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:
| Strata Communities Endorse Call for Enhanced Resilience Reforms 15 Feb 2026: Paige Estritori Strata communities are at the forefront of Australia's resilience battle, facing escalating costs, declining coverage, and prolonged recovery periods following disasters. Strata Community Association Australasia (SCA) has expressed strong support for the Insurance Council of Australia's (ICA) recent call for coordinated, long-term resilience reforms to protect communities from these challenges. - read more |
| Artificial Intelligence Revolutionises Australian Insurance Sector 15 Feb 2026: Paige Estritori The Australian insurance industry is undergoing a significant transformation, with companies increasingly integrating artificial intelligence (AI) into their operations. This shift aims to enhance efficiency, improve customer service, and strengthen risk management practices in a rapidly evolving market. - read more |
| Australian Insurers Confront Financial Risks Amid Climate Change 15 Feb 2026: Paige Estritori Climate change is increasingly impacting the Australian insurance industry, presenting significant financial risks as the frequency and severity of natural disasters escalate. Insurers are grappling with the challenge of adapting to this new reality while maintaining financial stability and providing affordable coverage to consumers. - read more |
| Budget Direct Triumphs as 2026 Insurer of the Year 15 Feb 2026: Paige Estritori Budget Direct has been honoured with the inaugural 'Insurer of the Year' title at the 2026 Finder Provider of the Year Awards, marking a significant achievement in the Australian insurance sector. This accolade underscores the company's commitment to delivering exceptional value and service to its customers. - read more |
| Top Insurance Policies Every Working Adult Should Consider Insurance is an essential component of achieving financial stability. In life, unexpected events such as illnesses or accidents can pose serious financial challenges. Without adequate preparation, these can disrupt your finances significantly, making recovery even more complicated. This is where the crucial role of insurance becomes apparent. - read more
|
| A Millennial's Guide to Life Insurance For many millennials, navigating the complexities of personal finance and future planning can feel like a bewildering journey. Among these financial responsibilities, life insurance emerges as a paramount consideration. More than just a safety net, life insurance can be the cornerstone of a sound financial strategy, providing peace of mind for both the policyholder and their loved ones. - read more
|
| How to Ensure Your Travel Insurance Covers Your Next Adventure Sport Australians are known for their adventurous spirit, often seeking thrills through activities such as bungee jumping, surfing, and skiing. Adventure sports provide an adrenaline rush and an escape from the everyday routine, making them highly appealing to those who crave excitement and challenge. - read more
|
| Income Protection vs. Life Insurance: Why You Need Both Insurance plays a crucial role in safeguarding our financial future. It serves as a safety net, ensuring that we can manage unexpected events without severely impacting our financial stability. For Australian adults, having the right types of insurance coverage is essential for peace of mind and financial security. - read more
|
An insurance that provides cover for liability incurred in the course of exercising a profession.