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

Cancer Claim Decision Shows Why Policy Wording Matters

01 Jul 2026: Paige Estritori

A new Australian Financial Complaints Authority decision has underlined a point that is easy to overlook when buying personal insurance: a serious diagnosis does not always mean a policy benefit will be payable. The ruling, reported on 29 June 2026, involved a claimant who sought benefits after being diagnosed with high-grade urothelial carcinoma of the bladder. Although the illness was serious and required treatment, AFCA found the insurer was entitled to rely on the specific wording of the policy. - read more

Claims Delays Put Life Insurance Service Standards in Focus

24 Jun 2026: Paige Estritori

A recent sanction against an unnamed life insurer has put claims handling back under the spotlight, particularly for Australians who rely on personal insurance as a financial safety net. The Life Insurance Code Compliance Committee found that the insurer failed to request required information from claimants at the earliest available opportunity, contributing to significant delays for some customers waiting on claim decisions. - read more

Hostplus and MetLife Extend Partnership to Strengthen Member Insurance Offerings

03 Jun 2026: Paige Estritori

Hostplus, a leading Australian superannuation fund, has announced the extension of its group insurance partnership with MetLife Australia until June 2028. This strategic move aims to enhance the insurance benefits available to Hostplus members, reflecting the fund's commitment to providing comprehensive and cost-effective coverage. - 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

HESTA Announces 12% Reduction in Insurance Fees for Members

19 May 2026: Paige Estritori

HESTA, a leading Australian superannuation fund, has unveiled a significant reduction in insurance fees, set to take effect from 1 July 2026. This initiative aims to make insurance coverage more accessible and affordable for its members, aligning with the fund's commitment to enhancing member benefits. - read more

Click for more Insurance News