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:
| Survey Highlights Alarming Number of Australians Travelling Uninsured 16 Feb 2026: Paige Estritori Recent research conducted by the Insurance Council of Australia (ICA) and the Department of Foreign Affairs and Trade (DFAT) has unveiled a concerning trend: approximately 14% of Australian travelers embark on international journeys without any form of travel insurance. This statistic has prompted industry leaders to urge Australians to reconsider the importance of securing adequate coverage before traveling abroad. - read more |
| IAG's Impressive FY25 Performance and Strategic Outlook for FY26 16 Feb 2026: Paige Estritori Insurance Australia Group (IAG) has reported a notable 4.3% increase in gross written premium (GWP), reaching $17.1 billion for the fiscal year 2025. This growth is accompanied by a net profit after tax of $1.36 billion, marking a significant rise from the previous year's $898 million. The company's reported insurance profit stands at $1.74 billion, with a margin of 17.5%, and a return on equity improving to 19.4%. Shareholders are set to benefit from a full-year dividend of 31. - read more |
| Potential Decrease in Australian Insurance Premiums Amid Global Market Downturn 16 Feb 2026: Paige Estritori Recent developments in the global financial markets have sparked discussions about potential benefits for Australian insurance policyholders. A significant sell-off in the insurance sector on Wall Street has led analysts to speculate that Australian insurance premiums could see a reduction in the near future. - read more |
| NSW Court Decision Escalates Liability Risks for Construction Industry 16 Feb 2026: Paige Estritori A recent landmark ruling in New South Wales has significantly altered the liability landscape for the construction industry. The court's decision removes the ability for developers and builders to rely on proportionate liability defences under the Design and Building Practitioners Act 2020 (DBP Act), thereby increasing their exposure to claims related to building defects. - read more |
| Comparing Income Protection Policies: What Australians Should Look For Income protection insurance serves as a financial safety net for countless Australians, offering a replacement income when unforeseen circumstances such as illness or injury impede their ability to earn. For the self-employed and entrepreneurs who may not have the safety nets offered by corporate employment, such protection is particularly important. - read more
|
| How Much Life Insurance Do I Need? There are many different reasons to purchase life insurance (generation skipping tax, estate plan, estate preservation, surviving spouse needs, planning for your children's future and more). There is no right amount of life insurance, but here are some guidelines that might help you decide how much life insurance you need. - read more
|
| The importance of Income Protection Insurance for Employees While some people might think that income protection insurance is only for self-employed individuals, this is not accurate. This type of insurance is just as beneficial for employees, because accidents and illnesses can happen to anyone at any time. Workers' compensation provides only limited coverage, and most employees don't have much more than a few weeks' sick leave accrued. Of course, if you have more than one job, the situation becomes more of a concern if you are injured at one workplace resulting in being unable to work at either. - read more
|
| How to Compare Life Insurance Policies in Australia Without Overpaying Life insurance stands as a pillar of financial stability in the lives of many Australians, providing peace of mind and security for families and individuals facing the uncertainty of the future. The importance of life insurance cannot be overstated; it offers a safety net that serves to protect your loved ones in the event of a tragedy, ensuring their financial well-being during difficult times. - read more
|
An insurance that pays a lump-sum amount on the diagnosis of one of several critical illnesses or events