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

Medical Timing Decides Travel Insurance Claim Dispute

21 Jun 2026: Paige Estritori

A recent travel insurance dispute reported by Insurance News has put a spotlight on one of the most important parts of any cancellation claim: timing. The case involved a policyholder who argued that a doctor’s declaration that he could not travel overseas was the relevant claimable event, rather than the earlier appearance of illness. The policyholder was successful, reinforcing that the way a medical issue is documented can be just as important as the condition itself. - read more

Why the General Insurance Code Review Matters for Real Estate Agencies

21 Jun 2026: Paige Estritori

Australia’s general insurance sector appears to be moving closer to a major update to the General Insurance Code of Practice, with Financial Services Minister Daniel Mulino signalling that the long-running review should make visible progress soon. For real estate agencies, this is worth watching closely because the code influences how many insurers communicate, manage claims and resolve disputes. - read more

General Insurance Code Review Puts Service Standards in Focus

21 Jun 2026: Paige Estritori

Australia’s general insurance sector is edging closer to a significant reset of its customer service rulebook, with Financial Services Minister Daniel Mulino indicating he wants meaningful progress on the long-running review of the General Insurance Code of Practice. A draft of the revised code is expected to move towards consultation shortly, following a review process that began in November 2023 and produced more than 100 recommendations in late 2024. - read more

Victoria’s Strata Commission Debate Moves Into a New Phase

21 Jun 2026: Paige Estritori

Victoria’s strata reform agenda has taken another important turn, with consumer advocates continuing to push for a ban on insurance-related commissions paid to owners corporation managers after the state government chose to defer immediate action on the issue. - read more

Insurance Code Rewrite Could Lift Standards for Tradies

21 Jun 2026: Paige Estritori

Australian tradies could soon see an important shift in how general insurers are expected to communicate, manage claims and resolve disputes, with the industry’s General Insurance Code of Practice moving closer to a major rewrite. - read more

Click for more Insurance News