Insurer Compensates Claimants in Wake of Transition Issues
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.
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 data from the Council of Australian Life Insurers (CALI) reveals a significant shift in the landscape of income protection insurance in Australia. Mental health conditions have emerged as the leading cause of total and permanent disability (TPD) claims, accounting for nearly one-third of all claims paid. In 2024 alone, insurers disbursed over $2.2 billion for retail mental health claims, a figure that has almost doubled compared to five years prior. - read more
Recent research from Rainmaker Information indicates a notable decrease in income protection insurance premiums across Australia. Direct income protection premiums have fallen by 12% for policies with a 30-day waiting period and 13% for those with a 90-day waiting period since 2024. Similarly, premiums for life products sold through advisers have decreased by 5%, with income protection premiums dropping by 7% for 30-day waiting periods and 5% for 90-day periods. - read more
New research from the Association of Superannuation Funds of Australia (ASFA) reveals that superannuation insurance now provides critical protection to over 6 million Australians who would otherwise be uninsured. This expansion has been achieved without impacting household spending, as the coverage is included within superannuation contributions. - read more
In a significant move within the Australian beauty industry, Adore Beauty has announced the acquisition of wellness and skincare brand Ikou for $25 million. This strategic decision aims to bolster Adore Beauty's private label offerings and marks its entry into the physical retail space. - read more
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 is a key consideration for business owners in Australia. This type of insurance helps protect businesses against claims made by third parties for injuries or property damage. But what exactly does it do? In simple terms, public liability insurance covers legal costs and expenses, as well as any damages awarded, if your business is found liable for an incident. - 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
Liability insurance is a type of coverage designed to protect you from claims arising out of injuries or damages to other people or property. For freelancers, who often juggle multiple projects and clients, liability insurance can offer a safety net that reduces financial risk and instability. - read more
Start Here !
Knowledgebase
Insurance Policy Excess: The amount you will have to contribute when you make a claim.
