Commonwealth Bank of Australia’s under-pressure life insurance arm CommInsure said it has not yet found any evidence of wilful misconduct or wrongfully knocked back claims in any of its internal or independent reviews.
In a submission to a parliamentary inquiry into the $44 billion life insurance sector, CommInsure hit back at a number of claims which have besieged the company over the last year.
An independent review of declined claims over the last five years by Deloitte is currently around 90 per cent complete, and CommInsure said it had not revealed any “systemic issues” regarding inappropriate denials of claims. The company and independent reviewers have “electronically” reviewed more than five million emails and documents, manually reviewed around 200,000 documents and carried out around 80 interviews as part of the process.
Hmm, well, here’s what another “independent” source (Adele Ferguson and Four Corners) said:
The life insurer has disputed the prognosis of three specialists. Pashalis has accused CommInsure of “tormenting” a dying man who wants the money to plan his daughter’s education and future. He has never met the CommInsure doctors who made this call.
“I was classified as terminal, still am. Yet they declined.”
His case – which CBA finally moved to settle with an offer to Pashalis on the eve of this investigation being published – is part of a pattern of unethical behaviour within CommInsure exposed in a joint investigation by Fairfax Media and Four Corners.
It is behaviour laid bare in explosive internal documents, in numerous case studies and in the powerful testimony of whistleblower Dr Benjamin Koh.
Koh is a highly credentialed physician and was CommInsure’s respected chief medical officer. Appointed with great fanfare in 2013, he departed in disgust just two years later.
Koh agreed to speak about CommInsure’s treatment of its customers’ claims after repeatedly and unsuccessfully trying to speak out as a whistleblower inside the company. “It goes to the fundamental core of ethics of me being a doctor, of me doing the right thing,” he says.
In addition, Fairfax Media and Four Corners have obtained explosive internal documents, which were presented to and verified by Koh, suggesting the repeated use of delay tactics to avoid paying out claims and CommInsure using questionable and outdated medical definitions to deny customers their due.
There are allegations of claims managers cherry-picking doctors to get the prognoses they seek, and doctors being asked to change their opinions. In some cases, the files of claimants have gone missing.
It is systemic conduct that sick and suffering CommInsure customers say has added to their trauma; conduct that has broken trust with those the company is required to deal with in “utmost good faith”.
CommInsure has more than 4 million policyholders Australia-wide, and it collects $2.5 billion in premiums from them each year. In the past six months, it made a profit of $191 million for its parent company, the Commonwealth Bank, Australia’s biggest bank.
Every year, millions of Australians are funnelled into CommInsure life insurance policies through their industry super funds, as was the case with Pashalis, or through retail or corporate funds administered by Commonwealth-owned Colonial First State.
Others buy CommInsure life insurance, trauma insurance or income protection insurance through financial advisers, often through CBA’s army of financial planners.
It was Koh who, in mid-2014, audited the company’s trauma policy and found that it was using an outdated and discredited method for defining heart attacks. He warned it was an indefensible practice that potentially disadvantaged many customers and had the potential to tarnish the brand.
Now, who to believe…
And they wonder why folks are electing system wreckers.
This article was first found at: http://www.macrobusiness.com.au