Processing times for claims

Last updated: 22 August 2024

In the last six months, we have processed more claims than those that have come in. This has enabled us to progress the oldest claims. This is reflected in some of the processing times increasing. The average days to process a claim are calculated at the time that a claim is processed, and the average goes up when we make inroads into our backlog and process the claims that have been waiting the longest.

The average number of days it takes to process a claim at 30 June 2024

These statistics do not distinguish between urgent and non-urgent claims. Urgent claims are generally processed in 30 days, and these aren’t all of the entitlements that we administer.

Number of claims

The following table shows the history of claims that are in progress and those that have been completed. In the last period, we processed more claims than we received.

Claims received and processed

Since 2021 and until recently, the number of claims in progress has grown steadily, as shown by the red line. A gap between the claims that we received and those that we processed (the dark green line) opened up just after the COVID lockdown. But from 2023, we have generally achieved parity with the incoming claims, and recently, we processed more claims than we received.

Why processing times vary

Some claims are relatively simple and normally processed quickly. Urgent claims are given priority.

However, more complicated claims take longer to process. Those claims might:

• include complex conditions
• need further information from medical specialists.

What we're doing to reduce processing times

Budget 2024 provides us with funds to recruit more staff specifically to address the processing times. We are continuing to make our processes more efficient — checking all claims as they are received to identify and follow up on any missing information.

The reasons for the waiting times

• Over the last few years, we have been receiving more claims which caused a backlog.
• We have been receiving more complex claims, which take longer to process.
  Complex claims are broadly described as claims where a client claims for multiple conditions. These take much longer to process.
• Sometimes, it takes a long time to get the medical information we need to assess and decide on claims.
• The average time that it takes to obtain the additional information required for a claim is currently 196 days (168 days for 2023).
  A significant component of the time to process some claims is the time that it takes to receive the complete information of a claim or additional information required to make a decision. It is important to include in your application all the information that has been requested.

Let us know if your situation changes

For example, if your condition deteriorates, or the delay is causing you financial difficulties, contact us. We may be able to escalate your application for an earlier assessment. 

It is important that you continue to receive treatment from your health provider.

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How you can reduce your wait time

The most effective step that you can take to shorten the processing time for your claim is to provide all the information that we require when you send in your claim.

This means:

• having your GP or specialist confirm your diagnosis
• sending us all the documents or information that you have about your condition.

Tip: Use the checklist on the claim form to see what steps to take and what documents to include.

If we don’t have everything we need to process your claim, we will have to ask you or your GP or specialist for the missing information. This will delay your claim.

Contact us if you’re not sure what documents you need to support your claim.

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We will make sure that you don't miss out

If your claim is approved, we will backdate any payments to the date we received your completed application. We'll also consider reimbursing you for any reasonable medical costs related to that condition.