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

Australian Truck Drivers Seek Relief Amid Fuel Price Surge

28 May 2026: Paige Estritori

The Australian trucking industry is confronting a severe challenge as escalating fuel prices place immense financial pressure on drivers and operators. This crisis has led to urgent appeals for major clients, including retailers and manufacturers, to share the burden to prevent widespread business closures. - read more

Easing Conditions in Australia's Commercial Insurance Market

28 May 2026: Paige Estritori

In the first half of 2026, Australia's commercial insurance market has experienced a notable softening, characterized by easing pricing across various lines and a broadening of insurer appetite. This trend is detailed in the latest Insurance Market Trends and Outlook report released by EBM Insurance & Risk on May 11, 2026. - read more

APRA Freezes Unjustified Premium Increases in Commercial Auto Insurance

28 May 2026: Paige Estritori

In March 2026, the Australian Prudential Regulation Authority (APRA) took decisive action to address significant premium hikes in the commercial auto insurance sector. Responding to widespread industry concerns, APRA issued emergency regulations to freeze unjustified baseline premium increases exceeding 25%, pending external review. - read more

Rising Mental Health Claims Lead to Surge in Income Support Access

27 May 2026: Paige Estritori

Recent data reveals a concerning trend: over 8 million Australians are now accessing some form of income support, marking an increase of approximately 2 million individuals over the past decade. This surge is predominantly driven by a rise in mental health-related claims, underscoring the pressing need for comprehensive mental health support and effective income protection strategies. - read more

Acenda Life Introduces Higher Coverage Limits in Income Protection Policies

27 May 2026: Paige Estritori

Acenda Life has recently implemented a series of updates to its Retail Life Insurance portfolio, effective from 11 April 2026. These changes are designed to provide greater flexibility and accessibility for Australians seeking income protection insurance, addressing common concerns about policy limitations and entry age restrictions. - read more

Click for more Insurance News