As a result of the industry issues highlighted in the media relating to declined claims in March 2016, MLC Life Insurance proactively initiated an independent Claims Assurance Review. The review seeks to identify any systemic issues in our claims practices, and includes a closer look at denied claims going back to 1 January 2012. There is a particular focus on critical illness claims across a range of conditions, including heart attacks.

Overview

The purpose of the review is to provide confidence to past, current and future customers, intermediaries and employees that decisions made by MLC Life Insurance in determining whether or not a benefit is payable are appropriate. If issues are identified, MLC Life Insurance is committed to undertaking actions to strengthen our practices to rectify identified shortfalls and, if appropriate, to expand the scope of the review.

To ensure independence and transparency, we appointed Mr Michael Arnold as the Independent Expert to the Review. As a former Ombudsman at the Financial Ombudsman Service, Mr Arnold brings extensive experience in dispute resolution within life insurance, in particular in claims.

Update on Claims Assurance Review

Today, MLC Life Insurance is able to provide an update on the progress of this review.

Commencing in April 2016, the first phase of the review sought to identify any systemic issues in claims practices and was completed in late 2016 and shared with Australian Securities and Investments Commission. The first phase independently reviewed past claims decisions for critical illness claims declined by MLC Life Insurance over a five-year period from 1 January 2012. It also contained a targeted review of claims and product-related policies, systems and processes.

Whilst there are areas noted for improvement, the outcomes to date do not identify any systemic or significant events, with findings in many areas broadly consistent with those published by ASIC in late 2016[1].

Support for industry initiatives on claims

MLC Life Insurance is committed to continuing the review of claims decisions and practices across our business. We would expect the findings from the additional phases of our review to be made incrementally throughout 2017. Any resultant recommendations are expected to be adopted as is appropriate following the findings being made reporting regime for claims data and claims outcomes, including claims handling timeframes and dispute levels across all policy types.

Further, as noted in our submission for the Parliamentary Inquiry into Life Insurance, we welcome the FSC’s Life Insurance Code of Practice. We have been active and constructive in driving the development of this Code in collaboration with other FSC life insurance members. The Code is customer-focused. It will also ensure that there are consistent standards which will be binding on FSC industry members from 1 July 2017.

[1] http://asic.gov.au/about-asic/media-centre/find-a-media-release/2016-releases/16-347mr-asic-issues-industry-review-of-life-insurance-claims/

Summary

Our ambition is to become Australia's leading and most trusted life insurer. The Claims Assurance Review is an important part of how we regain trust as an industry.

Last year we paid out almost 900 million dollars in claims to customers in their time of need. 

The overwhelming majority of our claims are paid quickly and with a minimum of fuss. This is underpinned by a philosophy and culture of supporting our customers through their time of need.

Further updates on the progress of the review will be provided over the course of 2017.