News Corp’s Herald Sun newspaper has published a series of articles reporting claim disputes involving three AFL footballers.
The footballers – Angus Brayshaw, Nathan Murphy and Paul Seedsman are reported by the newspaper as having been medically retired by an independent expert AFL panel due to concussion-related conditions they suffered as AFL players.
The Herald Sun articles document a series of issues relating to what it reports as invasive tracking of the three claimants by the insurer, Zurich, in a bid to avoid compensation payouts. These actions have been labelled unethical and immoral.
Arguments reported by the Herald Sun as being put forward in support of the claimants include:
- Unreasonable delays in assessing the claims
- Unreasonable requests for additional medical tests
- Inappropriate, unnecessary use of personal information obtained by a social media firm as part of monitoring the day-to-day activities and the lifestyle of the claimants where there is no dispute over medical facts
- Failure to release information regarding one of the claimants’ cognitive assessments, conducted on behalf of the insurer
- Criticism made by an independent concussion expert contacted by the Herald Sun stating elements of the forensic data collection tactics were above and beyond what would reasonably be accepted from an insurer to assess a claim
When contacted, Zurich provided the following statement, sections of which have also been included in the Herald Sun reporting:
In order to protect the privacy and confidentiality of our customers, Zurich does not comment on the specifics of individual cases or claims.
All cases are assessed individually in accordance with Zurich’s standard claims process and relevant policy terms, which may include consideration of available evidence and could involve engaging an Independent Medical Expert (IME) to undertake an objective assessment.
As set out in the Life Insurance Code of Practice, insurers, including Zurich, may rely on information that is in the public domain. Publicly available online information could include material such as passwords. However, Zurich does not, nor would it ever, specifically seek to obtain or use this type of material.
More generally, as an insurer with significant involvement across the Australian Football League (AFL), we acknowledge the ongoing work of the AFL and the AFL Players’ Association – including recent enhancements to the AFL & AFLW Players’ Injury & Support Fund and the introduction of a new Severe Injury Benefit – to ensure that appropriate safeguards and support mechanisms are in place for professional footballers at risk of experiencing repeated head trauma, concussion and the subsequent development of Chronic Traumatic Encephalopathy (CTE).
These are challenges facing professional contact sporting codes, clubs and associations across the globe, including in Australia.
The Herald Sun notes these complaints have been reported to ASIC and that the Australian Financial Complaints Authority has already recommended Zurich pay one of the players’ claims.
A spokesperson at the authority advised the AFCA statement reported in the Herald Sun is not a public document and was not shared with the Herald Sun by AFCA.
The AFCA spokesperson also stated that due to confidentiality and privacy rules governing its work as an ombudsman service, it cannot disclose information about any individual complaint – including whether it has received a particular complaint.
Riskinfo notes that for most complaints, an AFCA determination is legally binding on the financial firm if the complainant accepts the decision. However, the complainant is not obligated to accept the decision and can still take their complaint to court.
