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.

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

Please Note: We do not endorse any specific products or companies. Some content is sourced from third parties, including press releases, and may not be independently verified for accuracy or completeness.

Share this news item:

Insurance News

Clear

ACCC Halts IAG's Acquisition of RAC WA's Insurance Division

16 Jun 2026: Paige Estritori

The Australian Competition and Consumer Commission (ACCC) has intervened to prevent Insurance Australia Group (IAG) from acquiring the insurance operations of the Royal Automobile Club of Western Australia (RAC WA). The proposed $1.35 billion transaction raised significant competition concerns, prompting the ACCC to act in the interest of consumers and the broader insurance market. - read more

Broker Held Accountable for Denied Truck Damage Insurance Claim

16 Jun 2026: Paige Estritori

The Australian Financial Complaints Authority (AFCA) has determined that a broker breached its duty of care, resulting in the denial of a truck damage claim due to the driver's inexperience. This case underscores the critical importance of brokers thoroughly understanding and communicating policy exclusions to their clients. - read more

Daimler Truck and Geico Introduce Telematics-Based Insurance for Freightliner and Western Star

16 Jun 2026: Paige Estritori

Daimler Truck Financial Services and Geico Insurance have partnered to launch 'Connected Insurance,' a data-driven, telematics-based program designed to assist Freightliner and Western Star owner-operators and small fleets in reducing their commercial vehicle insurance costs while promoting safer driving practices. - read more

APRA's 2026 Insurance Summit: Tackling Climate Risks and Affordability

16 Jun 2026: Paige Estritori

The Australian Prudential Regulation Authority (APRA) is set to host the 2026 AFR Insurance Summit on June 16 at The Fullerton Hotel in Sydney. This pivotal event will bring together industry leaders to address pressing issues within Australia's insurance sector, with a particular emphasis on climate-related risks, insurance affordability, and maintaining public trust. - read more

Click for more Insurance News