The corporate regulator said on Thursday it has commenced proceedings in the Federal Court against insurance company OnePath Life, alleging it failed to comply with its duty to act with utmost good faith during claims handling.
This is the first time ASIC is seeking financial penalties for a breach of this duty, following the introduction of new civil penalties in 2019.
“Insurers play an important role in providing financial security to consumers, particularly in times of crisis,” said ASIC deputy chair Sarah Court.
“Consumers need to be confident that their insurer will act in good faith and provide procedural fairness when handling their claims. Now more than ever, Australian insurers need to focus on their claims handling procedures and ensure they are meeting their legal obligations.”
ASIC’s case includes a customer with a OnePath Life income protection policy that was obtained in 2016 with advice and assistance from an ANZ financial adviser at the time that OnePath Life was owned by ANZ.
ASIC explained that in applying for the policy, the customer disclosed prior mental health-related issues.
In 2018, the customer made a claim on the policy following a shoulder injury. OnePath Life then investigated the customer’s prior medical history, which revealed more specific information about hospitalisation for mental health issues many years prior to her applying for the policy. Ultimately, OnePath Life decided not to pay out the policy on the basis that the customer had acted fraudulently by failing to disclose the hospitalisation.
ASIC alleges that, in doing this, OnePath Life failed to act with utmost good faith in the handling of the customer’s claim by:
- Failing to make clear to the customer that it was concerned that the lack of disclosure was fraudulent.
- Failing to fully investigate the customer’s explanation for the non-disclosure, including failing to speak to the ANZ adviser about the completion of the application for the insurance.
- Failing, when it avoided the policy and denied the shoulder injury claim, to inform the customer of the right to appeal the decision through OnePath Life’s internal dispute resolution process or by filing a complaint with the Australian Financial Complains Authority.
“If an insurer is concerned a customer has engaged in fraudulent non-disclosure, they must make their concerns explicit, give the customer the opportunity to respond and make proper inquiries into any explanation given by the customer before concluding that fraud has occurred,” said Ms Court.
She noted that the insurer’s duty is not just owed to whoever the insurer considers to be a perfect policyholder.
“Insurers deal with their consumers at their most vulnerable. This makes it crucially important that they ensure their customers understand their rights, including their rights of appeal if an insurance claim is declined,” concluded Ms Court.
ASIC is seeking declarations of contraventions, pecuniary penalty orders, and ancillary orders.
The case has been scheduled for a case management hearing on a date yet to be set.
Failing to make clear to the customer it was concerned that the lack of disclosure was fraudulent – is this something that the adviser should be doing or OnePath as this has been provided in all disclosures?
I thought all these product providers were supposed to be acting in their client’s interest. Is this another case of this not happening…
No doubt the costs of this will be born by me…
ASIC needs to investigate this across all insurers and super funds!!! Much worse scenarios out there than this!!
It’s London to a brick on that the ANZ adviser was not allowed to intervene on the clients behalf with the processing of the claim. At the risk of being accused to be egotistical, I’m confident this would not have happened on my watch. That’s why advisers have a value in life risk advice and claims delivery. Pity we don’t get paid enough though!
Onepath – pay up and act in your clients best interests
SO….we Advisers funding this one too?