On Wednesday, CommInsure managing director Helen Troup was questioned by counsel assisting Rowena Orr about whether the bank had misled the Financial Services Ombudsman (FOS) after one of its customers sent a complaint to FOS about CommInsure denying their trauma insurance claim.
Ms Orr asked Ms Troup whether, in one of CommInsure’s emails, it was fair to say its group customer relations officer misled FOS into thinking it didn’t have a medical report on whether the customer satisfied the updated heart attack definition, when in fact the opposite was true.
“Do you accept that?” Ms Orr asked.
“Yes,” Ms Troup responded.
“Is that acceptable, Ms Troup?” Ms Orr said.
“Absolutely not,” Ms Troup said.
Ms Orr also noted the medical opinion CommInsure sent to FOS in response to their request for justification in rejecting the customer’s claim.
She pointed to a sentence in that medical opinion, and asked Ms Troup whether it conveyed that CommInsure didn’t have an opinion about whether the customer met the updated definition of a heart attack, when in fact it did have an opinion and that it was favourable to the customer.
“That’s right,” Ms Troup said.
Ms Orr then asked whether CommInsure had made a decision to redact the part of the medical opinion favourable to the customer from the version it sent to FOS?
“That’s right,” Ms Troup said.
“And this email to FOS was misleading, was it not?” Ms Orr asked
“Unfortunately, yes,” Ms Troup conceded.
Whats the common thread in lot of the RC items…ASIC pandering to the big insto’s or doing nothing…the buck stops at the top….In the words of a famous man- Kell your fired.
You realise FOS referred the matter to ASIC… ASIC did nothing. Just asked Commnsure to resubmit the relevant documents to FOS.
How can Kell and Mullaly explain this?
It’s a clear and disturbing pattern of virtually no action against institutions.
Are you a fit and proper person if you mislead the regulator, deceive your clients, doctor the client’s advice files, decline their insurance claims because you want to make more money? Have you acted in utmost good faith when you wilfully decline a claim to make more money and ignore medical opinion?
The answers are obvious. Unfortunately, we have a captive regulator who is simply not able to stand up to the big players. The biggest and most shocking casualty of the Royal Commission will be ASIC. It has failed at every level and every opportunity. The twin peaks regulatory model has been utterly discredited. APRA was turned upside down after the HIH Royal Commission; now its ASIC’s turn and the medicine will be poisonous….to industry but fatal to ASIC.
watching the live feed now TAL you should hang your head in shame, this is at a product level for god sake when will the real issue be addressed and give up on this adviser witch hunt
I was a senior planner at CBA for 5 years and I once met a client who had called CommInsure about filing a trauma claim as she had a cancer event which required a hysterectomy with chemo. The person who anwsered said they would check with a claims manager and put her on hold, only to come back minutes later to say it wasn’t a claim. This poor lady 2 yrs later when I met her said she didn’t want to pursue it again. How many hundreds of policy holders have rung up to make a claim and been told over the phone it wasn’t a claim and believed them? There would not be any notes in the system at CommInsure and no way to check this. I have since helped 2 other clients with CommInsure claims that were similar. One was a Trauma claim that went back over 10 years! I got CommInsure to admit fault, pay the claim with interest and refund all the premiums!!! ADVISERS ARE THE ONLY PEOPLE DEFENDING AND PROTECTING THE CLIENTS!!! WAKE UP STUPID POLITICIANS!
You shouldn’t have commented on this as ‘Anonymous’ in my opinion. You should have put your name up in lights for this exemplary service as an adviser doing what WE do. You deserve far more credit than you’ve given yourself – for the claim work AND your comments! Bravo,…
Again and agin we see that its is Management and not the Adviser . The vast majority of advisers are Honest, Decent People who fight and advocate and act in our clients best interest. I can not say the same for Management irrespective of the insurance institution …. disgusted!
110% agree with that sentiment but what Advisers should now be asking is why are planners getting all the blame, why are we having all the red tape imposed on us, why are we having to pay levies. Why are we now turning people away that need our advice. Quite frankly I’m sick of it.
Even if you’re honest but you roll around with Pigs you’ll have mud on you. We as advisers are all well positioned to select who we roll around in the mud with. We need to think before handing over $1,000 to the FPA, and think who we’re licensed under.
CommInsure and many others have a very shady history of rejecting claims. Unless you know what you are doing and have a legal team behind you it is highly unlikely your claim will ever be paid unless extremely obvious you are tpd’d or dead. I’m surprised you don’t have to drag in a corpse to get a cheque. Shame on you comminsure. Your claims documentation is so complex it is near impossible to have two doctors sign off on the papers without spending hours filling in the forms.
That’s OK, they will make it back by charging that corpse Adviser Service Fees!
Despite the litany of wrongdoings, neither APRA nor ASIC have imposed any real penalties. For all the searing criticism, the irony of APRA’s report into the ethical vacuum in which the CBA has operated is that it perpetuates the very climate it condemns. All rhetoric and absolutely NO action, not helped by defunding both regulators.
And let’s not forget that our current PM vehemently denied the need for this RC. In the end he had to be dragged kicking and screaming by those in his party that thought there might be a few votes in it.
i assume people are being sacked
My heart sinks when I read stories like this… I think about the person and their family. The stress and pain they have gone through, with absolutely no recourse as CommInsure simply lied to the Tribunal without any fear of consequence. If anyone doubts the reason we needed the Royal Commissions then this simple case sums up why we did.
The level of illegality is breathtaking. This goes way beyond unethical into the realm of criminality. Put some of these people in gaol !
Send white collar females to gaol? Very unlikely to happen in the PC age – unless we get a quota to even up the number of people incarcerated to eliminate any gender bias.
Hi Judy, could you send the standard press release out please. Just note the following amendments:
It’s not us. I blame the financial adviser. (insert the usual text here Judy)… The one that goes.. What we need is more reform in the financial advice space, more education and whilst we’re at it… we’re forcing our staff to join the FPA (we’ll pay for it & please tell payroll). We’re committed to moving forward nothing to see here, blah blah insert standard text here please.
Oh and could you please tell Audit to throw say, 5 financial planners (don’t pick any good writers) under the bus for us with ASIC.
Please move my 11am back 15 minutes as I’ve got to call the FPA and tell them I’m writing out a cheque and we need a united message on this.
Kind regards.
CEO of Comminsure.
That’s just gold and it sums up exactly what the attitude is that these sanctimonious a-holes will no doubt adopt too! Meanwhile, the ‘Kelly O’Dwyers’ of the world will continue to behave like saviours to the masses by crucifying the INDEPENDENT advisers out there that are actually doing the right thing by their clients. Why does this whole thing JUST STINK so much???!!!
Ps Judy , keep the direct TV insurance adds going … its getting great premiums in , and hey , no pesty financial planners to try and get a claim paid !!! Why are they still writing insurance , didn’t we legislate to get rid of hard working Life insurance lifewriters ?? .
This is evil, greed, dishonesty, unethical despite of earnings in billions. I really feel for the poor guy who has been robbed of his rights. I hope he is still alive and get the compensation and BIGGGGGG apology.
Was there an adviser involved ?
Wowwwwwww! I’ll be watching this space with keen interest the next few weeks…I actually saw this conversation live as it went to air and was staggered with the honesty and admission by Helen Troup.
Just dodgy behaivour that hurts the whole industry –
This is disgusting, nothing more, nothing less.