CommInsure has used its appearance before the Parliamentary Joint Committee (PJC) Inquiry into Life Insurance to defend a review of its claims handling processes, following criticisms of an expert report which stated they contained no systemic problems.
CommInsure released the report, prepared by Deloitte, on 28 February which stated that Deloitte “…did not identify any systemic issues relating to historically declined claims” and it “did not identify any evidence that the current and planned improvements to the claims handling processes are designed in a way that could systemically deliver poor customer outcomes”.
The report, which was the final in a series of reviews and investigations first begun in mid-2016 also stated, “Given the level of coverage obtained by our sample we believe that the work performed is sufficient to have reasonably identified any matters that may systemically affect the declined claims population.”
Legal firm Maurice Blackburn criticised the report stating that it appeared to be highly selective in the types of claims chosen for review and had not gathered any input from people holding CommInsure policies.
“The terms of reference for this report appear to have been very carefully limited to ensure an outcome that does not fully account for what was clearly a dark period within CBA,” Maurice Blackburn Superannuation and Insurance Principal Josh Mennen said.
“…there was nothing in the mistakes to suggest any wilful misconduct or anything malicious…”
“We also have concerns at how comprehensive this review has been, as the report confirms that no customers have been interviewed as part of the investigation. Nor does it say that any claims staff were interviewed,” Mennen said.
In addressing the PJC, Commonwealth Bank Group Executive Wealth Management, Annabel Spring said “…the reviews and investigations showed a picture of the business which is vastly at odds with some of the commentary.”
Spring added the review also found that CommInsure did not have a culture of deliberately avoiding paying customers, nor was there evidence that medical opinions were tampered with to deny claims or that doctors were selectively chosen to provide medical opinions to deny claims.
“We made nine mistakes which impacted customers and we take them seriously…and there are 11 claims we are still looking into,” Spring said, adding that CommInsure reviewed more than 800 claims since mid-2016.
“The nature of the mistakes – there was no pattern to those mistakes. This was a review of our systems and processes and outcomes and Deloitte was looking for systematic issues. There was no pattern to the mistakes at all, and there was nothing in the mistakes to suggest any wilful misconduct or anything malicious in the nature of claims staff.”
Spring said the mistakes were the result of ‘people dealing with people’ during complex and emotional situations and “…at the end of the day, these were human mistakes.”
Spring also defended the fact that Deloitte did not contact any CommInsure customers during its review stating Deloitte was provided with all data related to the claim, including initial claim forms, file notes, correspondence and medical reports.
“If they (Deloitte) felt they did not have the information required to make a claim, whether from a customer or from CommInsure, they asked us to request of the customer and provide it to Deloitte,” Spring said.
“I cannot imagine a scenario in which it would be appropriate for Deloitte to call our customers and state ‘we would like more information from you’. At the end of the day they are CommInsure’s customers and their relationship is with CommInsure and Deloitte had full access to all that information.”
