report into its investigation of CommInsure<\/a>, ASIC also stated that it found no evidence to support allegations that the insurer applied pressure on doctors to change medical opinions.<\/p>\nASIC said it also found there were no breaches of the law in the CommInsure surveillance processes and neither was there any compromise of a CommInsure database.<\/p>\n
ASIC will, however, continue an investigation into whether CommInsure advertising and promotions of life insurance policies to consumers prior to March 2016 contained potentially misleading or deceptive information.<\/p>\n
Regarding the issue of the outdated medical definitions for heart attack and rheumatoid arthritis the report states, “ASIC found that there is no legal basis for us to take enforcement action in relation to this concern.”<\/p>\n
“ASIC found that there is no legal basis for us to take enforcement action in relation to this concern.”<\/h6>\n
“This is because the law allows the insurer to set out the cover its policy provides and to define what it means by various terms including medical terms. Under the law, it can use definitions that are out of date, as long as it clearly discloses those definitions in the policy,” the report stated.<\/p>\n
The regulator said an insurer could also continue to sell policies which have outdated definitions and while this was also not against the law \u201c\u2026it is clearly out of step with community expectations, given that consumers cannot be expected to know whether a medical definition is already outdated when they purchase life insurance\u201d.<\/p>\n
“As set out in our broader review of life insurance claims handling, this is an industry wide issue that needs to be addressed, including through the recently announced Life Insurance Code of Practice,” ASIC stated in the report.<\/p>\n
In response to the investigation, CommInsure has stated it would further backdate the application of its updated heart attack definition to October 2012 after having previously backdated them to May 2014.<\/p>\n
CommInsure would also make improvements in the areas of better and more timely communications with consumers and enhanced training and assistance for claims managers, after these were identified as areas of concern by ASIC.<\/p>\n
The effectiveness of the changes will be examined under an implementation review conducted by an independent expert in mid-2018.<\/p>\n
ASIC’s investigation into CommInsure began in April 2016 following allegations made in mainstream media a month earlier that the insurer had was using\u00a0outdated medical definitions, ‘cherry-picking’ doctors to support a particular claim decision strategy and deliberately delaying decisions about claim outcomes.<\/p>\n
The investigation included an examination of around 60,000 documents, interviews with the financial and legal advisers of CommInsure clients, reviews of client files from CommInsure, the Financial Ombudsman Service and the Superannuation Complaints Tribunal and consultations with APRA, external legal advisers and independent expert medical advisers.<\/p>\n","protected":false},"excerpt":{"rendered":"
The Australian Securities and Investments Commission (ASIC) has found that CommInsure did not break any laws in its handling of claims but was critical of its use of out of date medical definitions.<\/p>\n","protected":false},"author":3,"featured_media":36539,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[8294,48,8],"tags":[4247],"class_list":["post-36467","post","type-post","status-publish","format-standard","has-post-thumbnail","category-claims","category-company-news","category-compliance-regulation","tag-feature"],"_links":{"self":[{"href":"https:\/\/riskinfo.com.au\/news\/wp-json\/wp\/v2\/posts\/36467","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/riskinfo.com.au\/news\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/riskinfo.com.au\/news\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/riskinfo.com.au\/news\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/riskinfo.com.au\/news\/wp-json\/wp\/v2\/comments?post=36467"}],"version-history":[{"count":0,"href":"https:\/\/riskinfo.com.au\/news\/wp-json\/wp\/v2\/posts\/36467\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/riskinfo.com.au\/news\/wp-json\/wp\/v2\/media\/36539"}],"wp:attachment":[{"href":"https:\/\/riskinfo.com.au\/news\/wp-json\/wp\/v2\/media?parent=36467"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/riskinfo.com.au\/news\/wp-json\/wp\/v2\/categories?post=36467"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/riskinfo.com.au\/news\/wp-json\/wp\/v2\/tags?post=36467"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}