‘Laughable’, ‘ridiculous’: CommInsure victims give their verdict

The Age, News 23/03/2017, picture by Justin McManus. Nick Bishop. Nick had a lot of trouble with Comminsure over his claim when he needed a double lung transplant. Nick with his dog Amelia. Photo: Justin McManus”Totally laughable”. That is how Nick Bishop describes the findings of an ASIC investigation into CommInsure.

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The report released on Thursday found problems with CommInsure’s medical definitions, claims handling process, advertising and remuneration but found no evidence to support allegations its staff pressured doctors.

“To say there was no corrupt activity or policies or procedures… is a total joke,” he says.

Bishop had his CommInsure claim declined in 2013 and 2014 on the chance he may receive a lung transplant. When he threatened media exposure, the bank settled.

Internal emails revealed there were concerns within CommInsure that Bishop’s lawyer and the media may “raise the issue that our decision/rationale to decline the claim is flawed”.

The claims manager wrote in an email that the public would side with the patient due to “the circumstances surrounding his medical condition and the fact that he won’t present well in front of the cameras”.

She also expressed concern though that the position the media may take when “a 57 year old male nurse, who has held life insurance cover for 12 years, is diagnosed with a terminal condition and requires a lung transplant, is unable to access his insurance benefits”.

Bishop says the report by ASIC, which didn’t speak to customers and found that doctors weren’t being leant on to change opinions, confirmed the need for a royal commission.

“Those people are taking advantage of clients when they are at their most vulnerable,” he says. ‘I don’t get it’

James Kessel describes the ASIC report into CommInsure as “ridiculous”.

???Kessel had his $1.1 million life insurance claim refused after he had a major heart attack in September 2014. He had been paying premiums for almost 30 years.

The claim was rejected on the basis he didn’t meet a medical definition that was a decade out of date. After his story broke in the media, CommInsure apologised and paid out his claim. It also agreed to back date the definition to 2014. It has since agreed to backdate it another two years.

Kessel says he is disappointed by the findings, which found that the insurer sold policies with outdated medical definitions but that this wasn’t a breach of the law.

“What is going on here? It is sickening.

Does ASIC not understand that? I don’t get it. How can this be legal?”

Kessel wants a royal commission.

“Why don’t they want one? Is it that it costs too much or they are afraid of what they will find?” he says.

Kessel says he is still yet to hear from Commonwealth Bank chief executive Ian Narev. Victims ignored

Michael Gill describes the ASIC report into CommInsure as “light on” and “disappointing.”

Gill was diagnosed with severe arthritis in December 2010 but his claim was rejected, despite the definition used by CommInsure being years out of date.

He says the ASIC report didn’t give victims the opportunity for redress or assess the impact of the bank’s decision not to back date the definition of rheumatoid arthritis to 2010.

“The ASIC document talks of “medical definitions” not “diagnostic criteria”. It refers to criteria as a definition when it is obfuscation,” he said.

He said the rheumatoid arthritis diagnostic criteria were updated by the profession in 2010 “so why was the trauma insurance documents not updated the same year?”

After the media investigation, CBA back-dated its severe rheumatoid arthritis definition to May 2014, which meant Gill wasn’t covered.

The trauma insurance policies require customers to be “deformed” by the condition, and meet other criteria including blood tests, before they can receive a payment.

However, modern treatments prevent many patients with severe rheumatoid arthritis becoming deformed, even as they continue to suffer from the pain and debilitation brought on by the condition.

“It essentially means you have to stop taking the drug and when you get deformed come back and we will pay you,” he said.

“Australian Consumer Law needs to be improved to better prevent obfuscation by insurance companies.”