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

Understanding the 4.41% Increase in Private Health Insurance Premiums

23 Apr 2026: Paige Estritori

Australians are set to experience a significant rise in private health insurance premiums, with an average increase of 4.41% scheduled for 1 April 2026. This marks the steepest hike since 2017, adding to the financial pressures faced by many households. - read more

Australia Faces AUD 4.8 Billion in Insured Losses Due to Extreme Weather in 2025

23 Apr 2026: Paige Estritori

In 2025, Australia experienced a dramatic escalation in insured losses due to extreme weather events, totaling AUD 4.8 billion-a staggering 727% increase compared to the previous year. This surge underscores the growing impact of climate change on the nation's economy and the insurance sector. - read more

Climate Change's Role in Rising Home Insurance Premiums: Insights from IAG

23 Apr 2026: Paige Estritori

Insurance Australia Group (IAG), one of the nation's leading insurers, has issued a warning that climate change is increasingly contributing to the rise in home insurance premiums across Australia. The insurer's recent report indicates that the escalating frequency and severity of weather events are placing upward pressure on insurance costs. - read more

Rising Claims Challenge Australia's Compensation Scheme of Last Resort

22 Apr 2026: Paige Estritori

Australia's Compensation Scheme of Last Resort (CSLR) is facing significant pressure due to a surge in claims linked to failed financial products. This uptick has led the Insurance Council of Australia (ICA) to call for structural reforms to ensure the scheme's sustainability. - read more

Escalating Professional Indemnity Claims in Australia's Financial Services Industry

22 Apr 2026: Paige Estritori

Australia's financial services sector is currently experiencing a notable increase in professional indemnity (PI) claims, driven by intensified regulatory scrutiny and recent legal actions. This trend has significant implications for professionals and insurers operating within the industry. - read more

Click for more Insurance News