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:
"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
| Human Factors Identified as Leading Causes in Major Truck Accidents 14 Mar 2026: Paige Estritori Recent findings from the National Truck Accident Research Centre's (NTARC) 2025 Major Incident Investigation Report have brought to light the significant role human error plays in major truck accidents across Australia. The report, supported by National Transport Insurance (NTI), indicates that human factors such as inattention, distraction, and inappropriate speed are the predominant causes of these incidents. - read more |
| AFCA Sides with Freight Company in Dangerous Goods Disclosure Dispute 14 Mar 2026: Paige Estritori The Australian Financial Complaints Authority (AFCA) has recently ruled in favour of a freight company in a dispute over the disclosure of transporting dangerous goods. This decision provides valuable insights into the obligations of transport companies regarding insurance disclosures. - read more |
| Navigating Rising Premiums: Challenges for Australian Insurers in 2026 14 Mar 2026: Paige Estritori In 2026, Australian insurers are confronting a trio of significant challenges: escalating premium costs, persistent cyber threats, and a tightening labour market. These issues are reshaping the industry's priorities and strategies. - read more |
| The Future of Insurance: Australia's Insurtech Market Set for Explosive Growth 14 Mar 2026: Paige Estritori Australia's insurtech sector is on the brink of a significant transformation, with projections indicating a surge from $377 million in 2025 to an impressive $4.2 billion by 2034. This anticipated growth, at a compound annual growth rate (CAGR) of 30.68%, reflects the increasing integration of digital technologies within the insurance industry. - read more |
| Decoding the Fine Print: What to Look out for in Your Income Protection Policy Income protection insurance serves as a vital safety net for Australian workers, ensuring financial stability in the face of unexpected illness or injury. As the landscape of work and health continues to evolve, understanding the essentials of income protection becomes increasingly crucial for anyone who relies on a steady income to support themselves and their loved ones. - read more
|
| The Impact of Parenthood on Your Life Insurance Choices Life insurance, a contract between an insurer and a policyholder, is designed to provide financial protection to loved ones in the event of the policyholder's death. For parents, this protection takes on a new level of significance. The birth of a child heralds a profound shift in priorities, with a focus on safeguarding the future of one's family. Hence, understanding life insurance options becomes a crucial aspect of responsible parenting. - 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
|
| Avoiding Overinsurance: How to Choose Adequate Coverage Without Wasting Money Income protection insurance is a key component of financial planning that safeguards your earning potential in the untimely event of illness or injury. In Australia, it reassures individuals that their most valuable asset, the ability to earn, is shielded against unforeseen circumstances. Adequate income protection can provide peace of mind, with the security of a regular income even when you're unable to work. - read more
|