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

WFI Insurance Rewards Sustainable Farming with Premium Discounts

08 Dec 2025: Paige Estritori

In a significant move towards promoting sustainable agriculture, WFI Insurance has announced a new initiative offering premium discounts to farmers who obtain AgCarE certification. This program, developed by AgForce, aims to recognise and reward farmers implementing eco-friendly practices on their properties. - read more

IAG and Ag Guard Forge Partnership to Elevate Crop Insurance for Australian Farmers

08 Dec 2025: Paige Estritori

In a significant development for Australia's agricultural sector, Insurance Australia Group (IAG) has announced a strategic partnership with Ag Guard, a specialist rural underwriting agency. This collaboration will see Ag Guard managing the underwriting for IAG-owned CGU and WFI's crop insurance portfolios starting June next year. - read more

AFCA Mandates Higher Payout for Farmers in Flood Damage Dispute

08 Dec 2025: Paige Estritori

The Australian Financial Complaints Authority (AFCA) has recently ruled in favour of a farming group, mandating that insurer Achmea increase its payout for flood damage claims. This decision underscores the critical importance of thorough and expert assessments in the insurance claims process. - read more

WFI Insurance's $250,000 Donation Supports Flood-Affected Queensland Farmers

30 Nov 2025: Paige Estritori

In response to the catastrophic flooding that has devastated parts of western Queensland, WFI Insurance has stepped forward with a substantial donation of $250,000 to Rural Aid. This contribution is aimed at bolstering relief efforts for farming communities grappling with the aftermath of the region's most severe floods in half a century. - read more

AFCA Supports Significant Home Insurance Premium Increase Based on Updated Flood Risk Assessment

30 Nov 2025: Paige Estritori

The Australian Financial Complaints Authority (AFCA) has recently upheld a substantial increase in home insurance premiums for a property, attributing the rise to updated assessments of flood risk. This decision underscores the critical role of accurate risk evaluation in determining insurance costs and the necessity for property owners to stay informed about potential changes in their risk profiles. - read more

Revolutionising Crop Insurance: DAS Unveils Cutting-Edge Data Tool

22 Nov 2025: Paige Estritori

Digital Agriculture Services (DAS) has introduced an innovative crop insurance solution in Australia, leveraging machine learning, automapping, and geospatial data to improve policy accuracy. This tool is designed to assist insurers, underwriters, brokers, and loss adjusters by precisely locating insured paddocks and identifying crop types, yields, and other critical details. - read more

Click for more Insurance News