Life Insurers Under Scrutiny: The Consequences of Failing to Meet Obligations
Life Insurers Under Scrutiny: The Consequences of Failing to Meet Obligations
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 regulation of insurance claims handling and settling as a financial service under the Corporations Act 2001 in Australia has far-reaching implications for both consumers and life insurers.
As per the Australian Securities and Investments Commission (ASIC), the handling of claims must be done efficiently, honestly, and fairly, and any breaches in these obligations can result in severe consequences for life insurers.
For consumers, this regulation ensures that they receive accurate and fair payments in case of a claim. The miscalculation of policy benefits can lead to significant financial losses for the policyholder, and this regulation ensures that life insurers are held accountable for their actions. Additionally, the ASIC's call for life insurers to review their systems and controls for claims calculations and payments gives consumers peace of mind that the insurance company they trust is adhering to the highest standards of practice.
Life insurers, on the other hand, must take the necessary steps to ensure that their claims calculation and payment processes are accurate and in line with the regulations set forth by ASIC. This may involve examining and rectifying the root causes of miscalculations, including complex product rules, inadequate staff training, outdated technology systems, ineffective controls, and lack of monitoring. The seven life insurers who have been reported for breaches have taken steps to implement system fixes and customer remediation programs, but all life insurers must be proactive in ensuring their processes are in line with the regulations.
Here are some examples to illustrate the potential consequences of miscalculations and the steps that could be taken to resolve the issue:
Mrs. Smith had taken out a life insurance policy on her husband's life with a prominent insurer. Upon filing a claim following her husband's passing, she was shocked to learn that her policy benefits had been miscalculated, leading to a significant underpayment of her claim. She reached out to the insurance company and found out that the error was due to an outdated system that failed to apply the correct consumer price indexation to her policy benefits. Mrs. Smith was able to resolve the issue by working with the life insurer to complete a customer remediation program.
Mr. Johnson had an income protection policy with a different life insurer. Upon filing a claim, he learned that his policy benefits had been miscalculated, leading to an overpayment of his claim. The error was due to inadequate staff training on the manual processes for assessing and calculating income protection benefits. Mr. Johnson was able to resolve the issue by working with the life insurer to help identify and rectify the training issues and ensure accurate calculation of benefits going forward.
In both of these examples, the customers were able to resolve the issue by working with their life insurers and taking advantage of the customer remediation programs offered by the insurers. This highlights the importance of being aware of the terms of your insurance policy and of the steps that can be taken to resolve any issues that may arise. It's also essential to choose a reputable and trustworthy insurance company that adheres to the regulations set forth by ASIC and takes the necessary steps to ensure accurate and fair claims calculation and payment.
So, the regulation of insurance claims handling and settling as a financial service under the Corporations Act 2001 serves to protect the rights and interests of Australian consumers while holding life insurers accountable for their actions. It is essential for both consumers and life insurers to be aware of these obligations and take the necessary steps to ensure accurate and fair claims calculation and payment. Failing to meet these obligations can result in severe consequences, including financial penalties, legal action, and reputational damage.
Published:Thursday, 2nd Feb 2023 Source: Paige Estritori
Please Note: If this information affects you, seek advice from a licensed professional.
In a significant move to address the longstanding issue of insurance affordability in Northern and Regional Queensland, Sure Insurance has announced an increase in its residential strata insurance coverage from $5 million to $20 million. This strategic enhancement aims to provide body corporates and lot owners with more competitive premium options and improved access to essential insurance services. - read more
CHU has released its 2025 State of the Strata Market report, providing a comprehensive analysis of the current state of the industry. The report offers valuable insights into premium movements, the impact of weather events, regulatory developments, and emerging risks affecting strata insurance. - read more
TelstraSuper, a profit-for-member superannuation fund, has announced a substantial decrease in income protection insurance premiums for its members. Effective from 1 July 2023, members can expect reductions ranging from 11.5% to 30%, following a comprehensive review of the fund's insurance pricing. - read more
Recent data from Plan For Life indicates a sharp decline in individual income protection insurance sales in Australia, with new risk income sales experiencing an 8.3% downturn in the year ending September 2024. This contrasts with previous periods of growth, highlighting shifting dynamics within the insurance market. - read more
In response to escalating global shipping challenges, leading broker Marsh and Lloyd's underwriter Tokio Marine Kiln have launched a pioneering business interruption insurance specifically designed for ports. This innovative product aims to mitigate the financial impact of trade disruptions caused by various factors, including geopolitical tensions and operational strikes. - read more
Life insurance can seem complex at first, but understanding the basics can help demystify this important financial product. At its core, life insurance is a contract between you and an insurer, where the insurer promises to pay a designated beneficiary a sum of money upon your passing, in exchange for premium payments. - read more
The horizon of the insurance industry has undergone a transformative shift with the advent of digital technology. With a few clicks, consumers can navigate the once-complex world of insurance policies from the comfort of their home. The digital landscape for insurance services offers unprecedented access to information, comparisons, and instant communication, fostering a more empowered insurance client. - read more
Being prepared when it comes to life insurance claims can make a world of difference. Proper preparation helps you prevent delays and denials, ensuring that your loved ones receive the financial support promised by your policy without unnecessary hold-ups. By paying attention to the details, you can streamline the claims process, giving you and your family peace of mind during what is already a stressful time. - read more
Life insurance and estate planning are critical components of financial security. They ensure that your loved ones are protected financially when you are no longer around. By understanding these tools, you can take significant steps to secure your family's future. - read more
Life insurance is a fundamental component of a robust financial plan, yet its significance is often underestimated. It serves as a safety net, ensuring that your loved ones are financially secure in the event of your absence. Understanding life insurance is the first step towards safeguarding your family’s future. - read more
Start Here !
Apply now for your free Insurance assessment and price comparisons!
Knowledgebase
Incontestability Clause: A provision in a life insurance policy that prevents the insurer from voiding coverage due to a misstatement by the insured after a certain period.
