Insurer Compensates Claimants in Wake of Transition Issues

3

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
Source: Paige Estritori

Please Note: If this information affects you, seek advice from a licensed professional.

Share this news item:

Insurance News

Clear

QBE Insurance's Premium Growth Deceleration Impacts Share Value

29 Nov 2025: Paige Estritori

QBE Insurance Group, a prominent player in the Australian insurance sector, has recently experienced a notable decline in its share value, reaching a seven-month low. This downturn is primarily attributed to a slowdown in the company's premium rate growth during the third quarter of the 2025 fiscal year. - read more

ACCC Scrutinises IAG's Bid to Acquire RAC Insurance

29 Nov 2025: Paige Estritori

The Australian Competition and Consumer Commission (ACCC) has recently voiced concerns regarding Insurance Australia Group's (IAG) proposed acquisition of the Royal Automobile Club of Western Australia's (RAC) insurance business. Valued at A$1.35 billion, this deal aims to expand IAG's footprint in Western Australia. However, the ACCC warns that such consolidation could diminish competition in the state's motor and home insurance markets, potentially leading to higher premiums and reduced service quality for consumers. - read more

QBE Insurance Faces Market Challenges as Premium Growth Slows

29 Nov 2025: Paige Estritori

QBE Insurance Group, Australia's largest insurer by market value, has recently experienced a significant downturn in its share price, reaching a seven-month low. This decline is primarily attributed to a slowdown in the company's premium rate growth during the third quarter of fiscal 2025. For tradespeople across Australia, this development could have notable implications, particularly concerning insurance premiums and coverage options. - read more

ASIC Highlights Concerns Over Self-Managed Super Fund Advice

29 Nov 2025: Paige Estritori

The Australian Securities and Investments Commission (ASIC) has recently raised significant concerns regarding the quality of financial advice provided to individuals about self-managed superannuation funds (SMSFs). This development is particularly relevant for tradespeople considering SMSFs as a means to manage their retirement savings. - read more

Regulators Call for Action as Australia Faces Retiree Wave

29 Nov 2025: Paige Estritori

Australia's financial regulators, the Australian Prudential Regulation Authority (APRA) and the Australian Securities and Investments Commission (ASIC), have issued a strong warning to the country's A$4.5 trillion superannuation industry. They emphasize the urgent need to prepare for an anticipated influx of approximately 2.5 million retirees over the next decade. This development holds significant implications for tradespeople, many of whom rely on superannuation funds for their retirement savings. - read more

Click for more Insurance News