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:
| Allianz Australia Penalised for Misleading Travel Insurance Information 24 Feb 2026: Paige Estritori In a significant ruling, the Supreme Court of New South Wales has imposed fines totaling $16.8 million on Allianz Australia Insurance and its subsidiary, AWP Australia, for disseminating misleading information about their travel insurance products between 2016 and 2018. This decision underscores the critical importance of transparency and accuracy in the insurance sector. - read more |
| Survey Highlights Alarming Number of Australians Travelling Uninsured 24 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 |
| Surge in Medical Claims Among Australian Travellers Highlights Importance of Comprehensive Insurance 24 Feb 2026: Paige Estritori In 2024, medical incidents emerged as the leading cause of travel insurance claims among Australian travelers, accounting for more than 40% of all claims handled by nib Travel. This trend underscores the critical importance of securing comprehensive travel insurance to mitigate the financial risks associated with medical emergencies abroad. - read more |
| Australian Homeowners Confront Steep Rise in Insurance Premiums 24 Feb 2026: Paige Estritori Over the past five years, Australian homeowners have experienced a significant 51% increase in home insurance premiums. This surge has placed a considerable financial burden on property owners nationwide, with Darwin residents facing the highest costs. - read more |
| Understanding the Role of Life Insurance in Financial Security Life insurance can seem complex at first, but understanding the basics can help demystify this important financial product. At its core, life insurance is a contract between you and an insurer, where the insurer promises to pay a designated beneficiary a sum of money upon your passing, in exchange for premium payments. - read more
|
| Disability Income Protection: What Every Hotel Operator Needs to Know Running a café is a rewarding yet challenging endeavor. With the hospitality industry being fast-paced and ever-changing, café owners often face unique financial challenges. Operating in an industry that is both physically demanding and unpredictable can sometimes lead to unforeseen circumstances that affect the stability and success of your business. - read more
|
| How Life Insurance Provides Financial Security for Your Loved Ones Life insurance is a crucial part of any comprehensive financial plan, providing peace of mind that your loved ones will be financially secure in the event of your passing. - read more
|
| What to Look for in Basic Health Insurance Cover Welcome to our discussion on basic health insurance cover, a topic that is crucial yet often overlooked in the hustle and bustle of everyday life. Navigating the world of health insurance can be daunting, but understanding your options is vital for peace of mind and financial stability. - read more
|
Notification to an insurance company requesting payment of an amount due under the terms of the policy.