Insurer Compensates Claimants in Wake of Transition Issues
Insurer Compensates Claimants in Wake of Transition Issues
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
Share this news item:
| NSW Strata Commission Ban: A Catalyst for Industry Reform 07 Feb 2026: Paige Estritori The New South Wales (NSW) government's proposal to ban commissions on strata insurance has ignited a contentious debate between consumer advocacy groups and industry leaders. This reform aims to eliminate potential conflicts of interest and enhance transparency within the strata management sector. - read more |
| Queensland Strata Owners Advised to Leverage New Premium Reduction Programs 07 Feb 2026: Paige Estritori Strata property owners in North and Central Queensland are being encouraged to take advantage of newly introduced federal and state initiatives designed to reduce insurance premiums and enhance cyclone resilience. These programs offer financial incentives for property upgrades that can lead to significant savings on insurance costs. - read more |
| Australian Insurers Struggle to Keep Pace with Emerging Risks 07 Feb 2026: Paige Estritori Recent findings from the PwC Insurance Banana Skins Survey reveal that Australian insurers are trailing their global counterparts in risk preparedness. The survey, which gathered insights from 698 insurance executives across 42 territories, indicates that Australian insurers scored 6.6% lower on the Preparedness Index compared to the global average. This gap is particularly concerning as the industry faces escalating challenges from cyber threats and the rapid advancement of artificial intelligence (AI). - read more |
| Significant Increases in Australian Home Insurance Premiums 07 Feb 2026: Paige Estritori Australian homeowners are experiencing substantial increases in home insurance premiums, with the average premium rising by 16% over the past year. Consumer advocacy group Choice reports that some insurers, including Kogan, RAC, and Honey, have raised their rates by more than 30%. These hikes are attributed to various factors, including high supply chain inflation, increased claims costs, and higher reinsurance expenses due to severe weather events. - read more |
| Breaking Down the Barriers: Understanding Income Protection for Self-Employed Aussies Hello to all the self-employed Aussies out there! Embarking on the journey of self-employment brings with it a unique set of challenges and freedoms. One area we often overlook is the need for a solid financial safety net, customized to our varied incomes and work lifecycles. That's where income protection insurance steps in as a critical component for ensuring financial stability. - read more
|
| How Much Life Insurance Do You Really Need? A Family's Guide to Assessment Life insurance is one of those cornerstones of financial planning that often gets overlooked. Yet, the importance of life insurance in safeguarding your family's future cannot be overstated. It's a robust financial instrument that provides peace of mind, knowing that your loved ones will be financially secure in the event of your untimely passing. This introductory section lays the groundwork for understanding why life insurance is pivotal in your family's financial health. - read more
|
| Income Protection Insurance for Personal Trainers: What You Should Know Imagine waking up to find you're unable to work for an extended period due to an unexpected injury. For personal trainers, whose livelihood depends on their physical ability, this scenario can be both financially and emotionally daunting. - read more
|
| Top 5 Reasons to Consider Life Insurance While You're Young When you’re young, life is all about new experiences and making plans for a promising future. While factors like travel, career, and relationships often take centre stage, one aspect often overlooked is life insurance. It might seem like something to consider later in life, but starting a policy while you're young can be a savvy financial move. - read more
|
The ratio of claims paid by an insurer to the premiums earned, used as a measure of profitability.