Insurer Compensates Claimants in Wake of Transition Issues

3

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
Source: Paige Estritori

Please Note: If this information affects you, seek advice from a licensed professional.

Share this news item:

Insurance News

Clear

Beauty Therapist Successfully Challenges Insurer Over Flood Damage Claim

23 Nov 2025: Paige Estritori

In a significant ruling, a beauty therapist has achieved partial coverage for damages after contesting her insurer's application of a flood exclusion clause. This case underscores the complexities beauticians face when navigating insurance claims related to water damage. - read more

ASIC Intensifies Oversight on Insurance Pricing and Claims Handling

23 Nov 2025: Paige Estritori

The Australian Securities and Investments Commission (ASIC) has unveiled new enforcement priorities for the upcoming year, placing a spotlight on insurance pricing, claims handling, and complaints processes. This move aims to enhance consumer protection and ensure fair practices within the insurance industry. - read more

Melbourne Hairdresser Successfully Claims Business Interruption Due to Pandemic

23 Nov 2025: Paige Estritori

A Melbourne-based hairdressing salon has won a business interruption (BI) insurance dispute after demonstrating that a local COVID-19 outbreak led to a significant decline in revenue, even before government-imposed lockdowns. - read more

Revolutionising Crop Insurance: DAS Unveils Cutting-Edge Data Tool

22 Nov 2025: Paige Estritori

Digital Agriculture Services (DAS) has introduced an innovative crop insurance solution in Australia, leveraging machine learning, automapping, and geospatial data to improve policy accuracy. This tool is designed to assist insurers, underwriters, brokers, and loss adjusters by precisely locating insured paddocks and identifying crop types, yields, and other critical details. - read more

Significant Drop in Farm Liability Claims Reflects Improved Safety Measures

22 Nov 2025: Paige Estritori

WFI Insurance has reported a notable decrease in farm liability claims across most categories, including a 75% reduction in falls from height over the past year. This decline suggests that Australian farmers are adopting more effective safety practices, leading to fewer accidents and injuries. - read more

Click for more Insurance News