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
Source: Paige Estritori

Please Note: If this information affects you, seek advice from a licensed professional.

Share this news item:

Insurance News

Comprehensive Indemnity Insurance Now Available for Private Midwives

28 Dec 2025: Paige Estritori

As of 1 July 2025, the Department of Health, Disability and Ageing has introduced a professional indemnity insurance (PII) product specifically designed for midwives providing intrapartum care. This development, under the Midwife Professional Indemnity Scheme (MPIS), ensures that private midwifery practitioners now have access to insurance coverage encompassing all facets of their practice, including intrapartum services. - read more

Australian Surgeons Confront Escalating Indemnity Insurance Costs

28 Dec 2025: Paige Estritori

In recent developments within the Australian healthcare sector, a significant number of bariatric surgeons are contemplating the future of their medical practices due to a substantial increase in indemnity insurance premiums and a rising incidence of legal claims. This trend poses potential challenges to the accessibility of obesity-related procedures for patients across the country. - read more

Health Insurance Premiums Expected to Surge by Over 10% in 2026

28 Dec 2025: Paige Estritori

Recent projections indicate that global health insurance costs are set to rise by 10.3% in 2026, marking a continuation of the upward trend observed in recent years. This follows a 10% increase in 2025 and a 9.5% rise in 2024, underscoring the sustained inflationary pressures faced by insurers and employer-sponsored health plans worldwide. - read more

Comprehensive Insurance Solutions for Fitness Professionals by Marsh

28 Dec 2025: Paige Estritori

Marsh, a leading insurance broker, offers tailored insurance solutions designed specifically for fitness professionals across Australia. Recognising the unique risks associated with the fitness industry, Marsh provides comprehensive coverage options to safeguard personal trainers, gym owners, and other fitness practitioners. - read more

Click for more Insurance News

Business Insurance Articles

Professional Indemnity vs Public Liability: What's the Best Choice for Your Small Business?

As a small business owner, understanding the intricacies of liability insurance is pivotal to safeguarding the fruit of your hard work. Insurances such as professional indemnity and public liability are not just safety nets; they are vital components that can mean the difference between bouncing back and closing down following unforeseen legal hurdles. - read more

The Importance of Documentation in Public Liability Claims

Public liability insurance is an essential part of any business's risk management strategy, especially for those operating in Australia. It's designed to protect businesses when they're found legally responsible for injury or damage to third parties due to their operations. But what happens when you need to make a claim? That's where understanding the claims process becomes vital. - read more

Public Liability Insurance Claims: What to Expect and How to Prepare

When it comes to navigating the complex waters of insurance, understanding public liability insurance claims is crucial for businesses and individuals alike. Public liability insurance serves as a safeguard, protecting against the financial repercussions that arise from accidents or injuries that occur on your premises or through your operations. In this introductory section, we will delve into the essence of public liability insurance and underline its significance. - read more

Critical Risk Management Strategies for Every Australian Tradesman

Welcome to the crucial world of risk management for Australian tradesmen. Whether you're a seasoned professional or just starting, understanding and mitigating the inherent risks in the trades industry is paramount to both the safety and sustainability of your business. This article intends to guide you through the world of risk management, emphasizing the pivotal role of liability insurance. - read more

Start Here !

Knowledgebase

Moral Hazard:
The concept that individuals may take on more risk when they do not bear the full consequences of that risk, often relevant in insurance scenarios.

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 do not provide financial product advice or credit assistance. We act solely as an introducer and refer enquiries to licensed third-party intermediaries, insurers, and lenders - with whom you can then deal directly. 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 always verify the credentials of your financial adviser before proceeding with recommendations that they may present. Visit the ASIC website for further information.