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

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

Australian Government Enacts Stringent Reforms to Protect NDIS Integrity

02 May 2026: Paige Estritori

The Australian Government has enacted significant reforms to the National Disability Insurance Scheme (NDIS) to enhance its integrity and sustainability. These measures aim to protect the scheme from exploitation and ensure it continues to serve Australians with permanent and significant disabilities effectively. - read more

TAL Unveils Innovative TPD Support Option and Enhanced Income Protection for Self-Employed Australians

02 May 2026: Paige Estritori

Leading Australian life insurer TAL has announced significant enhancements to its flagship retail product, Accelerated Protection. These updates include the introduction of the Total and Permanent Disability (TPD) Support Option and strengthened income protection features tailored for self-employed individuals. - read more

Rising Claims Costs Challenge Australian Insurers Amid Natural Disasters

02 May 2026: Paige Estritori

Recent natural disasters have significantly impacted the Australian insurance industry, leading to a substantial increase in claims costs. According to KPMG's annual review, the general insurance sector reported a profit after tax of $5.2 billion for the calendar year 2025, a decrease from $6.2 billion in 2024. - read more

EML Group's Strategic Acquisition of Guild Insurance to Drive Growth and Innovation

02 May 2026: Paige Estritori

In a significant move within the Australian insurance industry, EML Group has acquired a 70% stake in Guild Insurance, forming a strategic partnership aimed at fostering growth and accelerating technological advancements. This collaboration combines Guild's extensive experience in general insurance and workers' compensation with EML's expertise in injury claims management and technology-driven solutions. - read more

Click for more Insurance News

Business Insurance Articles

How to Lower Public Liability Insurance Premiums Without Sacrificing Coverage

In the ever-evolving landscape of Australian commerce, business insurance stands as a crucial bulwark, safeguarding enterprises against unforeseen financial perils. Recognizing this, our in-depth exploration begins with an overview of the monumental role business insurance plays for Australian companies, both large and small. It's a cornerstone for risk management, providing business owners with peace of mind as they navigate the intricacies of their industries. - read more

The Cost of Public Liability Coverage: Is It Worth It?

Public liability insurance is a crucial safety net for both businesses and individuals, providing protection against the financial fallout from claims of injury or damage that your business operations might cause to third parties. This type of insurance is designed to cover legal and compensation costs, safeguarding you from unexpected financial burdens. - read more

The Importance of a Custom Risk Management Plan: A Guide for Australian Entrepreneurs

In the fast-paced world of entrepreneurship, the only constant is change, and with change comes the inherent realm of the unknown – risk. Australian entrepreneurs, much like their international counterparts, operate in dynamic environments where unpredictability is a staple. However, the unique economic, legal, and environmental aspects of Australia demand a more localized understanding of these risks. Acknowledging this unpredictability is the first step towards mitigating potential threats to one's business venture. - read more

The Essential Guide to Liability Insurance for Freelancers

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 Claim:
Notification to an insurance company requesting payment of an amount due under the terms of the 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 act solely as an introducer and refer enquiries to licensed third-party brokers, insurers, and lenders. We do not provide financial product advice or credit assistance. 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 independently verify the credentials and licensing of any adviser or provider you engage. Visit the ASIC website for further information.