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

TAL's Health Sense Plus Now Covers Income Protection Policies

04 Feb 2026: Paige Estritori

In a significant development for policyholders, TAL has expanded its Health Sense Plus program to encompass income protection (IP) policies. This initiative, effective from August 8, 2025, aims to incentivise proactive health management by offering premium discounts to clients who engage in preventative health checks. - read more

Surge in Mental Health Claims Puts Pressure on Australia's Insurance Industry

04 Feb 2026: Paige Estritori

Australia's insurance sector is facing unprecedented challenges as mental health conditions have become the leading cause of total and permanent disability (TPD) claims. Recent data from the Council of Australian Life Insurers (CALI) reveals that mental health issues now account for nearly one-third of all TPD claims paid out. - read more

Rest Super Faces Class Action Over Alleged Wrongful Deduction of Income Protection Premiums

04 Feb 2026: Paige Estritori

Shine Lawyers has initiated class action proceedings in the Federal Court against Rest Superannuation, alleging that the fund wrongfully deducted income protection premiums from members' accounts between December 2008 and June 2019. The lawsuit claims that up to 500,000 Rest members may have been affected by these deductions. - read more

Marine Skippers Insurance Expands to International Waters

04 Feb 2026: Paige Estritori

Marine Skippers Insurance has recently unveiled a new international coverage plan tailored for captains navigating vessels to and from Australia. This development is particularly timely, coinciding with preparations for the upcoming Sydney to Hobart yacht race. - read more

NM Insurance and Zurich Forge Long-Term Partnership

04 Feb 2026: Paige Estritori

NM Insurance has solidified its position in the marine insurance sector by entering into a five-year agreement with capacity provider Zurich. This strategic partnership is set to bolster NM Insurance's growth trajectory and instill greater confidence among brokers. - read more

Click for more Insurance News