Health Insurance Online :: News
SHARE

Share this news item!

Insurer Compensates Claimants in Wake of Transition Issues

Insurer Compensates Claimants in Wake of Transition Issues

Insurer Compensates Claimants in Wake of Transition Issues?w=400

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.

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:

Rate this article

0 Comments

No comments yet. Be the first to share your thoughts.

Insurance News

APRA's Intervention: Halting Unjustified Premium Hikes in Commercial Auto Insurance
APRA's Intervention: Halting Unjustified Premium Hikes in Commercial Auto Insurance
24 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. This intervention aims to protect independent transport operators and logistics enterprises from immediate financial strain. - read more
HESTA to Reduce Insurance Fees by 12% Starting July 2026
HESTA to Reduce Insurance Fees by 12% Starting July 2026
24 May 2026: Paige Estritori
HESTA, a leading Australian superannuation fund, has announced a significant reduction in insurance fees, averaging 12% across all cover types. This change is set to take effect from 1 July 2026 and is part of a broader initiative to make insurance more accessible and affordable for its members. - read more
Government Announces Major NDIS Cuts to Save Over $36 Billion
Government Announces Major NDIS Cuts to Save Over $36 Billion
24 May 2026: Paige Estritori
The Australian government has unveiled plans to significantly reduce the growth of the National Disability Insurance Scheme (NDIS), aiming to save $36.2 billion over the next four years. This decision marks the largest single savings measure in the 2026 federal budget. - read more
Australian Insurers Highlight Key Risks for 2026
Australian Insurers Highlight Key Risks for 2026
24 May 2026: Paige Estritori
As 2026 unfolds, Australian insurers have identified three primary challenges: rising premium costs and shrinking insurability, ongoing cyber and data risks, and increasing difficulty in hiring and retaining skilled workers. These insights are drawn from industry feedback cited in Gallagher Bassett’s upcoming report, 'The Carrier Perspective: 2026 Claims Insights.' - read more
QLS Approves 15% Reduction in Professional Indemnity Insurance Levies for 2026/27
QLS Approves 15% Reduction in Professional Indemnity Insurance Levies for 2026/27
24 May 2026: Paige Estritori
The Queensland Law Society (QLS) has announced a significant 15% reduction in professional indemnity (PI) insurance levies for the 2026/27 period. This decision, approved by the QLS Council in April 2026, is set to benefit legal practitioners across Queensland by lowering their insurance premiums. - read more


Health Insurance Articles

The Benefits of Private Health Insurance for Families: Is It Worth the Cost?
The Benefits of Private Health Insurance for Families: Is It Worth the Cost?
Health insurance is a crucial aspect of financial planning for individuals and families alike. It provides protection against unexpected medical costs and ensures that you have access to necessary healthcare services when you need them most. - read more
The Ultimate Guide to Comparing Health Insurance Plans in Australia
The Ultimate Guide to Comparing Health Insurance Plans in Australia
Australia is renowned for its iconic landmarks, diverse ecosystems, and robust healthcare system. While the public healthcare system, Medicare, provides essential health services, it might not cover everything. The allure of private health coverage lies in its promise of broader options, reduced wait times, and coverage for services not included in Medicare, like dental and optical care. - read more
Keeping Your Family Protected: The Importance of Adequate Health Insurance Coverage
Keeping Your Family Protected: The Importance of Adequate Health Insurance Coverage
The modern Australian family faces a dynamic and ever-evolving set of health needs, with access to quality healthcare remaining a cornerstone of managing our wellbeing. As these needs shift through the different stages of life, the assurance of having a safety net in place can provide unparalleled peace of mind. It's this sense of security that makes adequate health insurance coverage indispensable in today's fast-paced society. - read more
How to Choose the Best Family Health Cover for Your Needs
How to Choose the Best Family Health Cover for Your Needs
With healthcare being a critical aspect of every family's well-being in Australia, securing the right family health insurance is not just a necessity but a responsibility. Recognizing the importance of this safety net is the first step towards safeguarding the future health needs of your loved ones. Balancing comprehensive coverage against affordable premiums can seem overwhelming with a multitude of plans available. - read more
The Importance of Comparing Health Insurance Extras for Maximum Savings
The Importance of Comparing Health Insurance Extras for Maximum Savings
Health insurance is more than just a precautionary measure; it's a vital component in managing both your health and financial well-being. In Australia, where healthcare costs can quickly escalate, health insurance extras serve as a buffer, ensuring that services like dental, optical, and physiotherapy remain within reach. These extras can significantly reduce the out-of-pocket expenses you might otherwise encounter for non-hospital treatments. - read more

Knowledgebase
Claim Adjuster:
An insurance professional who investigates and evaluates insurance claims to determine the amount the insurance company should pay.