Compare Life Insurance :: News
SHARE

Share this news item!

Insurer Compensates Claimants in Wake of Transition Issues

Insurer Compensates Claimants in Wake of Transition Issues

On September 2, 2024, an insurer has been mandated to compensate over 900 policyholders due to its failure to adhere to claims processing time frames outlined in the Life Insurance Code of Practice.

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:

Insurance News

APRA Halts Unjustified Premium Increases in Commercial Auto Insurance APRA Halts Unjustified Premium Increases in Commercial Auto Insurance
18 Apr 2026: Paige Estritori

The Australian Prudential Regulation Authority (APRA) has recently taken decisive action to address significant concerns within the commercial auto insurance sector. In response to widespread industry protests over substantial premium increases, APRA has introduced emergency regulations aimed at safeguarding transport operators from financial hardship. - read more
Deloitte Forecasts Transformative Trends in Australian Insurance for 2026 Deloitte Forecasts Transformative Trends in Australian Insurance for 2026
18 Apr 2026: Paige Estritori

As the Australian insurance industry navigates a rapidly evolving landscape, Deloitte's 2026 Insurance Predictions report highlights two pivotal trends poised to reshape the sector: the integration of artificial intelligence (AI) and the adoption of advanced climate risk modeling. - read more
TAL's Health Sense Plus Now Covers Income Protection Policies TAL's Health Sense Plus Now Covers Income Protection Policies
17 Apr 2026: Paige Estritori

In a significant development for policyholders, leading Australian life insurer TAL has announced the expansion of its Health Sense Plus program to encompass income protection (IP) policies. Effective from 8 August 2025, this initiative aims to incentivise proactive health management by offering premium discounts to clients who engage in preventative health checks. - read more
AFCA Directs Insurer to Reinstate Critical Illness Coverage After Miscommunication AFCA Directs Insurer to Reinstate Critical Illness Coverage After Miscommunication
17 Apr 2026: Paige Estritori

The Australian Financial Complaints Authority (AFCA) has recently ruled in favour of a policyholder who inadvertently cancelled his critical illness insurance due to unclear communication from his insurer, TAL Life. This decision underscores the critical importance of transparent communication between insurers and their clients, particularly regarding the implications of policy modifications. - read more


Life Insurance Articles

How to Prepare Financially for Unexpected Sickness How to Prepare Financially for Unexpected Sickness
Life is full of surprises, and unfortunately, not all of them are pleasant. Unexpected sickness can strike anyone at any time, and when it does, it can have a significant impact on your income. Whether it’s a sudden illness, a chronic condition, or an accident, the loss of income can add stress to an already difficult situation. - read more
How to Compare Income Protection Insurance for Self-Employed Australians How to Compare Income Protection Insurance for Self-Employed Australians
For self-employed Australians, the financial stability provided by consistent income is the backbone of both personal and business success. Unlike traditional employees, who might have access to sick leave or employer-sponsored disability benefits, self-employed individuals are solely responsible for their financial security in the event of illness or injury. This is where income protection insurance steps in as a crucial safeguard. - read more
How Pre-Existing Conditions Influence Life Insurance Premiums How Pre-Existing Conditions Influence Life Insurance Premiums
When it comes to life insurance, a pre-existing condition refers to any medical condition or illness that you have been diagnosed with before applying for a life insurance policy. - read more
Income Protection Insurance: A Lifeline for Self-Employed Aussies Income Protection Insurance: A Lifeline for Self-Employed Aussies
Income protection insurance is a vital financial safety net designed to support individuals who find themselves unable to work due to illness or injury. It provides a replacement income stream, cushioning the financial blow when life throws unexpected challenges your way. For self-employed Australians, who don't enjoy the same benefits as salaried employees—like sick leave or employer-funded superannuation—income protection becomes even more essential. - read more


Start Here !
life insurance
Apply now for your free Insurance assessment and price comparisons!

Start Here

Life Cover Amount:
Postcode:


All quotes are provided free and without obligation. We respect your privacy.
Knowledgebase
Occupational Hazard:
A risk associated with the nature of a particular occupation, which may affect insurance premiums.