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

Navigating the Surge in Insurance Risks for Australian Businesses

18 Feb 2026: Paige Estritori

Australian businesses are currently grappling with a complex landscape of escalating insurance risks, driven by factors such as increased litigation, rapid technological advancements, supply chain disruptions, catastrophic events, and geopolitical tensions. These challenges necessitate a proactive approach to risk management and insurance coverage. - read more

Learning from Near Misses: Enhancing Farm Safety in Australia

18 Feb 2026: Paige Estritori

In July 2025, Farmsafe Australia launched the 'Second Chances - Who Knows How Many You'll Get' campaign, aiming to transform near misses on farms into learning opportunities to prevent future accidents. This initiative underscores the critical importance of recognising and addressing close calls in agricultural settings. - read more

WFI's 2025 Farm Accident Insights: A Call for Enhanced Safety Measures

18 Feb 2026: Paige Estritori

In October 2025, WFI Insurance unveiled its annual farm accident insights as part of Farmsafe Australia's 2025 Safer Farms Report. The findings paint a stark picture of the challenges facing Australian agriculture, with 2024 recording 72 farm-related deaths-the highest in over two decades. - read more

ASIC Highlights Deficiencies in Insurers' Complaint Handling Practices

18 Feb 2026: Paige Estritori

The Australian Securities and Investments Commission (ASIC) has recently conducted a comprehensive review of insurers' complaint handling processes, uncovering significant deficiencies that fail to meet regulatory obligations. The findings indicate that insurers are not adequately identifying and addressing customer complaints, with one in six complaints going unrecognized. Additionally, systemic issues are often overlooked, communication timeframes are missed, and existing systems fail to record outcomes such as compensation payments. - read more

Forecast: Continued Decline in Australian Commercial Insurance Rates Through 2026

18 Feb 2026: Paige Estritori

Following a significant 12% decline in commercial insurance rates during the fourth quarter of 2025, industry experts anticipate that this downward trend will persist throughout 2026. The Australia-Pacific region has been at the forefront of this global decrease, with the recent drop marking the steepest since early 2024. - read more

Click for more Insurance News