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:
| Autonomous Cars: Navigating the New Claims Terrain 10 Sep 2024: Paige Estritori The rapid evolution of automobile technology, particularly in autonomous vehicles, is poised to reshape the insurance landscape significantly, according to insights from Howden Re. Reinsurers need to anticipate a more complex claims environment that requires advanced strategies to effectively manage the potential complexities. - read more |
| Coalition Innovates with Advanced Cyber Reinsurance Services 10 Sep 2024: Paige Estritori Cyber security leader Coalition has unveiled an innovative reinsurance intermediary, enhancing its offerings with sophisticated insights and capabilities in the cyber domain. - read more |
| Home Parking Dilemma Leads to Insurance Dispute Loss 09 Sep 2024: Paige Estritori A homeowner's struggle with her narrow driveway has culminated in the rejection of her car theft claim, illustrating the critical importance of adhering to insurance policy stipulations. - read more |
| Insurance Claim Rejected After Flight Crew Timing Violation 09 Sep 2024: Paige Estritori A traveler who faced a canceled flight due to the flight crew reaching their legal working hour limits will only receive partial reimbursement for his expenses. This ruling came from an official complaints authority. - read more |
| Income Insurance Calculators: A User-Friendly Tool for Adequate Coverage Income insurance, also known as income protection insurance, is a type of policy designed to provide support in the event that you are unable to work due to illness or injury. In today's uncertain economic climate, securing your income is more critical than ever. It acts as a financial safety net, ensuring that you can continue to meet your living expenses without depleting your savings or facing severe financial hardship. - read more
|
| From Illness to Injury: Understanding the Scope of Income Protection Insurance In the uncertain times we face today, where both health and economic climates are unpredictable, safeguarding your financial stability becomes paramount. This is where income protection insurance steps in as an essential safety net. For many Australian families, it's the buffer that ensures life's financial commitments are met, even when ability to work is compromised. - read more
|
| How to Compare Income Protection Policies When You Have a Medical History In today's ever-changing world, financial security is a cornerstone of peace of mind, particularly for Australians grappling with medical histories. Income protection insurance emerges as a pivotal solution, safeguarding not only the individual’s fiscal health but the well-being of their dependents. This introduction explores the nuances of income protection insurance and its particular significance for those with pre-existing medical conditions. - read more
|
| Making Sense of Income Protection Insurance: A Must-Read Comparison for Australians When life throws unexpected challenges our way, the assurance of financial stability can be a beacon of hope amidst the uncertainty. For many Australians, income protection insurance is that beacon, safeguarding their livelihood and providing a crucial safety net when they need it most. It's more than just a policy; it's a strategic step towards longer-term peace of mind. - read more
|
A type of life insurance policy that provides coverage for a specified period, such as 10 or 20 years.