Insurer Compensates Claimants in Wake of Transition Issues

3

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

Share this news item:

Insurance News

Clear

Court Denies E-Scooter Negligence Allegation Against City Council 14 Jul 2025: Paige Estritori An Australian court recently ruled in favour of the City of Joondalup, rejecting a negligence claim lodged by an injured e-scooter rider. The Western Australia District Court found the city not liable for an accident involving insurance broker Kirstin Leibbrandt, who collided with a fence post while riding an e-scooter in the Perth suburb of Hillarys. - read more

Mental Health Surpasses Other Causes in TPD Claims, Doubling Payouts Over Five Years 14 Jul 2025: Paige Estritori Recent findings from the Council of Australian Life Insurers (CALI) reveal that mental health issues have become the primary cause of Total and Permanent Disability (TPD) claims. Insurers disbursed nearly twice the amount for such claims in 2024 compared to five years prior. This data originates from the CALI and KPMG's Cause of Claims Results Report, highlighting a significant shift in the nature of insurance claims. - read more

Impact of Trump Tariffs on Global Insurance Industry 11 Jul 2025: Paige Estritori According to Swiss Re’s latest Sigma report, the growth of property and casualty premiums is moderating in both Australia and globally. This moderation is primarily driven by a slowdown in rate hikes. Additionally, the Trump administration's America First trade policy is putting further pressure on the insurance sector. - read more

Navigating Changes in Australia's Life Insurance Advice Landscape 10 Jul 2025: Paige Estritori The conversation on the shifting dynamics in Australia's life insurance advice sector featured Zurich Australia's head of adviser channel, Kieran Forde, and Hayes & Co director, Katherine Hayes. They engaged with editor Chris Dastoor to spotlight the current market conditions and future prospects for financial advisers in this domain. - read more

ASIC Challenges Federal Court's 'Fair Term' Ruling 09 Jul 2025: Paige Estritori The Australian Securities and Investments Commission (ASIC) is appealing a Federal Court decision regarding the wording of a 'pre-existing condition' clause in certain HCF Life insurance products. The court previously determined that while the wording had the potential to mislead consumers, it did not constitute an unfair contract term under the current laws set out in the ASIC Act 2001. - read more