Insurer Compensates Claimants in Wake of Transition Issues
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.
Recent research has unveiled a concerning trend: 14% of Australian travellers embark on international journeys without any form of travel insurance. This statistic is even more alarming among younger travellers under 30, with nearly one in four opting to travel uninsured. Such decisions expose individuals to significant financial risks, especially when unforeseen events occur abroad. - read more
Insurance Australia Group (IAG) has reported a significant 91% increase in net profit for the first half of the 2025 financial year, reaching $778 million. This surge is largely attributed to favourable weather conditions and a reduction in claims. Despite this positive financial performance, IAG's CEO, Nick Hawkins, has indicated that insurance premiums are expected to continue rising, albeit at a slower pace than in previous years. - read more
The Australian Prudential Regulation Authority (APRA) has released its latest bi-annual report on intermediated general insurance, providing insights into market activity for the six months ending June 2025. The data indicates a stable performance among general insurance intermediaries, with total premiums invoiced through intermediaries reaching $21.5 billion. Of this, $17.6 billion was placed with APRA-authorized general insurers, $2.6 billion with Lloyd’s underwriters, and $1.3 billion with unauthorized foreign insurers. - read more
CHU, Australia's leading strata insurance underwriting agency, has recently launched an upgraded residential strata insurance policy aimed at providing more comprehensive protection for property owners and strata communities. This initiative underscores CHU's commitment to evolving with the needs of its customers by simplifying insurance processes and enhancing community resilience. - read more
Welcome to the complex world of running a small business in Australia where navigating through liability risks is as crucial as managing daily operations. This article is crafted to illuminate why every Australian small business needs liability coverage — a shield to protect against potential financial catastrophes. - read more
As a small business owner, understanding the intricacies of liability insurance is pivotal to safeguarding the fruit of your hard work. Insurances such as professional indemnity and public liability are not just safety nets; they are vital components that can mean the difference between bouncing back and closing down following unforeseen legal hurdles. - read more
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
Public liability insurance is an essential part of any business's risk management strategy, especially for those operating in Australia. It's designed to protect businesses when they're found legally responsible for injury or damage to third parties due to their operations. But what happens when you need to make a claim? That's where understanding the claims process becomes vital. - read more
Start Here !
Knowledgebase
Coverage: The amount of risk or liability covered for an individual or entity by way of insurance services.
