SIRA censures major insurance companies

SIRA censures major insurance companies | Insurance Business Australia

Insurance News

SIRA censures major insurance companies

Investigations found delays in processes

Insurance News

By
Roxanne Libatique

The State Insurance Regulatory Authority (SIRA) has issued a letters of censure to QBE Insurance Australia (QBE) and NRMA Insurance (NRMA).

The investigations, which involved three QBE customers’ cases, found delays in responding to surgery requests within the required timeframes. It deemed the delays and failures to comply with the requirements in each case contravened sections 1.3(2) and 10.7 of the Motor Accident Injuries Act 2017 and QBE’s CTP insurer licence conditions.

On November 10, 2022, SIRA issued a show cause notice to the insurer for each claim, requesting a response to the investigations’ findings. On November 17, 2022, QBE responded to SIRA, accepting the proposed findings.

In a recent statement, SIRA said: “After considering the results of the investigation, QBE’s regulatory compliance history in relation to treatment and care obligations including the imposition of special licence conditions, SIRA decided the appropriate enforcement action in these cases was to issue a letter of censure.”

SIRA found the claims investigated through complaints to the Independent Review Office (IRO) in March 2021. Its investigation into the seven claims found delays contravening Sections 1.3, 3.6(5), 3.19(1)(2), 7.14(4), and 10.7 of the Motor Accident Injuries Act 2017 and clauses of the Motor Accident Guidelines.

In November 2021, SIRA issued a regulatory notice to NRMA, requesting to analyse how the delays occurred and include a remediation plan and assurance that it will prevent similar breaches from occurring. In December 2021, the insurer started its remediation plan, which remains open.

In a recent statement, SIRA said: “After considering the results of the investigation and the actions and submissions by NRMA, SIRA decided the appropriate enforcement action in these cases was to issue a letter of censure.”

This month, SIRA has been independently verifying how insurance companies meet their weekly benefit obligations as part of their Insurer Claims and Conduct Assurance Program (ICCAP). The results of this audit will be published.