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:
| Heightened Road Risks as Holiday Travel Meets Freight Surge 23 Dec 2025: Paige Estritori As the Australian summer holidays approach, a significant increase in road traffic is anticipated, coinciding with peak freight activity. This convergence raises concerns about heightened road risks, prompting insurers and transport specialists to issue warnings to motorists. - read more |
| Addressing the Surge in Collision Risks Among Australian Fleet Operators 23 Dec 2025: Paige Estritori Australia's transport and haulage sector is currently navigating a period marked by an uptick in motor collision claims, posing significant challenges for fleet operators nationwide. This trend underscores the necessity for enhanced risk management and insurance strategies to safeguard operations and maintain profitability. - read more |
| Inattention and Speed: Primary Factors in Australian Truck Crashes 23 Dec 2025: Paige Estritori The National Truck Accident Research Centre (NTARC) has released its latest Major Incident Investigation Report, shedding light on the predominant causes of significant truck crashes across Australia. The findings underscore the critical need for targeted interventions to enhance road safety within the transport industry. - read more |
| Australian Insurers Urged to Strengthen Cyber Risk Defenses 23 Dec 2025: Paige Estritori Recent findings from the PwC Insurance Banana Skins Survey indicate that Australian insurers are trailing behind their global counterparts in preparedness for cyber threats. The survey, which gathered insights from 698 insurance executives across 42 territories, revealed that Australian insurers scored 6.6% lower on the Preparedness Index compared to the global average. - read more |
| A Guide to Choosing Income Protection Insurance for Tradespeople Income protection insurance is a vital safety net for those who earn their livelihood through skilled trades. It is designed to replace a portion of your income if you're unable to work due to illness or injury, ensuring that you can meet your financial obligations while you recover. This type of insurance provides peace of mind, knowing that even if the unexpected happens, your bills can still be paid and your lifestyle maintained. - read more
|
| How Much Life Insurance Do You Truly Need? Assessing Your Personal Coverage There's often confusion surrounding the amount of life insurance one truly needs. Common misconceptions cloud our judgment, leading some to undervalue their coverage, while others may overinsure, unnecessarily straining their financial resources. It is a delicate balance to strike, and understanding the nuances of life insurance is pivotal to making informed decisions. - read more
|
| Tackling Unexpected Illness: How Income Insurance Can Help Maintain Your Standard of Living Illness limps in unannounced, derailing both physical health and financial stability without warning. When you're sideswiped by unexpected medical conditions, the uncertainty can compound, leading to a precarious balance of meeting health needs and financial commitments. Many are left pondering how to maintain their lifestyle amidst this turmoil. - 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 specific type of property insurance that covers losses and damage caused by flooding.