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:
| Netstrata's Undisclosed Commissions and Conflicts of Interest Revealed 06 Dec 2025: Paige Estritori In February 2025, an independent review conducted by McGrathNicol uncovered significant issues within Netstrata, a prominent strata management company. The investigation revealed that Netstrata failed to disclose commissions and did not obtain multiple quotes for services, potentially breaching legal obligations. Additionally, the review identified undisclosed personal relationships between Netstrata employees and suppliers, raising serious concerns about conflicts of interest. - read more |
| NSW Fair Trading Revokes Strata Licences Due to Insurance Failures and Misconduct 06 Dec 2025: Paige Estritori In May 2025, NSW Fair Trading took decisive action against Result Strata Management Pty Ltd and its General Manager, Michael Lee, by permanently revoking their licences to operate in the state's strata management sector. This move followed an investigation that uncovered multiple breaches of the Property and Stock Agents Act 2002, highlighting significant misconduct within the company. - read more |
| CHU's 2025 Strata Market Report: Stability Amidst Climate and Regulatory Challenges 06 Dec 2025: Paige Estritori In November 2025, CHU, Australia's largest strata insurance underwriting agency, released its 2025 State of the Strata Market report, providing a comprehensive analysis of the current trends and challenges within the strata industry. The report offers valuable insights into premium trends, climate-related risks, regulatory developments, and emerging sector challenges. - read more |
| Rising Insurance Costs Amidst Climate Change: What Homeowners Need to Know 06 Dec 2025: Paige Estritori Australian homeowners are experiencing significant increases in home insurance premiums, largely due to the escalating risks associated with climate change. Recent analyses reveal a national average premium hike of 14%, translating to an additional $343 annually for policyholders. This trend underscores the growing financial burden on homeowners as extreme weather events become more frequent and severe. - read more |
| Avoiding Overinsurance: How to Choose Adequate Coverage Without Wasting Money Income protection insurance is a key component of financial planning that safeguards your earning potential in the untimely event of illness or injury. In Australia, it reassures individuals that their most valuable asset, the ability to earn, is shielded against unforeseen circumstances. Adequate income protection can provide peace of mind, with the security of a regular income even when you're unable to work. - read more
|
| Covering the Unexpected: A Guide to Trauma Insurance for Australian Families Trauma insurance, also known as critical illness insurance, is a type of coverage that provides a lump sum payment in the event that the insured suffers from a critical illness or injury. Unlike health insurance, which covers medical expenses, trauma insurance is designed to provide financial protection by helping to cover the additional costs associated with recovery from a severe illness or injury. - read more
|
| Making Sense of Income Protection Insurance: A Must-Read Comparison for Australians When life throws unexpected challenges our way, the assurance of financial stability can be a beacon of hope amidst the uncertainty. For many Australians, income protection insurance is that beacon, safeguarding their livelihood and providing a crucial safety net when they need it most. It's more than just a policy; it's a strategic step towards longer-term peace of mind. - read more
|
| Life Insurance for Young Adults: Why It’s Never Too Early to Get Covered Life insurance might not be at the forefront of your mind, especially when you're young and healthy. However, understanding the essence of life insurance early on can significantly impact your financial future and provide much-needed peace of mind. - read more
|
A very broad term for insurance covering liability exposures for individuals and business owners. It provides broad coverage, generally including all exposures for property damage and bodily injury.