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:
| Inattention and Speed: Key Factors in Major Truck Crashes 28 Jan 2026: 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 reveal that human factors, particularly inattention, distraction, and inappropriate speed, continue to be the leading contributors to these incidents. - read more |
| TAL's Health Sense Plus Now Covers Income Protection Policies 27 Jan 2026: Paige Estritori In a strategic move to enhance the value of its offerings, TAL has announced the expansion of its Health Sense Plus program to encompass income protection insurance. This initiative, effective from 8 August 2025, aims to incentivise proactive health management among policyholders by providing premium discounts. - read more |
| Rising Mental Health Claims Reshape Australia's Insurance Landscape 27 Jan 2026: Paige Estritori Australia's insurance sector is experiencing a significant shift as mental health conditions become the predominant cause of total and permanent disability (TPD) claims. Recent data from the Council of Australian Life Insurers (CALI) indicates that mental health issues now account for nearly one-third of all TPD claims, marking a substantial change in the industry's claim patterns. - read more |
| APRA Calls for Reforms in Income Protection Insurance Sector 27 Jan 2026: Paige Estritori The Australian Prudential Regulation Authority (APRA) has raised concerns about the sustainability of income protection insurance, following industry losses amounting to $2.5 billion over five years. APRA has urged life insurers to implement reforms to enhance the viability of these products and ensure they continue to meet policyholders' needs. - read more |
| Tailoring Income Protection for Medical Professionals Income protection insurance is a vital safety net for individuals across various professions, designed to provide financial stability if one is unable to work due to illness or injury. This type of insurance replaces a percentage of your income, alleviating the burden of regular expenses while you focus on recovery. For medical professionals who often have high earnings and extensive financial commitments, this coverage is particularly important. - read more
|
| The Role of Life Insurance in Your Overall Financial Strategy Financial planning plays a pivotal role in managing your economic resources effectively. By assessing your income, expenses, and goals, you can create a plan that helps achieve financial security. A comprehensive financial plan covers saving, investing, budgeting, and managing liabilities to secure your future. - read more
|
| Income Protection Insurance: Understanding Waiting Periods and Benefit Periods Income protection insurance is a financial product designed to support individuals in the event that they are unable to work due to illness or injury. This type of insurance provides a regular income, helping to replace a portion of lost earnings and meet daily living expenses. Virtually anyone earning an income, especially those with financial dependents or significant debts, should consider the peace of mind that income protection can offer. - read more
|
| How Pre-Existing Conditions Affect Your Income Protection Insurance Options Income protection insurance is a type of insurance policy designed to provide you with a continuous flow of income in case you are unable to work due to illness or injury. It's a safety net that helps ensure you can maintain your standard of living, even when unforeseen health issues arise. - read more
|
A professional who analyzes the financial costs of risk and uncertainty using mathematics, statistics, and financial theory.