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

What a Major Quad Bike Fine Means for Farm Risk

03 Jul 2026: Paige Estritori

A recent quad bike fatality case in New South Wales has put farm safety, workplace liability and risk management back under close attention. ABC Rural reported on 2 July 2026 that Wumbulgal Agriculture Pty Ltd was fined $555,000 after an 82-year-old worker died in a quad bike accident at Yenda in the Riverina in February 2023. The company was found to have breached work health and safety obligations. - read more

What DVA’s 2027 Allied Health Changes Mean for Provider Risk

03 Jul 2026: Paige Estritori

The Department of Veterans’ Affairs has confirmed a significant change to the way allied health care for eligible veterans will be funded from 1 July 2027. The reform combines higher provider fees with the removal of the current treatment cycle and the introduction of a $5,000 annual allied health expenditure threshold for review of clinical effectiveness. - read more

Draft Insurance Code Puts Claims Standards Back in Focus

03 Jul 2026: Paige Estritori

The Insurance Council of Australia has opened public consultation on a redrafted General Insurance Code of Practice, with feedback invited from 24 June 2026 until 21 July 2026. For fitness professionals, this is more than an insurance-sector process. It is a timely reminder that the value of a policy is tested not only by the premium, but by what happens when a claim, complaint or vulnerable customer situation arises. - read more

APRA’s Cyber Data Shift: What Consultants Should Watch

03 Jul 2026: Paige Estritori

APRA’s latest move on insurance data may sound technical, but it has practical implications for Australian consultants reviewing their risk programmes. The regulator has confirmed it will separately publish cyber insurance and management liability data within the National Claims and Policies Database, rather than leaving those lines blended into broader liability categories. - read more

Click for more Insurance News