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.

On September 2, 2024, an insurer has been mandated to compensate over 900 policyholders due to its failure to adhere to claims processing time frames outlined in the Life Insurance Code of Practice.

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

Calls for Super Funds to Accelerate Mental Health Insurance Claims Processing

11 Jan 2026: Paige Estritori

Consumer advocates are raising concerns over significant delays in processing mental health-related insurance claims by Australian superannuation funds. As mental health conditions become a leading cause of total and permanent disability (TPD) claims, the efficiency of claim processing has come under scrutiny. - read more

GT Insurance Provides Flexible Solutions Amid Global Trade Shifts

11 Jan 2026: Paige Estritori

As global trade dynamics undergo significant shifts, GT Insurance is reaffirming its commitment to supporting marine clients navigating these challenges. The recent imposition of US tariffs-25% on Australian steel and aluminium, and 10% on other exported goods-has introduced new uncertainties for local exporters, particularly in sectors like beef and bulk freight. These tariffs, effective from April 5, 2025, have prompted concerns about declining export volumes and reduced freight margins. - read more

Northern Australian Marinas Struggle with Rising Insurance Costs

11 Jan 2026: Paige Estritori

Marina operators in Northern Australia are confronting a significant crisis as insurance premiums escalate dramatically, with some experiencing increases exceeding 300% over recent years. This surge in costs is placing immense financial strain on the industry, prompting urgent calls for government intervention. - read more

Significant Rise in Australian Home Insurance Premiums in 2025

11 Jan 2026: Paige Estritori

In 2025, Australian homeowners experienced a substantial increase in home and contents insurance premiums, with the average annual premium rising by 14%, equating to an additional $343. This surge has placed a significant financial burden on many households, prompting concerns about the affordability and accessibility of essential insurance coverage. - read more

Click for more Insurance News

Business Insurance Articles

Understanding Product Liability Insurance in Australia: A Business Owner's Guide

As a business owner in Australia, navigating the complexities of protecting your company is crucial, with product liability insurance being an essential aspect to consider. This type of insurance is designed to shield businesses from financial losses that may arise if a product they manufacture, supply, or sell causes harm to a consumer or damages property. - read more

The Impact of Environmental Liability on Australian Business Operations

In today's ever-evolving business landscape, the significance of environmental sustainability and legal accountability is increasingly paramount. Australian enterprises, in particular, are encountering a growing need to understand and manage environmental liability. This reality not only influences corporate image but also carries substantial financial and legal ramifications. - read more

Freelancer or Employee? Understanding the Difference and the Liability Implications

The contemporary business landscape in Australia is witnessing a significant shift towards the gig economy, with a growing number of professionals opting for the flexibility and autonomy that freelancing offers. This trend has not only revolutionized the way work is performed but has also introduced new dynamics in the legal distinctions between freelancers and traditional employees. - read more

The Top 5 Risks Small Businesses Face and How to Mitigate Them

Running a small business can be both rewarding and challenging. One of the key challenges is the variety of risks that can arise unexpectedly. These risks can range from financial uncertainties to operational hiccups, each potentially impacting your business's success. Understanding these risks and preparing for them is crucial for the longevity and sustainability of any small enterprise. - read more

Start Here !

Knowledgebase

Double Indemnity:
A clause or provision in a life insurance policy that doubles the payout in cases of accidental death.

This website is owned and operated by Clark Family Pty Ltd (ACN 010 281 008) as Trustee for the Clark Family Trust (ABN 35 957 893 714), 43 Larch Street Tallebudgera QLD 4228. Clark Family Pty Ltd is an Authorised Representative (AR 1298860) of Unique Group Broker Services Pty Ltd (AFSL 509434) for financial product referrals and an Authorised Credit Representative (ACR 401491) of Saccasan Pty Ltd (ACL 386297). Check our licensing details on the ASIC registers: Clark Family Pty Ltd ACR, Clark Family Pty Ltd AR, Saccasan Pty Ltd, Unique Group Broker Services.

IMPORTANT: We do not provide financial product advice or credit assistance. We act solely as an introducer and refer enquiries to licensed third-party intermediaries, insurers, and lenders - with whom you can then deal directly. We may receive a fee or commission from these third parties in consideration for the referral. Before any action is taken to obtain a product or service referred to by this website, advice should be obtained (from either the third party to whom we refer you or from another qualified intermediary) as to the appropriateness of obtaining those products having regard to your objectives, financial situation and needs. Whilst we have our own process for validating the legitimacy of our referral partners, you should always verify the credentials of your financial adviser before proceeding with recommendations that they may present. Visit the ASIC website for further information.