When a claim stops moving: what the regulators' own data shows

A claim does not have to be declined to fail. It can simply stop.

Australia's regulators publish data on exactly this, and it shows that stalled claims are far more common than most people expect. Here is what the evidence says, with every source listed, so you can check each figure yourself.

Most of the figures below concern claims on total and permanent disability cover, called TPD. It is insurance that many Australians hold inside their super without ever being told, and depending on the policy it can pay a benefit when illness or injury means a person may never return to their usual work.

One in eight TPD claims never reached a decision at all

When the Australian Securities and Investments Commission (ASIC) reviewed 35,026 TPD claims across seven insurers, it found that 12.5 per cent of them, 4,365 claims, were withdrawn before any decision was made (ASIC Report 633, Holes in the safety net, October 2019, covering claims finalised or withdrawn between 1 January 2016 and 31 December 2017).

These were not declines. They were claims that stopped. ASIC split them into two kinds. An active withdrawal is where the person, their fund or the administrator tells the insurer the claim will not be pursued. A passive withdrawal is where the insurer marks a claim withdrawn because the person did not respond to a request for information. At the four insurers ASIC could compare, the two ran almost level: 41 per cent active, 40 per cent passive.

So roughly four in ten of those stopped claims ended without anyone deciding anything, because a letter went unanswered. That tends to happen to the people least able to keep chasing paperwork, at the point when they are most unwell. If that is where you are, it is not a personal failing. It is a pattern the regulator has documented. ASIC also found insurers were generally poor at recording why claims were withdrawn at all.

The "most claims get paid" figure counts only the claims that finished

You will often see that around nine in ten TPD claims are accepted. That figure is real, but it counts only the claims that reached a decision.

Of TPD claims through group super that were finalised in the year to December 2025, 90.2 per cent were admitted (the Australian Prudential Regulation Authority (APRA) and ASIC, Life Insurance Claims and Disputes Statistics, December 2025 edition, published 29 April 2026). Group super means cover held automatically through a super fund rather than bought directly.

Count every claim lodged over the same period and the picture changes:

• 66.2 per cent were admitted
• 20.0 per cent were still undetermined at the end of the year
• 6.6 per cent were withdrawn before any decision
• 7.2 per cent were declined

(Same source. The admitted, undetermined and withdrawn shares are as published. The declined share is the balance of the four outcome categories.)

One claim in five had no answer at all. The acceptance rate describes the finish line, not the journey, and it says nothing about how long the wait to get there can be.

Most delay is not caused by the person claiming

ASIC examined how ten superannuation trustees handled death benefit claims. It found that 78 per cent of the claim files it reviewed were delayed by processing issues within the trustee's own control, not by the people claiming, and not by insurers (ASIC Report 806, Taking ownership of death benefits: How trustees can deliver outcomes Australians deserve, 31 March 2025, covering ten trustees representing 38 per cent of all member benefits in APRA-regulated super funds, over the two years to 31 March 2024).

The gap between funds was stark. The best performing trustee closed 48 per cent of death benefit claims within 90 days. The slowest closed 8 per cent.

How quickly a claim moves can depend more on which fund a person happens to be with than on anything about their own circumstances.

The wording in the policy can matter more than the diagnosis

Not all TPD cover is the same. The strictest test, called an activities of daily living definition, asks whether a person can still do basic tasks such as feeding, dressing or washing themselves. That is a far harder test to satisfy than being unable to return to work.

Claims assessed under an activities of daily living definition were declined at 60 per cent: five times the 12 per cent rate for all other TPD definitions (ASIC Report 633, Holes in the safety net, October 2019).

Two people with identical conditions can receive opposite answers because their policies are worded differently. Which definition applies depends on the policy itself, and reading it is exactly the kind of work a licensed professional does.

Delay is one of the most complained about problems in financial services

Across all of financial services in 2024-25, delay in insurance claim handling was the second most complained about issue at the Australian Financial Complaints Authority (AFCA), behind only misleading product or service information (AFCA Annual Review 2024-25).

Superannuation complaints then rose 29 per cent to 7,687 across the 2025 calendar year, driven largely, AFCA said, by delays in claim handling and disputes over claim decisions. AFCA received 111,373 complaints in total that year, a record, and up 14 per cent (AFCA media release, "AFCA receives record number of complaints in 2025 calendar year", February 2026).

The problem is documented, and regulators are acting on it

In November 2025 the Federal Court ordered United Super, the trustee of Cbus, to pay a $23.5 million penalty over serious failures that delayed death benefit and TPD insurance claims. ASIC says the failures affected more than 7,000 Australians, and that Cbus is separately running a remediation program of about $32 million (ASIC media release 25-286MR, 25 November 2025).

ASIC has separate proceedings on foot against AustralianSuper over delays in death benefit claims. Those allegations have not been proven in court (ASIC media release 25-034MR, 12 March 2025).

If a claim has dragged on for months with no clear explanation, that is not imagination, and it is not unusual. Delay of this kind is a documented, regulated problem, not a normal part of the process that has to be accepted quietly.

Cover can switch off without anyone saying so

The number of Australians insured for TPD through their super was 12,170,717 in June 2018. By June 2023 it had fallen to 7,597,083. It has since started to recover, reaching about 8.11 million by June 2024 (ASFA, Providing cover to those who need it: The success of insurance in superannuation, March 2025, drawing on APRA's Life Insurance Claims and Disputes Statistics).

Most of that fall was by design. Since 2019, default insurance switches off after 16 months without a contribution (Protecting Your Super reforms, from 1 July 2019). Since 2020, cover does not start automatically for members under 25, or on accounts that have not reached $6,000 (Putting Members' Interests First reforms, from 1 April 2020). ASFA notes the reduction landed close to what it expected at the time, around five million people.

Holding a super account is not the same as holding cover. If you ask, a super fund has to tell you what insurance is attached to your account: the law requires a fund to give a member the information they reasonably need to understand their benefits (Corporations Act 2001, section 1017C). Asking costs nothing.

What this all adds up to

None of this means any particular claim will fail. Acceptance rates for cover held through super are high, and the great majority of claims that reach a decision are paid. That is worth saying plainly.

What the evidence does show is that the process has specific, well documented friction points: information requests that quietly stall a claim, policy definitions that shape the outcome before the medical evidence is even read, and delays that often have nothing to do with the person making the claim.

Knowing where those points are is often the difference between a claim that keeps moving and one that quietly stops.

If you want to talk any of this through, we'll explain which doors exist for your situation and, if you want, introduce you to a firm on our panel. It costs you nothing.

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ClaimsGuide provides general information only. Nothing here takes your personal circumstances into account, and it is not financial, legal, medical or tax advice. The statistics above describe across the industry patterns and say nothing about the likely outcome of any individual claim. Whether a policy can respond always depends on the policy wording, the legislation, the medical evidence and the person's circumstances, and those are questions for licensed professionals.

Sources and further reading

• ASIC, Report 633: Holes in the safety net, a review of TPD insurance claims (October 2019). Withdrawn claims: paragraph 155 and Table 11. Activities of daily living decline rates: Finding 1.
• ASIC, Report 806: Taking ownership of death benefits: How trustees can deliver outcomes Australians deserve (31 March 2025), and media release 25-049MR.
• ASIC, media release 25-286MR, Cbus ordered to pay $23.5 million penalty (25 November 2025).
• ASIC, media release 25-034MR, proceedings against AustralianSuper over death benefit claims (12 March 2025). Allegations not yet proven.
• APRA and ASIC, Life Insurance Claims and Disputes Statistics, December 2025 edition, covering 1 January to 31 December 2025 (published 29 April 2026).
• ASFA, Providing cover to those who need it: The success of insurance in superannuation, research paper, March 2025. TPD lives insured: Table 2.
• AFCA, Annual Review 2024-25, and media release AFCA receives record number of complaints in 2025 calendar year (February 2026).
• Corporations Act 2001 (Cth), section 1017C.