The life insurance code monitor will hold an inquiry into claims outcomes, focusing on cases where decisions have been reversed following a complaint.

“Overturned claims can provide important insights for insurers,” the Life Insurance Code Compliance Committee said in its annual report.

“The inquiry will examine how and why reversals occur, how insurers monitor and respond to these outcomes, and how insurers use this information to improve their systems, processes and decision frameworks. By identifying patterns, root causes, and better practices, we aim to support strengthened decision-making processes across the industry.”

The inquiry will examine claim reversals by insurers’ internal dispute resolution teams and externally by the Australian Financial Complaints Authority.

“In some cases, they may point to poor decision-making, flawed assessments, inadequate training or inconsistent processes,” the monitor said. 

“But they can also demonstrate that insurers have reconsidered the facts or evidence and taken steps to correct a decision, ensuring a fairer outcome for the customer.”

The 2024-25 report says inquiries form a significant part of the monitor’s work. A review of how insurers manage claims by sick or injured policyholders has started, and findings from a probe into the industry’s support for Aboriginal and Torres Strait Islander customers will be published soon.

“Our inquiries provide important opportunities for reflection and reform,” committee chair Jan McClelland said. “They shine a light on practices that can and must improve if insurers are to meet both the letter and the spirit of the code.”