Regrettable, unacceptable, inappropriate. They were words wheeled out at various times by CommInsure boss Helen Troup in response to some disturbing behaviour going on inside the division.
Troup’s words sugarcoat what is tantamount to serious misconduct in the life insurance arm’s dealings with the Financial Ombudsman Service (FOS). Dealings described by senior counsel assisting
Rowena Orr QC as not being frank and open, and which included hiding and redacting a medical opinion to mislead FOS and failing to provide FOS with relevant information.
At the end of the day, the behaviour and motives of Commonwealth Bank’s life insurance division boiled down to money. It was profit before its policyholders.
The royal commission heard how executives had known that the universal definition of heart attacks had changed years earlier and that CommInsure chose not to update its policies.
Instead, it opted to deny legitimate claims. The reason? The cost.
In one email written in 2012, the then chief medical officer, said the existing definition used in CBA trauma policies for heart attacks could discriminate against people. It required levels of an enzyme in the blood called troponin that was 20 times higher than those required by the universal medical definition of a heart attack.
“In an ideal world I would personally move to the universal definition from 2007,” the chief medical officer said.
His advice fell on deaf ears. Then in May 2014 a second chief medical officer, Ben Koh, called on executives to review the heart attack definition, which was now long overdue for an update.
“Otherwise, in order to stick strictly to definitional terms there may be unnecessary time wasted, financial and opportunity costs, legal implications and the tarnishing of brand reputation when trying to decline legitimate claims that would reasonably have been admitted within the spirit of the policy," he wrote in an email.
His advice was also ignored and legitimate claims of heart attacks continued to be declined. The commission heard how an internal report into CommInsure in 2015 found that customer advocacy had worsened between 2011 and 2015. Still nothing was done.
It makes a mockery of Troup’s comments to the royal commission that the Fairfax Media and Four Corners joint investigation in CommInsure in 2016 was found to have put forward unsubstantiated allegations.
The heart of the allegation goes to the heart of a life insurance company… the accusation was we were denying claims and mistreating our customers
CBA's Helen Troup
“The heart of the allegation goes to the heart of a life insurance company… the accusation was we were denying claims and mistreating our customers,” Troup said. “Out of all the allegations that’s the one that caused me the most concern for myself, my people, my customers.”
What is most shocking about the behaviour at CommInsure is that shortly after the joint media investigation, and a day after CBA had agreed to backdate the definition of heart attacks by two years to May 2014 and apologised to customers for poor behaviour, it was at it again.
A policyholder who suffered a severe heart attack in January 2014, and had his claim denied, had read the stories and watched the program. When he saw the definition had been backdated, he decided to try again.
He was again knocked back, this time because CBA had only backdated its definition to May 2014. This was despite knowing the definition was many years out of date.
He took the complaint to FOS, which requested CommInsure hand over documents and justification for knocking back the claim. CommInsure pulled every trick in the book to obfuscate, including redacting a medical opinion that said the insured met the definition of a heart attack.
Rowena Orr QC said: “You accept that CBA misled FOS by implying that the medical opinion had not already been obtained?”
Troup replied yes.
The behaviour was so disgraceful FOS reported it to ASIC.
“Do you accept that in making decisions not to update the definition [of heart attacks] between 2011 and 2016 CMLA was motivated by commercial considerations and that it did not adequately take into account the interests of its customers in making those decisions?”
Orr put to Troup, who whispered a faint “yes”.
Perhaps Troup needs to rethink just how “unsubstantiated” the allegation is that CommInsure deliberately denied claims and mistreated customers levelled really were. Going by the evidence, it might give her some pause for thought.This article was first published by https://www.smh.com.au
Author: Adele Ferguson comments on companies, markets and the economy.