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:

Rate this article

0 Comments

No comments yet. Be the first to share your thoughts.

Insurance News

What easing liability pricing momentum means for Australian businesses

10 Nov 2026: Paige Estritori

Australia’s liability insurance market appears to be moving into a more competitive phase, after several years in which many businesses faced firmer premiums and tighter underwriting. Recent analysis of the Australian Prudential Regulation Authority’s National Claims and Policies Database suggests pricing momentum is moderating in parts of the professional indemnity and public and product liability market, but the shift is not uniform and should not be read as a guaranteed premium fall for every business. - read more

Click for more Insurance News

Business Insurance Articles

Understanding Liability Insurance for Australian Small Business Owners

Liability insurance helps Australian small businesses manage the financial impact of legal claims involving injury, property damage, negligent services or products connected with business activities. Understanding the main types of cover, policy limits, exclusions and claims processes can help business owners make more informed risk management decisions. - read more

Product Liability Insurance in Australia: A Practical Guide for Business Owners

Product liability insurance can help protect Australian businesses from the financial impact of claims alleging that a product they manufactured, imported, distributed or sold caused injury, illness or property damage. This guide explains how the cover works, what to check in a policy and how it fits into broader product risk management. - read more

Public Liability Insurance Cost: Is It Worth It for Australian Businesses?

Public liability insurance is designed to help protect a business from the financial impact of third-party injury or property damage claims connected with its business activities. The cost varies by industry, risk profile and cover needs, so the value of a policy depends on how exposed your business is to the public, clients, contractors and property risks. - read more

Public Liability Insurance in Australia: What It Covers and How It Works

Public liability insurance can help Australian businesses manage the financial impact of third-party injury or property damage claims connected with their business activities. This guide explains what it may cover, what it usually excludes and how it works in practice. - read more

Start Here !

Knowledgebase

Premium:
The amount paid for an insurance policy, usually on a regular basis, to maintain coverage.

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). Check our licensing details on the ASIC registers: Clark Family Pty Ltd ACR, Clark Family Pty Ltd AR, 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.