Insurer Compensates Claimants in Wake of Transition Issues

The information on this website is general in nature and does not take into account your objectives, financial situation, or needs. Consider seeking personal advice from a licensed adviser before acting on any information.

The Life Code Compliance Committee reported that the insurer failed to meet the necessary timelines for handling claims, resulting in 3580 breaches between November 2022 and August last year. This failure predominantly affected policyholders with income protection and total permanent disability coverage from a superannuation fund.

The issue arose following the insurer and the fund's decision to transfer claims processing responsibilities from a third-party service provider back to the insurer. The transition period saw numerous staffing issues at the third-party organization, which critically hampered its ability to meet the code's stipulated time frames for claims processing, the committee's investigation revealed.

The committee's findings indicated that the insurer violated several provisions of the claims handling process defined in the code. Specifically, the insurer failed to:

• Inform customers about the claims process within 10 business days;
• Provide updates on the progress of claims every 20 working days;
• Notify customers in advance when their income protection claim payments were nearing their end.

"Insurers must ensure their change management plans allocate adequate resources to meet service standards and prescribed time frames," the determination stated. "Utilizing effective risk mitigation strategies is crucial in countering potential issues, thereby protecting against disruptions and safeguarding customer interests during transitions."

Post-transition, the insurer took over claims management on July 1 of the previous year and initiated several steps to bolster compliance with the code. The company formed new teams and conducted training focusing on code requirements and system utilization.

"The insurer has augmented its oversight of claims processing by increasing case conferencing, setting up weekly performance tracking, and holding monthly governance meetings," the determination noted. "These improvements led to noticeable increases in compliance rates regarding time frame obligations, which became more stable starting in December."

These measures indicate significant shifts in how the insurer manages and processes claims, fostering better service standards and accountability.

Published:Wednesday, 4th Sep 2024
Author: Paige Estritori

Please Note: We do not endorse any specific products or companies. Some content is sourced from third parties, including press releases, and may not be independently verified for accuracy or completeness.

Share this news item:

Insurance News

Clear

Cyclone Pool Delivers Some Relief for High-Risk Strata Schemes

05 Jul 2026: Paige Estritori

The ACCC’s fifth and final insurance monitoring report has given strata committees in cyclone-exposed regions a clearer view of what the Cyclone Reinsurance Pool is-and is not-achieving. Released on 25 June 2026, the report found that the pool has helped reduce or moderate premiums for policyholders in higher cyclone-risk areas, including residential strata schemes. - read more

Renewal Notice Gaps Put Insurance Costs Back in Focus for Tradies

05 Jul 2026: Paige Estritori

Australian tradies know the pressure of keeping cover in place while juggling wages, materials, fuel, tax, vehicle costs and unpredictable cash flow. A new review by the General Insurance Code Governance Committee is a timely reminder that the way an insurance renewal is presented can make a real difference to what a small business owner understands, compares and ultimately pays. - read more

Mercer Super Fine Shows Why Life Cover Needs Regular Checks

05 Jul 2026: Paige Estritori

A new Federal Court penalty against Mercer Super has put another spotlight on the systems that sit behind insurance held through superannuation. Mercer Super has been ordered to pay $10.3 million after failures to report internal investigations into significant member service issues to ASIC, including one matter involving insurance premiums that continued to be charged after members had died. - read more

H5 Bird Flu Detections: What Farm Operators Should Review Now

05 Jul 2026: Paige Estritori

Australia’s H5 bird flu situation has moved quickly, with authorities responding to new detections in migratory seabirds, including a confirmed case in New South Wales and further concerns in Western Australia. Importantly for producers, officials have continued to stress that there is currently no evidence of infection in poultry or the wider agricultural production system, and the public health risk remains low. - read more

BHSI Launch Highlights SME Management Risk Needs

05 Jul 2026: Paige Estritori

Australian small and medium-sized businesses have another management liability option to consider, after BizCover expanded its partnership with Berkshire Hathaway Specialty Insurance Company on 1 July 2026. The new product has been added to BizCover’s online platform and is aimed at organisations with annual turnover up to $25 million and up to 200 staff, with cover limits available up to $5 million. - read more

Click for more Insurance News