CommInsure had rejected the customer’s breast cancer claim because she didn’t meet their medical definition – one that was found to be out-of-date.
In a written submission to the Hayne commission, CommInsure said there was no evidence that it acted “less than honestly, or capriciously or unreasonably”, and that the documents before the commission and the evidence of CommInsure managing director Helen Troup do not support such a finding.
“Rather, the evidence suggests that CommInsure acted honestly and upon the opinion of its medical officer, who took the view (which was not, on its face, unreasonable) that ‘radical surgery’ for breast cancer meant a mastectomy,” the submission said.
“When the original determination of CommInsure was challenged, CommInsure caused its medical officer to reconsider the position having regard to further and other information provided by the [customer].
“In so doing, CommInsure acted consistently with the duty of utmost good faith.”
CommInsure said it accepts that, in failing to give adequate consideration to differences in medical opinions concerning the nature of the surgery undertaken by the customer and failing to escalate her claim for review, its conduct fell below community standards and expectations.
“CommInsure has acted to remedy those aspects of its handling of the [customer’s] claim that fell short of community standards and expectations,” it said.
“In particular, CommInsure paid the [customer’s] claim plus interest in 2017, recognised that the claim ought to have been met earlier and has apologised for the shortcomings in the way in which the [customer’s] claim was handled.”
Lies, Lies and more Lies, the Banks and Insurance companies just can’t help continue to spin utter rubbish to try to defend themselves and usually ASIC let them get away with it.
CommInsure and CBA tell that many lies that they actually believe them themselves.
Sad, sad Banks and Institutions just don’t get it and never will.
The protected species (CBA), moves on unscathed.
a bit bloody late now to be putting resources into spinning the outcome, seeking to virtue signal of some pretext of commercial imperative. All the while from the clients perspective a really poor (in fact dreadful) experience. And in part there in lies the problem – I go to my clients (as an adviser) – with a long held view that Comminsure – as one of the better in the market – and one of the more expensive – will have a better assessment process, a better client treatment, – not a mealy mouthed commercial expediency as their core business approach. The comminsure people I deal with are gobsmacked and saddened by this case and the actions of their team.
The evidence and statements of the former chief medical officer ( who was drummed out of CBA for not going with the flow) are in stark contrast to this approach – frankly a load of bollocks.
In essence – nothing changes – Note to CBA and Comminsure – if you want to be held in high regard – then the proper course of action is not a denial, not some spin trickery, “as the terms of the RC state” to act in what would be considered to be acceptable public conduct” – this fails and fails badly.
The advisers have some power here. Gather up and file these rejected claims and articles and tell your clients we don’t recommend Comminsure for these very reasons. [b]If you don’t you are not acting in the clients best interests [/b]
Insurers just need to cop it sweet. Indefensible conduct is indefensible- the court of public opinion has been in session with the insurers not doing a great job in defence of their behaviour. The RC is the capstone of this.
Well, they would say that wouldn’t they?