98% overall in the 12 months to December 2025, and the hurdles on group cover sit in the cover level, the definitions and the lodging process.
What does an adviser do when a claim is made?
An adviser does not change the insurer's decision rules. The role is to check that the cover and its definition suit the policyholder's circumstances at the start, and to help gather evidence and lodge the claim when it is needed.
Policyholders considering a review of their existing cover can book a 15-minute phone discussion with an adviser here.
Table 1 source: Life Insurance Claims and Disputes Statistics, APRA, June 2020 (released 20 October 2020)
About the Author
Christopher Hall, AdvDipFP, is the principal financial adviser at Arrow Equities and an Authorised Representative under AFSL 526688. He has completed more than 500 life insurance policy reviews for Australian families, with a specialisation in life risk insurance.
Sources
# | Source | Type | Year |
1 | Australian Prudential Regulation Authority (APRA) — Life Insurance Claims and Disputes Statistics (adviser-placed and direct admitted-claim rates; group super admitted rates, 12 months to December 2025) — apra.gov.au | Government / regulator | 2026 |
2 | Australian Prudential Regulation Authority (APRA) — Life Insurance Claims and Disputes Statistics, June 2020 (released 20 October 2020) — Table 1 above | Government / regulator | 2020 |
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