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

19 Jan 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

New Legislation Prohibits Life Insurers from Using Genetic Test Results

19 Jan 2026: Paige Estritori

The Australian government has enacted legislation prohibiting life insurers from using the results of genetic tests to refuse coverage or increase premiums. This landmark decision aims to eliminate genetic discrimination and encourage individuals to undergo potentially life-saving genetic testing without fear of financial repercussions. - read more

Markel Insurance Expands into Australian Marine Market with New Leadership

19 Jan 2026: Paige Estritori

Markel Insurance has announced the appointment of Tim Wills as Head of Marine for Australia, marking a significant expansion into the country's marine insurance sector. Based in Sydney, Wills will spearhead the introduction of Markel's marine products, starting with marine cargo insurance. - read more

Pelagic Risk Services Strengthens Marina Support with Gold Sponsorship

19 Jan 2026: Paige Estritori

Pelagic Risk Services, a specialist marine insurance broker, has elevated its commitment to the marina industry by upgrading from Silver to Gold Sponsorship with the Marina Industries Association (MIA). This move underscores Pelagic's dedication to supporting marinas across Australia through enhanced financial contributions and the provision of exclusive risk management resources. - read more

Marinex Underwriting Enters Australian Market with Specialised Marine Insurance Solutions

19 Jan 2026: Paige Estritori

Rhodian Group has announced the launch of Marinex Underwriting, a new agency dedicated to providing specialised marine insurance products tailored to the Australian market. This initiative marks Rhodian's third agency launch, following the establishment of Halo Underwriting and Batch Underwriting in previous years. - read more

Click for more Insurance News