CommInsure has named two independent expert groups to oversee the insurer’s review of declined life insurance claims and possible issues around its policy wording and definitions and claims handling.
The insurer has appointed audit and consulting group Deloitte Touche Tohmatsu (Deloitte) as an independent expert to select and review a representative sample of declined claims over the last five years to 30 April 2016.
Deloitte will use that sample to ascertain whether the declined claims need further action by CommInsure and will make recommendations to its board as to changes that could be made to its claims policies and procedures.
CommInsure said the selection of claims, their assessment and the recommendations and the reporting would be carried out independently with no input from CommInsure, the CommInsure Board or the Commonwealth Bank.
While Deloitte will cover past declined claims, legal firm DLA Piper has been commissioned to investigate claims made in the media in March and April of this year regarding CommInsure’s policy wording and definitions, claims handling, interaction with medical practitioners, medical file and record keeping and treatment of staff and governance.
The insurer has also added one further member to its Claims Review Panel announced in mid-April with Dr Robyn Napier appointed as an external member.
Napier is a general practitioner, Chair of MDA National’s Cases (Eastern) Committee and Corporate Social Responsibility Committee, AMA (NSW) Medical Secretary and Medical Director and past AMA Federal Councillor.
I wonder just how “EXPERT” these entities are when it comes to understanding the complexities of the Life Insurance Industry and the interweaving components that can impact on claims.
I don’t like to be rude, though I find it hard to accept that a Legal firm would understand wording and definitions, claims handling, interaction with doctors, medical files and record keeping and treatment of staff and governance.
One thing I have learned from 30 years in Business, is if you broaden the scope of work for a lawyer, you exponentially complicate the process and pay higher and higher fee’s, to end up with a report that only Lawyers can understand and the original purpose of the commission being lost in translation.
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