The release today of the latest CommInsure claims handling report shows CBA still has much to learn from its history of poor claims handling and treatment of members, according to Maurice Blackburn Lawyers.
Maurice Blackburn Superannuation and Insurance Principal Josh Mennen said today’s report appeared to be highly selective in the types of claims chosen for review, raising questions about whether the outcome is a true reflection of assessment practices.
“The terms of reference for this report appear to have been very carefully limited to ensure an outcome that does not fully account for what was clearly a dark period within CBA,” Mr Mennen said.
“There are a number of concerning findings that are very selective in looking at historical claims data and the impacts of this.
“We also have concerns at how comprehensive this review has been, as the report confirms that no customers have been interviewed as part of the investigation. Nor does it say that any claims staff were interviewed.
“Claims samples that have been referenced in the report are also questionable.
“For example, the biggest sample referred to in the report was Group Total and Permanent Disability (TPD), which is notoriously well known for having the highest denial rates across the industry.
“Today’s report noted there were 2,172 Group TPD claims subject to review, yet only 10% of these were selected for review. This compares to 98% of death claims being selected for review, despite such claims being well known to be amongst the least disputed in the industry.
“The report also did not look at conflicted incentives paid to review and internal staff, indeed it expressly states that this was not looked at.
“That is completely unacceptable – we know from ASIC’s reporting that decline bonuses were paid by some insurers to claims staff. CBA seek to maintain such a practice is no longer occurring, but there is nothing to outline to what extent this may have occurred in the past or what has been done about this.
“With reference to outdated definitions on heart attack, something CBA were routinely criticised for publicly last year, this report offers the view that such outdated definitions were consistent with competitors.
“That again is unacceptable and no excuse. What is clear is that CBA’s definitions for conditions such as heart attacks were out of date with medical knowledge by up to a decade, yet in rectifying this CBA has only agreed to backdate new definitions to policies entered from 2014.
“While we welcome CBA releasing more information with respect to CommInsure’s claims handling, it is disappointing to see that this continues to shows a failure from the organisation to learn from the mistakes of the past in acknowledging poor claims handling and treatment of members,” he said.