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 NSW Emergency Services Levy Reform Could Mean for Strata Communities

01 Aug 2026: Paige Estritori

New South Wales strata communities should keep a close watch on renewed efforts to reform the way emergency services are funded through insurance premiums. The long-running concern is that adding emergency services charges to insurance bills can make cover look more expensive, particularly for apartment buildings, mixed-use schemes and larger owners corporations already managing high rebuilding values and complex risk profiles. - read more

Insurance Complaints Put Claims Preparation Back in Focus

01 Aug 2026: Paige Estritori

The Australian Financial Complaints Authority’s latest reporting has again highlighted insurance as a major source of disputes, with claim delays, communication breakdowns and disagreements over policy outcomes remaining common pressure points. For domestic and home service businesses, the message is practical: the strength of a policy is often tested not when it is bought, but when a claim is made. - read more

What Storm Claims Teach Freelancers About Cover

01 Aug 2026: Paige Estritori

The insurance fallout from Ex-Tropical Cyclone Alfred is a timely reminder that severe weather is not just a household issue. For Australian freelancers, consultants and sole traders, a storm can interrupt work, damage essential equipment, delay client delivery and expose gaps in cover that only become obvious at claim time. - read more

Why Trainers Should Recheck Cover as Costs Rise

01 Aug 2026: Paige Estritori

Fresh industry commentary on business underinsurance is a timely reminder for personal trainers, fitness instructors and small studio owners to look beyond the headline price of a policy. While parts of the commercial insurance market have become more competitive, rising replacement costs and changing business models can still leave fitness operators exposed if their cover has not kept pace. - read more

Click for more Insurance News