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

IAG Enhances Profit Projections Post-RACQ Insurance Integration

15 Dec 2025: Paige Estritori

Insurance Australia Group (IAG) has revised its annual profit forecast upward by $100 million, attributing this positive adjustment to the recent acquisition of RACQ Insurance. The company now anticipates a reported insurance profit ranging between $1.55 billion and $1.75 billion for the current financial year, an increase from the previous estimate of $1.45 billion to $1.65 billion. - read more

Queensland's Insurance Duty Revenue Set to Surpass $2 Billion

15 Dec 2025: Paige Estritori

The Queensland government is poised to collect over $2 billion annually from insurance duties by the 2028-29 financial year, marking a 19.7% increase over the next four years. This projection is detailed in the latest budget figures, which indicate that the state will receive $1.78 billion from insurance duties in 2025-26, approximately $120 million more than the previous year. - read more

Australian Insurance Industry Poised for Significant Growth

15 Dec 2025: Paige Estritori

The Australian general insurance industry is on a trajectory of substantial growth, with direct written premiums (DWP) projected to exceed $144 billion by 2029. This forecast, provided by data and analytics firm GlobalData, highlights the expanding demand for insurance coverage in response to the increasing frequency and severity of natural disasters. - read more

ABC Insurance Offers New Professional Indemnity Option for NSW Solicitors

15 Dec 2025: Paige Estritori

In a significant development for New South Wales' legal community, ABC Insurance has announced its entry into the professional indemnity (PI) insurance market, providing solicitors with an alternative to the longstanding sole provider, Lawcover. This move introduces competition and choice for over 23,000 solicitors in the state, who have traditionally relied on Lawcover for their mandatory PI insurance. - read more

ProRisk Unveils Comprehensive Professional Indemnity Insurance via ProBind

15 Dec 2025: Paige Estritori

Professional Risk Underwriting Pty Ltd (ProRisk) has launched a new Professional Indemnity (PI) Insurance policy available through their ProBind platform. This product caters to Australian-domiciled organisations with up to 500 employees and a turnover of up to $25 million, covering a wide array of 506 professional occupations, including consultants, accountants, engineers, and legal professionals. - read more

Professional Bodies Advocate for Insurer Recognition of Risk-Reducing Schemes

15 Dec 2025: Paige Estritori

The Professional Standards Councils are actively seeking to enhance insurer recognition of schemes designed to improve risk management among professionals. These schemes, established under state and territory legislation, aim to limit liability for members in exchange for adherence to stringent risk management practices, including mandatory professional indemnity (PI) insurance. - read more

Allianz Partners Highlights the Risks of Travelling Uninsured

14 Dec 2025: Paige Estritori

Recent research commissioned by the Insurance Council of Australia (ICA) and the Department of Foreign Affairs and Trade's (DFAT) Smartraveller program has unveiled a concerning trend: approximately 14% of Australian travellers embark on international journeys without any form of travel insurance. This statistic has prompted Allianz Partners to urge Australians to reconsider the importance of securing adequate coverage before travelling abroad. - read more

Surge in Medical Claims Among Australian Travellers Highlights Importance of Comprehensive Insurance

14 Dec 2025: Paige Estritori

In 2024, medical incidents emerged as the leading cause of travel insurance claims among Australian travellers, accounting for more than 40% of all claims handled by nib Travel. This trend underscores the critical importance of securing comprehensive travel insurance to mitigate the financial risks associated with medical emergencies abroad. - read more

Rising Travel Insurance Claims Among Australians Visiting Bali

14 Dec 2025: Paige Estritori

The allure of Bali continues to captivate Australian travellers, with a notable 43% increase in travel insurance policies purchased for the destination since the 2022/23 summer season. This surge has corresponded with a 50% rise in related insurance claims, now accounting for 16% of all claims submitted to Southern Cross Travel Insurance (SCTI) in 2024. - read more

QBE Insurance Faces Market Challenges with Slower Premium Growth

14 Dec 2025: Paige Estritori

QBE Insurance Group, Australia's largest insurer by market value, recently experienced a significant decline in its share price, reaching a seven-month low. This downturn is primarily attributed to a slowdown in the company's premium rate growth during the third quarter of 2025. - read more

Click for more Insurance News