CommInsure Claims No Systemic Issues Around Declined Claims

CommInsure has stated that independent reviews of past declined claims has not found any systemic issues around the insurer’s actions with around three quarters of selected declined claims having already been reviewed.

The Commonwealth Bank (CBA), owner of CommInsure, has released a statement outlining the progress of the review which was the result of media reports raising questions around the processes and criteria used by the insurer when assessing claims.

The statement said good progress was being made on the independent reviews of declined life insurance claims sourced through retail advice and group life arrangement and ‘…over 70% of the past declined terminal illness, death, trauma and total permanent disablement claims selected by Deloitte have now been reviewed’.

“…there is nothing that supports the assertion of systemic inappropriate decline of claims…”

“While there is more work to be done, from the work we have done to date there is nothing that supports the assertion of systemic inappropriate decline of claims,” CBA stated.

CBA also denied that claims staff received incentives to decline claims with an independent review of claims staff key performance indicators for 2015-2016 finding they did not raise issues that created adverse customer outcomes, with the bank adding any incentives on offer only made up a small portion of overall staff pay.

The bank also denied that medical files were maliciously deleted or tampered with and that internal and independent investigations found no evidence to support such claims.

CBA did not directly answer the question of whether its heart attack and severe rheumatoid arthritis definitions were out of date but stated that an update planned for both definition for late 2016 was brought forward to March of this year and backdated to May 2014.

As a result of that change it had written to 630,000 former and current customers notifying them of the change with a search of previously declined claims resulting in payments to 17 people who become eligible under the new backdated definitions.