Do Insurance Companies Actually Pay Claims?
Yes. Insurance companies pay a significant amount in claims every year.
In the year to September 2025, Financial Services Council figures show $1.368 billion in life insurance claims and $2.545 billion in health insurance claims were paid in New Zealand.
Fidelity Life separately reported paying $247.7 million in claims during the financial year ending 30 June 2025, supporting 2,279 customers and accepting 93% of new claims during that period.
Those numbers answer the broad question.
But if you are the person actually making a claim, the more important question is:
Will my policy pay my claim?
That depends on what you are covered for and whether the circumstances meet the terms of your policy.
A Claim Is Not Just a Yes-or-No Decision
A person may have been paying insurance for ten years and still feel uncertain when it comes time to claim.
They may be dealing with a cancer diagnosis, recovering from a heart attack, unable to work after an injury or trying to make a life insurance claim after losing someone close to them.
At that point, reading policy definitions and gathering medical evidence is probably the last thing they feel like doing.
That is why understanding your policy before claim time matters.
Why Can Claims Be Declined?
Claims can be declined for a range of reasons.
Depending on the policy and circumstances, these could include:
- The event not being covered
- A policy exclusion applying
- The required definition not being met
- Cover no longer being in force
- Relevant information not having been disclosed when required
- The particular benefit being claimed not being held
- Insufficient evidence being available to assess the claim
That does not make a declined claim easy for the person involved.
Claims can be stressful, and policy wording that made little difference when the insurance was purchased can suddenly become very important.
If a claim is declined, the claimant should be given an explanation of the decision and can discuss the available next steps or complaints process.
Sometimes the Bigger Problem Is Not Knowing You Can Claim
One of Halo’s own client cases demonstrates this particularly well.
A client came to Halo wanting to review his existing insurance and discuss medical cover.
During the conversation, Halo learned that he had suffered a heart attack around two years earlier.
The client already held trauma insurance, income protection and waiver of premium cover, but he had not realised that the previous event could trigger benefits.
After reviewing his medical information and existing policies, Halo identified three potential claims.
The eventual payments totalled $56,489.90.
That case highlights a very different claims problem.
Sometimes people are not missing insurance.
They are missing benefits sitting inside insurance they already have.
Have you experienced a heart attack, cancer diagnosis, serious illness or extended period away from work since arranging your insurance? If you never checked your policy at the time, it may be worth asking whether a benefit could have applied.
Disclosure Still Matters
When applying for insurance, you will generally be asked questions relevant to the insurer’s assessment.
These may cover health, medical history, occupation, income, nicotine use and certain activities.
Answering application questions accurately gives the insurer the information it needs to make an underwriting decision.
Having a medical condition does not automatically mean someone cannot get insurance. The insurer may request more information or offer particular terms depending on the circumstances.
Claims Support Is Part of Advice Too
Buying insurance and claiming insurance are two very different experiences.
An adviser can help a client understand what information the insurer is asking for, identify which benefits may be relevant and communicate with the insurer during the process.
An adviser cannot guarantee a claim will be accepted.
What they can do is help the client navigate a process they may never have been through before.
Know What You Have Before You Need It
Pull out your current policy and ask yourself:
- What could I actually claim for?
- Are there exclusions on my policy?
- Which benefits are included?
- Does my partner know what cover we have?
- Do we know who to call?
- Have we had an illness or injury since arranging the cover that we never discussed with anyone?
Need Help With a Claim or Existing Policy?
Insurance claims are not hypothetical when you’re the family making one.
If you already have cover and have experienced a significant illness, injury or life event, Halo Advisers can help you understand the policy you hold and whether there may be a benefit worth investigating.
Halo can also provide support through an active insurance claim.