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:
| AMA Advocates for Regulatory Reforms to Curb Health Insurers' Market Power 14 Feb 2026: Paige Estritori The Australian Medical Association (AMA) has recently highlighted concerns regarding the substantial market power wielded by private health insurers and its potential adverse effects on patient care and healthcare costs. In a position statement released on 4 February 2026, the AMA emphasised the need for regulatory reforms to prevent insurers from exploiting their dominant positions in the healthcare sector. - read more |
| Declining Value in Private Health Insurance: AMA Calls for Urgent Reforms 14 Feb 2026: Paige Estritori Recent findings from the Australian Medical Association (AMA) reveal a concerning trend in the private health insurance sector: Australians are facing higher premiums while experiencing diminishing returns on their policies. The AMA's latest Private Health Insurance Report Card, released on 5 December 2025, highlights the urgent need for reforms to address these issues. - read more |
| Private Health Insurers Under Fire for Premium Increases Despite Government Warnings 14 Feb 2026: Paige Estritori Private health insurers in Australia are facing mounting criticism for implementing significant premium increases, despite explicit warnings from the Health Minister. This development has sparked concerns about the affordability of healthcare and the practices employed by insurers to maximise profits. - read more |
| AIA Australia's Commitment to Mental Health: City2Surf Partnership 14 Feb 2026: Paige Estritori In August 2025, AIA Australia, a leading life, health, and wellbeing insurer, took a significant step in addressing the nation's mental health crisis by partnering with the City2Surf event in Sydney. This collaboration aimed to raise both funds and awareness for mental health, a pressing issue that has seen a notable increase in related insurance claims over recent years. - read more |
| The Importance of Disability Income Protection Programs for Cafe Owners Running a cafe is more than just a business; it’s a passion for many. However, for cafe owners, the risk of an injury or illness that could interrupt their ability to work is a genuine concern. Disability income protection is crucial as it provides financial security if you're unable to earn an income due to health issues. - read more
|
| 5 Key Factors to Consider When Shopping for Income Protection in Australia Welcome to our comprehensive guide on securing your financial future in Australia. In a world of uncertainties, income protection insurance plays a critical role in maintaining your financial security and peace of mind. - read more
|
| Protecting Your Legacy: Estate Planning and Life Insurance for Australians When thinking about the future, it's essential to have a comprehensive strategy that ensures the well-being of your loved ones and the security of your assets. Estate planning and life insurance are two critical pillars in safeguarding your family's financial stability. Despite the complexity often associated with these topics, understanding their importance and implementing them correctly can provide immense peace of mind. - read more
|
| Why Every Australian Needs Income Protection Insurance Income protection insurance is designed to provide financial support if you are unable to work due to illness or injury. It ensures that you continue to receive a portion of your income, allowing you to cover your living expenses and maintain your standard of living during difficult times. - read more
|
An insurance that provides cover for liability incurred in the course of exercising a profession.