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

Victoria’s Apartment Defect Insurance Shift Raises the Bar for Builders

26 Jun 2026: Paige Estritori

Victoria is moving ahead with a decennial insurance framework for apartment building defects, adding another important signal that construction quality, documentation and insurability are becoming inseparable issues for builders, developers and project teams. - read more

New Draft Insurance Code Puts Motor Claim Delays in Focus

25 Jun 2026: Paige Estritori

Australia’s general insurance sector is facing a proposed step-up in accountability, with the Insurance Council of Australia opening consultation on a new draft General Insurance Code of Practice on 24 June 2026. For truck owners, small fleet operators and transport businesses, the most relevant shift is not just the wording of the code, but the possibility that parts of it could become contractually enforceable for the first time, subject to ASIC approval. - read more

Income Protection Demand Rises as Australians Revisit Personal Cover

24 Jun 2026: Paige Estritori

New market data points to a meaningful lift in Australians taking out individual income protection insurance, suggesting more households are reassessing how they would manage financially if illness or injury interrupted their pay. - read more

Claims Delays Put Life Insurance Service Standards in Focus

24 Jun 2026: Paige Estritori

A recent sanction against an unnamed life insurer has put claims handling back under the spotlight, particularly for Australians who rely on personal insurance as a financial safety net. The Life Insurance Code Compliance Committee found that the insurer failed to request required information from claimants at the earliest available opportunity, contributing to significant delays for some customers waiting on claim decisions. - read more

Click for more Insurance News