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:
| AFCA Upholds Policyholder's Income Protection Benefits Against Zurich 12 Feb 2026: Paige Estritori The Australian Financial Complaints Authority (AFCA) has recently ruled against Zurich Insurance, instructing the insurer to maintain the current income protection benefits for a policyholder after an 11-year delay in proposing a reduction. This decision underscores the critical importance of timely and transparent communication between insurers and their clients. - read more |
| Neos Recognized as Leading Income Protection Insurer in 2025 12 Feb 2026: Paige Estritori In the 2025 Life Insurance Awards presented by Money Magazine, Neos has been honored as the top provider in the Income Protection Insurance category. This accolade reflects Neos's commitment to delivering comprehensive and reliable income protection solutions to Australians. - read more |
| Northern Australian Marinas Struggle with Rising Insurance Costs 12 Feb 2026: Paige Estritori Marina operators in Northern Australia are confronting a significant crisis as insurance premiums escalate dramatically, with some experiencing increases exceeding 300% over recent years. This surge in costs is placing immense financial strain on the industry, prompting urgent calls for government intervention. - read more |
| GT Insurance Provides Flexible Solutions Amid Global Trade Shifts 12 Feb 2026: Paige Estritori As global trade dynamics undergo significant shifts, GT Insurance is reaffirming its commitment to supporting marine clients navigating these challenges. The recent imposition of US tariffs—25% on Australian steel and aluminium, and 10% on other exported goods—has introduced new uncertainties for local exporters, particularly in sectors like beef and bulk freight. These tariffs, effective from April 5, 2025, have prompted concerns about declining export volumes and reduced freight margins. - read more |
| Why Income Protection Insurance is Essential for Self-Employed Australians Income protection insurance is a type of coverage designed to provide you with a steady income if you are unable to work due to illness or injury. Unlike other types of insurance, which may focus on lump-sum payments, income protection insurance prioritises regular income replacement to help cover your everyday expenses. - read more
|
| Finding Accidental Coverage When Comprehensive Income Protection Isn't an Option Income protection is an integral part of maintaining your financial security, especially in the event that unforeseen illnesses or injuries prevent you from working. Enabling you to receive a percentage of your regular income, this type of insurance provides a safety net, ensuring that you can continue to cover your living expenses and financial obligations whilst recovering. - read more
|
| How to Determine the Right Income Protection Coverage for Your Needs Income protection insurance is a type of coverage designed to replace a portion of your income if you're unable to work due to illness or injury. - read more
|
| Understanding Life Insurance: Coverage Types to Protect Your Loved Ones The importance of life insurance in financial planning: Life insurance isn’t just a policy; it’s a cornerstone of comprehensive financial planning. By protecting your family’s financial future, life insurance offers peace of mind, knowing that your loved ones will be taken care of in the event of your untimely passing. It’s not solely about leaving behind a legacy, but also ensuring that your family can maintain their standard of living, pay off debts, and cover end-of-life expenses without financial burden. - read more
|
A clause or provision in a life insurance policy that doubles the payout in cases of accidental death.