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
Author: Paige Estritori
Sources

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

Share this news item:

Insurance News

Budget Direct Achieves Top Honors as Australia's Insurer of the Year

21 Mar 2026: Paige Estritori

Budget Direct has been honored with the inaugural 'Insurer of the Year' title at the 2026 Finder Provider of the Year Awards, solidifying its position as a leading choice for Australians seeking exceptional insurance coverage. This recognition is accompanied by four additional category wins, making Budget Direct the most awarded provider in this year's ceremony. - read more

Australian Insurers Advocate for Legislation Against Unfair Claims Practices

21 Mar 2026: Paige Estritori

The Insurance Council of Australia (ICA) has expressed strong support for the proposed Competition and Consumer Amendment (Unfair Trading Practices) Bill 2026, which aims to establish a general prohibition on unfair trading practices within Australian Consumer Law. This legislation is designed to empower regulators to take decisive action against predatory operators, particularly within the claims management sector. - read more

Significant Rise in Private Health Insurance Premiums Set for April 2026

21 Mar 2026: Paige Estritori

Australians are bracing for a substantial increase in private health insurance premiums, with an average rise of 4.41% scheduled to take effect from April 1, 2026. This marks the most significant hike since 2017 and is expected to place additional financial pressure on households already contending with the rising cost of living. - read more

Insurance Council Declares Significant Events for Northern Territory and Queensland Floods

21 Mar 2026: Paige Estritori

The Insurance Council of Australia (ICA) has declared Significant Events in response to the severe flooding that has recently impacted communities in the Northern Territory and Queensland. This declaration aims to expedite the insurance industry's response and provide necessary support to affected residents. - read more

Click for more Insurance News

Business Insurance Articles

The Role of Insurance in Protecting Your Small Business Assets

In the bustling world of small businesses, the phrase 'expect the unexpected' captures the essence of entrepreneurship. While you can plan for success, unforeseen risks are always lurking around the corner. That's where the importance of insurance comes into play. It acts as a safeguard, protecting the lifeblood of your business against potential perils. - read more

Public Liability Insurance Claims: What to Expect and How to Prepare

When it comes to navigating the complex waters of insurance, understanding public liability insurance claims is crucial for businesses and individuals alike. Public liability insurance serves as a safeguard, protecting against the financial repercussions that arise from accidents or injuries that occur on your premises or through your operations. In this introductory section, we will delve into the essence of public liability insurance and underline its significance. - read more

Liability Risks: What Small Businesses in Australia Should Know

Welcome to our comprehensive guide on liability risks for small businesses in Australia. The world of business is fraught with challenges, and one often overlooked aspect is the array of potential liabilities that can stifle growth or even lead to catastrophic financial loss. It's crucial for small business owners to grasp the critical role that insurance plays in the protection and longevity of their ventures. - read more

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

Start Here !

Knowledgebase

Insurance broker:
An agent acting on behalf of the insured (not the insurance company) who negotiates the terms and cover provided by the insurer in the insurance policy.

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.