Insurer Compensates Claimants in Wake of Transition Issues

The information on this website is general in nature and does not take into account your objectives, financial situation, or needs. Consider seeking personal advice from a licensed adviser before acting on any information.

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
Author: Paige Estritori

Please Note: We do not endorse any specific products or companies. Some content is sourced from third parties, including press releases, and may not be independently verified for accuracy or completeness.

Share this news item:

Insurance News

Clear

NSW Insurance Taxes Put Premium Affordability Back in Focus

03 Jul 2026: Paige Estritori

New South Wales insurance customers are again at the centre of a cost-of-cover debate, after the latest state budget papers showed insurance-related taxes and levies are expected to raise more than $3 billion a year across the forward estimates. - read more

What PSC’s Transport Broker Investment Means for Truck Operators

02 Jul 2026: Paige Estritori

PSC Insurance Brokers’ investment in MA Insurance Brokers is a timely reminder that transport insurance in Australia is becoming more specialised, more relationship-driven and more closely tied to claims performance. The deal, announced on 25 June 2026, sees MA begin operating as PSC Transport Insurance Brokers, with founders Barry Mathison and Mariann Illyes remaining involved as managing principals. - read more

Cancer Claim Decision Shows Why Policy Wording Matters

01 Jul 2026: Paige Estritori

A new Australian Financial Complaints Authority decision has underlined a point that is easy to overlook when buying personal insurance: a serious diagnosis does not always mean a policy benefit will be payable. The ruling, reported on 29 June 2026, involved a claimant who sought benefits after being diagnosed with high-grade urothelial carcinoma of the bladder. Although the illness was serious and required treatment, AFCA found the insurer was entitled to rely on the specific wording of the policy. - read more

What Renewal Price Transparency Means for Boat Owners

01 Jul 2026: Paige Estritori

A new review by the General Insurance Code Governance Committee has put renewal pricing transparency back under the spotlight, with findings that matter well beyond home and motor policies. For Australian boat owners, the message is simple: when your policy renewal arrives, the payment frequency can be just as important as the headline premium. - read more

Click for more Insurance News