Insurer Compensates Claimants in Wake of Transition Issues
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.
On September 2, 2024, an insurer has been mandated to compensate over 900 policyholders due to its failure to adhere to claims processing time frames outlined in the Life Insurance Code of Practice.
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.
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.
The ACCC’s fifth and final insurance monitoring report has given strata committees in cyclone-exposed regions a clearer view of what the Cyclone Reinsurance Pool is-and is not-achieving. Released on 25 June 2026, the report found that the pool has helped reduce or moderate premiums for policyholders in higher cyclone-risk areas, including residential strata schemes. - read more
Australian tradies know the pressure of keeping cover in place while juggling wages, materials, fuel, tax, vehicle costs and unpredictable cash flow. A new review by the General Insurance Code Governance Committee is a timely reminder that the way an insurance renewal is presented can make a real difference to what a small business owner understands, compares and ultimately pays. - read more
A new Federal Court penalty against Mercer Super has put another spotlight on the systems that sit behind insurance held through superannuation. Mercer Super has been ordered to pay $10.3 million after failures to report internal investigations into significant member service issues to ASIC, including one matter involving insurance premiums that continued to be charged after members had died. - read more
Australia’s H5 bird flu situation has moved quickly, with authorities responding to new detections in migratory seabirds, including a confirmed case in New South Wales and further concerns in Western Australia. Importantly for producers, officials have continued to stress that there is currently no evidence of infection in poultry or the wider agricultural production system, and the public health risk remains low. - read more
Australian small and medium-sized businesses have another management liability option to consider, after BizCover expanded its partnership with Berkshire Hathaway Specialty Insurance Company on 1 July 2026. The new product has been added to BizCover’s online platform and is aimed at organisations with annual turnover up to $25 million and up to 200 staff, with cover limits available up to $5 million. - read more
Accidental income protection insurance is a type of policy that provides financial support if you are unable to work due to an accident. Unlike regular income protection insurance, which can cover illnesses and injuries, this specific insurance focuses solely on accidents. - read more
Welcome to our comprehensive guide on securing your financial future in Australia. In a world of uncertainties, income protection insurance plays a critical role in maintaining your financial security and peace of mind. - read more
Income protection insurance is a safeguard that provides individuals with financial stability in the event they are unable to work due to illness or injury. This type of insurance typically replaces a significant percentage of the insured's income, ensuring that their financial commitments can still be met during periods when they cannot earn an income through employment. - read more
Have you ever thought about how you would manage financially if you couldn't work due to an illness or injury? Income protection insurance is designed to replace a significant portion of your income if you find yourself unable to earn for an extended period. It's an essential safety net, providing peace of mind and financial stability during times of uncertainty. - read more
Financial security is a cornerstone of peace of mind, particularly when life is known for its unpredictability. This introductory section sheds light on the vital nature of income protection insurance and its role in safeguarding Australians' financial well-being. Ensuring continual financial inflow during times of illness or injury not only offers stability but also protects one's standard of living. - read more
Knowledgebase
Insurance Policy: Broadly, the entire written contract of insurance. More narrowly, the basic written or printed document, as distinguished from the forms and endorsements added thereto.
No comments yet. Be the first to share your thoughts.