Better definitions and claims management is leading to a decline in group total and permanent disability (TPD) disputes reaching the Superannuation Complaints Tribunal (SCT).

CommInsure Head of Industry Funds Frank Crapis told insuranceNEWS.com.au policy documentation has improved in recent years, providing more clarity to fund members.

“We have also seen insurers spending a lot more time writing clear definitions,” he said.

“We have been learning from past claim cases where there were disputes over definitions.”

According to the latest SCT Bulletin, disability disputes fell from 13.3% of total disputes in the July-September quarter to 12.4% in the three months ending December 31.

Mr Crapis says this has also helped fund administrators to assess claims before passing them on to the insurer.

“In the past, the administrator would just send the claim straight to the insurer to assess,” he said. “Now they assess them first, seeing if they meet the policy criteria before passing them to the insurer.”

Mr Crapis says this has reduced the time between lodging a claim and the insurer providing a decision. Claims that do not meet the criteria are removed quickly.

TAL Head of Group Life Services Richard Poole told insuranceNEWS.com.au the work the industry has put in during the past few years is delivering results.

“Most insurers have been looking at their processes and we have put a lot of work into improving our claims forms,” he said. “The majority of complaints are time-related between the claim event and the decision.

“In the past we have made the member jump through a lot of hoops because of information missing from the claims form.” 

Mr Poole says the lack of information on the claim form would lead to more medicals. That creates more paperwork and questions, all slowing the process.

“It became a lengthy process and that created angst,” he said. “The things we have introduced to save time in the claims process has made a lot of sense.

“We now ask for a lot more information upfront and we are using tele-assessment more rather than sending a letter.”

Another factor in reducing complaints has been insurers introducing internal dispute resolution teams.

“Our team is independent and they look at all cases before they reach the SCT,” he said. “It is another step that has reduced the level of disputes.”

Mr Poole says communication of the claims process to the fund member has also contributed to a fall in complaints.

“The days of the insurer being the judge and jury are long gone,” he said. “All the evidence is provided to the claimant so they can challenge the process at any time and seek a resolution.

“It removes a lot of the complaints centred on frustration.”