ASIC finds no evidence that CommInsure pressured doctors to change medical opinions

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The corporate regulator ASIC has found no evidence that the Commonwealth Bank’s insurance arm, CommInsure, pressured doctors to change their opinions so that claims could be denied.

The bank has been under intense scrutiny over the insurance claims made by a whistleblower, facing questions in parliamentary committee hearings

The big four banks have also been hit by a series of scandals including faulty financial planning advice to customers and restricting payouts for disability insurance claims.

ASIC has been investigating CommInsure’s practices, including reviewing 60,000 documents and interviewing staff.

The latest findings agree with an expert report by Deloitte, commissioned by Comminsure, which could not identify any systemic issues relating to declined claims.

“ASIC found no evidence to support allegations that CommInsure claims managers applied undue pressure on doctors to change or alter their medical opinions,” the regulator said in a statement today.

CommInsure had trauma policies with medical definitions that were out of date with then current medical practice, including heart attack and severe rheumatoid arthritis.

However, ASIC says this isn’t against the law. An insurer can set out the level of cover its policy provides, including out of date medical definitions as long as these are clearly disclosed.

CommInsure has since updated its medical definitions, including for heart attack and severe rheumatoid arthritis, applying the updated heart attack definition back to May 2014.

ASIC says it identified a number of areas where CommInsure needs to make improvements to its claims handling.

Improvements include better and more timely communications with consumers and enhanced training and assistance for claims managers.

ASIC is continuing to investigate concerns that CommInsure’s advertising and promotion of life insurance policies to consumers contained potentially misleading or deceptive information.

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