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

Share this news item:

Insurance News

Clear

AUSactive's New Insurance Offering: Enhanced Protection at Lower Costs

26 Mar 2026: Paige Estritori

AUSactive, Australia's leading body for the exercise and active health sector, has unveiled a new insurance solution designed specifically for fitness and active health professionals. This initiative aims to provide enhanced protection while offering lower premiums compared to existing market options. - read more

Private Health Insurers Advocate for Reforms Amid Rising Specialist Fees

26 Mar 2026: Paige Estritori

Private health insurers in Australia are raising concerns over the increasing fees charged by medical specialists, which are leading to higher out-of-pocket expenses for patients and causing some to delay or cancel necessary care. A recent report by Private Healthcare Australia highlights that more than half of the surveyed patients received medical bills larger than expected, with specialist fees for in-hospital care rising by 22% over the past three years. - read more

AMA Calls for Urgent Reforms in Private Health Insurance Sector

26 Mar 2026: Paige Estritori

The Australian Medical Association (AMA) has released its annual Private Health Insurance Report Card, revealing that Australians are paying more for private health insurance while receiving less value. The report indicates that premiums have risen sharply, outpacing inflation and wage growth, with nearly 70% of policies now containing exclusions that limit coverage. - read more

Australians Uphold Insurance Commitments Amid Economic Challenges

26 Mar 2026: Paige Estritori

In the face of escalating cost-of-living pressures, Australian households are demonstrating a steadfast commitment to maintaining their insurance coverage. Recent research conducted by national insurance provider Youi reveals that despite financial strains, a significant portion of Australians continue to prioritise insurance as an essential component of their financial planning. - read more

Significant Health Insurance Premium Hikes Loom for Australians

26 Mar 2026: Paige Estritori

Australian health insurance policyholders are facing the most substantial premium increases since 2017, with recent approvals setting the stage for significant financial impacts on households. The federal health minister has sanctioned a notable fee hike, prompting concerns about affordability and the potential for consumers to downgrade their coverage. - read more

Click for more Insurance News