{"id":46810,"date":"2019-10-18T19:45:51","date_gmt":"2019-10-18T09:45:51","guid":{"rendered":"https:\/\/riskinfo.com.au\/news\/?p=46810"},"modified":"2025-09-02T11:33:54","modified_gmt":"2025-09-02T01:33:54","slug":"fsc-fires-back-at-asics-tpd-insurance-criticisms-with-new-data","status":"publish","type":"post","link":"https:\/\/riskinfo.com.au\/news\/2019\/10\/18\/fsc-fires-back-at-asics-tpd-insurance-criticisms-with-new-data\/","title":{"rendered":"FSC Fires Back at ASIC\u2019s TPD Insurance Criticisms"},"content":{"rendered":"<p class=\"p1\"><span class=\"s1\">The Financial Services Council has called out ASIC\u2019s reliance on data from 2016\/17, used in the regulator\u2019s recently released report that found \u2018significant industry-wide problems\u2019 with the design of total and permanent disability insurance and the claims handling process.<\/span><\/p>\n<p><!--more--><\/p>\n<figure id=\"attachment_46442\" aria-describedby=\"caption-attachment-46442\" style=\"width: 150px\" class=\"wp-caption alignright\"><a href=\"https:\/\/riskinfo.com.au\/news\/files\/2019\/09\/Sally-Loane-v2-e1569304980851.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-46442\" src=\"https:\/\/riskinfo.com.au\/news\/files\/2019\/09\/Sally-Loane-v2-e1569304980851.jpg\" alt=\"\" width=\"150\" height=\"180\" \/><\/a><figcaption id=\"caption-attachment-46442\" class=\"wp-caption-text\">FSC CEO, Sally Loane &#8230;the industry has initiated significant positive reforms<\/figcaption><\/figure>\n<p>ASIC called on insurers and trustees to take action to improve consumer outcomes from TPD insurance, stating the issues it uncovered mean many consumers can\u2019t rely on this cover when they need it most.<\/p>\n<p class=\"p1\"><span class=\"s1\">\u201cOver 12 million Australian workers automatically pay for TPD cover through their superannuation to provide financial protection when they are so sick or injured that they can never work again. ASIC expects industry to make prompt changes to ensure this cover provides real value,\u201d the regulator stated in its release presenting the report, \u2018<a href=\"https:\/\/download.asic.gov.au\/media\/5311117\/rep633-published-17-october-2019.pdf\" target=\"_blank\" rel=\"noopener\">Holes in the safety net: A review of TPD insurance claims<\/a>\u2019.<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">The FSC responded with an analysis using more recent 2018 data on TPD claims in life insurance.<\/span><\/p>\n<figure id=\"attachment_45681\" aria-describedby=\"caption-attachment-45681\" style=\"width: 150px\" class=\"wp-caption alignright\"><a href=\"https:\/\/riskinfo.com.au\/news\/files\/2019\/07\/Sean-Hughes-e1563867105343.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-45681\" src=\"https:\/\/riskinfo.com.au\/news\/files\/2019\/07\/Sean-Hughes-e1563867105343-250x300.jpg\" alt=\"\" width=\"150\" height=\"180\" srcset=\"https:\/\/riskinfo.com.au\/news\/files\/2019\/07\/Sean-Hughes-e1563867105343-250x300.jpg 250w, https:\/\/riskinfo.com.au\/news\/files\/2019\/07\/Sean-Hughes-e1563867105343.jpg 381w\" sizes=\"auto, (max-width: 150px) 100vw, 150px\" \/><\/a><figcaption id=\"caption-attachment-45681\" class=\"wp-caption-text\">ASIC Commissioner, Sean Hughes &#8230;insurers need to take action to improve consumer outcomes from TPD insurance<\/figcaption><\/figure>\n<p>FSC CEO, <strong>Sally Loane<\/strong>, says ASIC\u2019s report fails to highlight the significant positive reforms the industry has initiated since then, including the introduction of the Life Insurance Code of Practice and the world-class FSC\/KPMG claims data initiative.<\/p>\n<h6 class=\"p1\"><span class=\"s1\">\u201cThe 2018 data tells a very different story&#8230;&#8221;<\/span><\/h6>\n<p class=\"p1\"><span class=\"s1\">\u201cThe 2018 data tells a very different story and ASIC\u2019s report serves to highlight the substantial progress the life insurance industry has made in the last couple of years,\u201d said Loane. <\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">\u201cKPMG on behalf of the FSC collect TPD claims data every six months and we know this data collection initiative is unsurpassed anywhere else in the world, both for its granularity and timeliness.\u201d<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">According to ASIC\u2019s review: <\/span><\/p>\n<ul>\n<li class=\"p1\"><span class=\"s1\">Nearly half a million Australians are covered by a very narrow TPD policy definition that only pays out in the most catastrophic circumstances, if they are unable to perform several \u2018activities of daily living\u2019 (known as ADL cover), such as feeding, dressing or washing themselves<\/span><\/li>\n<li class=\"p1\"><span class=\"s1\">60% of claims assessed under this narrow cover are declined, which is five times higher than the average declined claim rate for all other TPD claims (12%)<\/span><\/li>\n<li class=\"p1\"><span class=\"s1\">Poor claims handling processes contributed to some consumers withdrawing their claims: one in eight, or 12% of claims lodged with insurers did not proceed to a decision<\/span><\/li>\n<li class=\"p1\"><span class=\"s1\"><span class=\"s1\">Insurers lacked ke<\/span><\/span><span class=\"s1\">y claims data to help them effectively manage the risk of consumer harm \u2013 including being able to identify the value of products to consumers and key friction points in their claims handling processes<\/span><\/li>\n<\/ul>\n<h6 class=\"p1\"><span class=\"s1\">&#8220;&#8230;three TPD claims a day are assessed under the restrictive \u2018activities of daily living\u2019 definition.,.&#8221;<\/span><\/h6>\n<p class=\"p1\"><span class=\"s1\">ASIC Commissioner, <strong>Sean Hughes<\/strong>, says, &#8220;Alarmingly, we found that three TPD claims a day are assessed under the restrictive \u2018activities of daily living\u2019 definition, which has a concerningly high decline rate. People that hold this type of automatic cover through superannuation are typically paying the same premium \u2013 for what is essentially junk insurance \u2013 as people who can access less restrictive definitions under general TPD cover.\u201d<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">He added: \u201cWe also find it inexcusable that insurers did not use, or in some cases even collect, data to enable them to identify the very poor consumer outcomes that are being produced because of these restrictive definitions.\u201d<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">ASIC\u2019s review found some of the problems consumers had during the claims assessment process included: <\/span><\/p>\n<ul>\n<li class=\"p1\"><span class=\"s1\">Difficult lodgement processes<\/span><\/li>\n<li class=\"p1\"><span class=\"s1\">Poor communication practices<\/span><\/li>\n<li class=\"p1\"><span class=\"s1\">Multiple requests for medical assessments<\/span><\/li>\n<li class=\"p1\"><span class=\"s1\">Excessive delays<\/span><\/li>\n<\/ul>\n<p class=\"p1\"><span class=\"s1\"><a href=\"https:\/\/download.asic.gov.au\/media\/5311117\/rep633-published-17-october-2019.pdf\" target=\"_blank\" rel=\"noopener\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-46811 alignleft\" src=\"https:\/\/riskinfo.com.au\/news\/files\/2019\/10\/Screen-Shot-2019-10-21-at-1.00.50-pm-719x1024.png\" alt=\"\" width=\"205\" height=\"292\" srcset=\"https:\/\/riskinfo.com.au\/news\/files\/2019\/10\/Screen-Shot-2019-10-21-at-1.00.50-pm-719x1024.png 719w, https:\/\/riskinfo.com.au\/news\/files\/2019\/10\/Screen-Shot-2019-10-21-at-1.00.50-pm-211x300.png 211w, https:\/\/riskinfo.com.au\/news\/files\/2019\/10\/Screen-Shot-2019-10-21-at-1.00.50-pm-768x1093.png 768w, https:\/\/riskinfo.com.au\/news\/files\/2019\/10\/Screen-Shot-2019-10-21-at-1.00.50-pm.png 914w\" sizes=\"auto, (max-width: 205px) 100vw, 205px\" \/><\/a>Loane explained the FSC\u2019s data to the end of 2018 shows 88 percent of TPD claims are paid in the first instance and 91 percent for mental health TPD claims. This includes claims against all definitions, including activities of daily living (ADLs), an initiative from the international medical community.<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">She added the FSC\u2019s 2018 data assessed a total of 11,427 TPD claims, of which 11,008 were assessed against an occupational definition, and only 419 or 3.6 percent were assessed using either a non-occupational or ADL definition.<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">\u201cWhat this shows is that non-occupational definitions such as ADLs are almost always used as part of a hierarchy of definitions in group insurance in super,\u201d said Loane. <\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">\u201cADLs then only apply in the tiny proportion of TPD claims where a definition higher up the hierarchy can\u2019t be used. This can be because, for example, the person isn\u2019t in paid employment so a more generous occupational definition has no relevance.\u201d<\/span><\/p>\n<figure id=\"attachment_46815\" aria-describedby=\"caption-attachment-46815\" style=\"width: 1024px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/download.asic.gov.au\/media\/5311066\/tpd-insurance-infographic-unfair-definitions.pdf\" target=\"_blank\" rel=\"noopener\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-46815 size-large\" src=\"https:\/\/riskinfo.com.au\/news\/files\/2019\/10\/Screen-Shot-2019-10-21-at-1.06.27-pm-1024x576.png\" alt=\"\" width=\"1024\" height=\"576\" srcset=\"https:\/\/riskinfo.com.au\/news\/files\/2019\/10\/Screen-Shot-2019-10-21-at-1.06.27-pm-1024x576.png 1024w, https:\/\/riskinfo.com.au\/news\/files\/2019\/10\/Screen-Shot-2019-10-21-at-1.06.27-pm-300x169.png 300w, https:\/\/riskinfo.com.au\/news\/files\/2019\/10\/Screen-Shot-2019-10-21-at-1.06.27-pm-768x432.png 768w, https:\/\/riskinfo.com.au\/news\/files\/2019\/10\/Screen-Shot-2019-10-21-at-1.06.27-pm.png 1591w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/a><figcaption id=\"caption-attachment-46815\" class=\"wp-caption-text\">Source: ASIC infographic from Holes in the safety net: A review of TPD insurance claims<\/figcaption><\/figure>\n<p class=\"p1\"><span class=\"s1\">Loane also noted that the Life Insurance Code of Practice (The Code) now provides additional consumer protections at claim interviews and for surveillance to ensure claims are not withdrawn for inappropriate reasons.<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">She said that since the Code has been in effect, data from the Life Code Compliance Committee shows 92 percent of all lump sum claims in the year to 30 June 2018 were paid out within the Code timeframes.<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">ASIC conducted the review between 1 January 2016 and 31 December 2017 and focused on the following seven insurers which represent 65\u201370 percent of the total number of TPD claims:<\/span><\/p>\n<ul>\n<li class=\"p1\"><span class=\"s1\">AIA Australia Limited<\/span><\/li>\n<li class=\"p1\"><span class=\"s1\">AMP Life Limited and the National Mutual Life Association of Australasia Limited (part of the AMP Group of companies)<\/span><\/li>\n<li class=\"p1\"><span class=\"s1\">Asteron Life &amp; Superannuation Limited \u2013 previously Suncorp Life &amp; Superannuation Limited<\/span><\/li>\n<li class=\"p1\"><span class=\"s1\">MetLife Insurance Limited<\/span><\/li>\n<li class=\"p1\"><span class=\"s1\">MLC Limited<\/span><\/li>\n<li class=\"p1\"><span class=\"s1\">TAL Life Limited<\/span><\/li>\n<li class=\"p1\"><span class=\"s1\">Westpac Life Insurance Services Limited<\/span><\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>The Financial Services Council has called out ASIC\u2019s reliance on data from 2016\/17, used in the regulator\u2019s recently released report that found \u2018significant industry-wide problems\u2019 with the design of total and permanent disability insurance and the claims handling process.<\/p>\n","protected":false},"author":20,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[282,8294,8,4],"tags":[],"class_list":["post-46810","post","type-post","status-publish","format-standard","category-associations","category-claims","category-compliance-regulation","category-products"],"_links":{"self":[{"href":"https:\/\/riskinfo.com.au\/news\/wp-json\/wp\/v2\/posts\/46810","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/riskinfo.com.au\/news\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/riskinfo.com.au\/news\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/riskinfo.com.au\/news\/wp-json\/wp\/v2\/users\/20"}],"replies":[{"embeddable":true,"href":"https:\/\/riskinfo.com.au\/news\/wp-json\/wp\/v2\/comments?post=46810"}],"version-history":[{"count":0,"href":"https:\/\/riskinfo.com.au\/news\/wp-json\/wp\/v2\/posts\/46810\/revisions"}],"wp:attachment":[{"href":"https:\/\/riskinfo.com.au\/news\/wp-json\/wp\/v2\/media?parent=46810"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/riskinfo.com.au\/news\/wp-json\/wp\/v2\/categories?post=46810"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/riskinfo.com.au\/news\/wp-json\/wp\/v2\/tags?post=46810"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}