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
| Call for Enhanced Support for Indigenous Insurance Customers 09 Dec 2025: Paige Estritori The Life Code Compliance Committee has identified significant gaps in support for Indigenous customers within the insurance sector, following an audit of three major insurers representing two-thirds of the market. The analysis reveals that these insurers lack adequate procedures for safe self-identification, a critical step towards ensuring cultural inclusivity and accessibility. - read more |
| Australian Insurtech Startups: Pioneering the Future of Insurance 09 Dec 2025: Paige Estritori The Australian insurtech sector is experiencing significant growth, with startups introducing innovative solutions that enhance efficiency, security, and customer engagement within the insurance industry. A recent report titled 'Insurtech Down Under: Trends, Tech and Triumphs' highlights the pivotal role these companies play in reshaping the market. - read more |
| Australian Insurers Address Surge in Mental Health Claims 09 Dec 2025: Paige Estritori The Australian insurance industry is facing unprecedented challenges due to a significant rise in mental health-related claims. The Council of Australian Life Insurers reports that mental health has become the leading cause of total and permanent disability claims, accounting for nearly one in three payouts. - read more |
| Calls for Overhaul in Australian Insurance Claims Handling Processes 09 Dec 2025: Paige Estritori Australian consumer advocacy groups are intensifying their calls for substantial reforms in the insurance industry's claims handling processes. The Australian Consumers Insurance Lobby (ACIL) has criticised the current system, highlighting ongoing issues that compromise consumer outcomes. - read more |
| Understanding Income Protection Insurance: A Comprehensive Guide for Australians Income protection insurance is an essential component of financial security for Australians, designed to provide a safety net by replacing a portion of your income if you're unable to work due to illness or injury. Despite its critical role in safeguarding livelihoods, it's often overlooked in personal financial planning. - read more
|
| The Role of Health Insurance in Supporting Preventive Care Preventive healthcare refers to measures taken to prevent diseases, rather than treating them after they occur. This includes actions like regular health screenings, vaccinations, and adopting healthy lifestyle practices. - read more
|
| Top Strategies for Long-Term Income Protection in Australia Income protection is a safeguard that ensures you have a steady stream of income if you're unable to work due to illness or injury. This type of insurance can be a lifesaver, providing peace of mind and financial stability during challenging times. - read more
|
| A Comprehensive Guide to Income Protection Insurance in Australia Income protection insurance is a type of insurance policy that provides financial support if you're unable to work due to illness or injury. It offers a replacement income, usually up to 75% of your normal wage, helping you maintain some level of income during tough times. - read more
|