{"id":71960,"date":"2024-06-17T14:08:59","date_gmt":"2024-06-17T04:08:59","guid":{"rendered":"https:\/\/riskinfo.com.au\/news\/?p=71960"},"modified":"2024-06-17T14:08:59","modified_gmt":"2024-06-17T04:08:59","slug":"delay-in-responding-to-tpd-claim-breaches-life-code","status":"publish","type":"post","link":"https:\/\/riskinfo.com.au\/news\/2024\/06\/17\/delay-in-responding-to-tpd-claim-breaches-life-code\/","title":{"rendered":"Delay in Responding to TPD Claim Breaches Life Code"},"content":{"rendered":"<p>The Life Code Compliance Committee has issued a Notice of Determination finding that a life insurer breached two sections\u00a0 of the Life Insurance Code of Practice with regard to a TPD claim.<\/p>\n<p>The committee says that following an assessment and investigation it found the life insurer:<\/p>\n<ul>\n<li>Failed to issue a letter within six months of a customer\u2019s claim assessment explaining the reason for the delay on the claim and how to make a complaint<\/li>\n<li>Failed to respond to a customer\u2019s complaint within the required 90-day timeframe<\/li>\n<li>Failed to provide all the required information to the customer when it did respond<\/li>\n<\/ul>\n<p>The committee says as to the cause of the issue \u201c\u2026the life insurer cited human error where staff did not follow established processes.\u201d<\/p>\n<p>It says that as remediation, the life insurer:<\/p>\n<ul>\n<li>Paid the customer interest of $3,181 for the claim delays<\/li>\n<li>Provided feedback to all staff on the importance of following processes<\/li>\n<\/ul>\n<blockquote><p>&#8230;this\u00a0 highlights the need for\u00a0 life insurers to identify and mitigate staff errors and the importance of promptly delivering claim decisions&#8230;<\/p><\/blockquote>\n<p>The LCCC says this case highlights the need for all life insurers to identify and mitigate staff errors &#8220;&#8230;and the importance of promptly delivering claim decisions.&#8221;<\/p>\n<p>The <a href=\"https:\/\/lifeccc.org.au\/app\/uploads\/2024\/06\/Determination-CX15952.pdf\" target=\"_blank\" rel=\"noopener\">full determination<\/a> says the breach related to a consumer who was a member of a superannuation fund. As part of that membership, the consumer had a TPD policy, which was a Group Policy issued by the insurer and owned by the Trustee.<\/p>\n<p><strong>Failing to Include Sum Insured in Annual Notices<\/strong><\/p>\n<p>In a separate Notice of Determination, the LCCC found that a life insurer failed to include the sum insured in annual notices it sent, affecting 3,679 customers.<\/p>\n<p>The committee says the life insurer cited an inherited issue as the cause \u201c\u2026and has implemented changes to its processes that will ensure its annual notices are all fully compliant with the Code.\u201d<\/p>\n<p>It adds that this case highlights the need \u201c\u2026for all life insurers to thoroughly review processes and documents, and engage with third-party service providers, to ensure compliance with the Code. Better compliance ultimately leads to better outcomes for consumers.\u201d<\/p>\n<p><a href=\"https:\/\/lifeccc.org.au\/app\/uploads\/2024\/06\/Determination-CX18625.pdf\" target=\"_blank\" rel=\"noopener\">Click here<\/a> for the Full Determination.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>The Life Code Compliance Committee has issued a Notice of Determination finding that a life insurer breached two sections\u00a0 of the Life Insurance Code of Practice with regard to a TPD claim. The committee says that following an assessment and investigation it found the life insurer: Failed to issue a letter within six months of [&hellip;]<\/p>\n","protected":false},"author":24,"featured_media":71965,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[8,3],"tags":[],"class_list":{"0":"post-71960","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-compliance-regulation","8":"category-general"},"_links":{"self":[{"href":"https:\/\/riskinfo.com.au\/news\/wp-json\/wp\/v2\/posts\/71960","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\/24"}],"replies":[{"embeddable":true,"href":"https:\/\/riskinfo.com.au\/news\/wp-json\/wp\/v2\/comments?post=71960"}],"version-history":[{"count":0,"href":"https:\/\/riskinfo.com.au\/news\/wp-json\/wp\/v2\/posts\/71960\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/riskinfo.com.au\/news\/wp-json\/wp\/v2\/media\/71965"}],"wp:attachment":[{"href":"https:\/\/riskinfo.com.au\/news\/wp-json\/wp\/v2\/media?parent=71960"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/riskinfo.com.au\/news\/wp-json\/wp\/v2\/categories?post=71960"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/riskinfo.com.au\/news\/wp-json\/wp\/v2\/tags?post=71960"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}