Insurer Compensates Claimants in Wake of Transition Issues

3

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
Source: Paige Estritori

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

Share this news item:

Insurance News

Clear

Nutrien Ag Solutions Tops Roy Morgan's Trusted Agribusiness Survey

27 Nov 2025: Paige Estritori

In a significant development within the Australian agricultural sector, Nutrien Ag Solutions has been recognised as the nation's most trusted agribusiness, according to the latest Roy Morgan survey. This marks the first time Nutrien has achieved this distinction, overtaking Elders, a longstanding leader in the industry. - read more

Australian Sheep Industry's $139.8 Million Transition Plan in Full Swing

27 Nov 2025: Paige Estritori

The Australian sheep industry is making significant strides in its $139.8 million transition plan, aimed at modernising and strengthening the sector. Recent weeks have seen the release of several grant programs under the Sheep Industry Transition Assistance Package (SITAP), providing much-needed support to farmers and associated businesses. - read more

PGA of Western Australia Back on Track After Financial Turmoil

27 Nov 2025: Paige Estritori

The Pastoralists and Graziers Association of Western Australia (PGA) has successfully navigated a period of financial uncertainty, emerging stronger after addressing internal financial irregularities. The organisation's commitment to transparency and effective management has been pivotal in restoring confidence among its members and the broader agricultural community. - read more

Rising Insurance Premiums Pose Financial Challenges for Australian Farmers

27 Nov 2025: Paige Estritori

Australian farmers are currently facing significant financial challenges due to a sharp increase in insurance premiums. Reports indicate that some farmers have experienced a 20% rise in premiums over the past year, a trend largely attributed to the escalating risks associated with climate change. This surge in costs is prompting a concerning number of farmers to reconsider their insurance coverage, with some opting to forgo it entirely, thereby exposing themselves to substantial financial risk. - read more

Empowering the Future: Rural Aid's Initiative to Support Young Australian Farmers

27 Nov 2025: Paige Estritori

Rural Aid has launched a compelling new fundraising campaign designed to secure the future of rural Australia by supporting the next generation of farmers. This initiative seeks to address the challenges faced by young and aspiring farmers, ensuring the sustainability and growth of the nation's agricultural sector. - read more

Click for more Insurance News