Life Insurers Under Scrutiny: The Consequences of Failing to Meet Obligations

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and rectifying the root causes of miscalculations, including complex product rules, inadequate staff training, outdated technology systems, ineffective controls, and lack of monitoring.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:

1. 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 She reached out to the insurance company and found out that the error was due to an outdated system that failed to apply the correct consumer price indexation to her policy benefits.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.

2. 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

Share this news item:

Insurance News

Antique Car Claim Hits the Brakes: Home Insurance Does Not Cover Vehicle Damage 24 Apr 2024: .Paige Estritori In an intriguing turn of events, a dedicated car enthusiast's claim for damages to his vintage vehicle under home insurance has been denied after a careful review by the Australian Financial Complaints Authority (AFCA). The individual's relic, a 1970 Mercedes-Benz 280e sedan, which was being lovingly restored and was far from operational, rolled into an adjacent van following the snap of a winch cable. - read more

Communities Laud Insurance Improvements Post-Flood Events 23 Apr 2024: .Paige Estritori Residents and officials from regions affected by flooding have observed a discernable shift in insurers' handling of claims following natural catastrophes, with recent proceedings reflecting a more positive trajectory. This outlook emerged during a federal inquiry session that gave a voice to flood-impacted communities in Heathcote, Victoria. - read more

Traveler's Appeal on Wildfire Claim Denied by Adjudicator 22 Apr 2024: .Paige Estritori An individual's anticipation of a serene vacation in Hawaii was met with a grievous twist when wildfires ravaged Maui, leading to an urgent evacuation and unplanned expenses. A customer of Mitsui Sumitomo ventured to the Pacific paradise only to have plans upended by nature's wrath. The ensuing insurance claim denial sparked a dispute which has now been resolved by the authoritative voice of the industry’s dispute resolver, leaving a glaring reminder of the importance of scrutinizing insurance options. - read more

Life Insurance Participation Drops By Nearly One-Fifth in Five Years 19 Apr 2024: .Paige Estritori Last year, research from a major insurance provider signaled a significant shift in the life insurance landscape within Australia, showing a marked decrease in the percentage of insured non-dependent adults of working age. Only 77% now carry some form of life insurance, a stark contrast to the 94% coverage rate recorded in 2017. Industries evolve, yet the dip in these figures marks a noteworthy trend within the life insurance sector. - read more

London's CFC Gears Up for Australian Expansion With Local Acquisition 18 Apr 2024: .Paige Estritori In a strategic move to fortify its Australian footprint, the prominent London-based cyber insurance firm CFC has announced the procurement of Melbourne's Solution Underwriting. Already an experienced player in the Australian insurance sector, CFC’s recent acquisition marks a significant augmentation of its local operations. - read more