By now, many (if not all) of you would have seen some news article or commentary on the CommInsure scandal – with the ASA now calling for a royal commission.
This follows in the wake of the former Chief Medical Officer of CommInsure filing an unlawful termination claim, and making damaging allegations of missing files, manipulation of medical reports and “artificial” declining of claims that should have been accepted across a major TV network during the week.
The flow on of these unbelievable revelations is the inevitable conclusion that legitimate claims of the sick and injured were delayed and often denied through manipulation of opinions and diagnosis, the purposeful disappearance of medical files and the cherry picking of evidence.
But does this stop at this CommInsure scandal or is this a systemic issue among many Australia life and TPD Insurers? Exactly how far does this go inside the Insurance Industry?
We are particularly well positioned to provide some insight into one side of this issue – having direct experience with clients making these types of claims, and the insurers delaying, postponing, negotiating or denying them.
Often, these insured individuals are simply seeking access to payouts within their policies for which they have paid insurance premiums (often over many years), after they have suffered an accident, injury or illness. In many cases these individuals cannot return to work and need these payouts to continue with their lives.
Frequently, the injured individual is supporting people other than themselves and genuinely needs access to financial support and stability that they have had the foresight to insure for via these policies of insurance.
We often hear from clients on their struggles with trying to approach their insurers in these circumstances – like those brought to light in this CommInsure scandal.
From them we hear things like:
- I completed all their paperwork, there was so much of it with so many questions;
- I did everything they asked;
- I went to see all their doctors;
- They wouldn’t give me their reports;
- They wouldn’t tell me what the reports said or what their decision was;
- They wouldn’t tell me how long it would take;
- Ultimately I just couldn’t speak to anyone who would give me an answer.
Many individuals have then had to seek specialist legal advice and only after pushing, threatening complaints and finally litigation had their claims accepted. The evidence never changed and was always available to the insurers, but they stretched it out for years and years.
We have so many examples. Too many examples.
On one recent claim we handled, exactly this happened.
The insured benefit was for almost $1,000,000, and our client had not worked for many years at the time she first lodged her application for TPD. She was so unwell she couldn’t do it herself and had a relative helping her.
She lodged everything asked of her and attended all medical appointed. Still, no results.
Eventually after 2 years of waiting, she came to speak with our Director Faran Gouldson.
Her situation was ridiculous, as the medical evidence clearly satisfied the definition of TPD under the policy, but the insurer was just refusing to make a final decision on the claim, and just continued to avoid making a decision. How many people give up at this point, and don’t seek out specialist superannuation legal advice? For my liking probably far too many individuals, who truly need access to this insurance payout in order to support themselves, their families and often, to adjust to life post-accident or injury.
Only through litigation was our client granted access to her insurance payout for TPD. Having seen how exasperated she was with the situation, we can see why some individuals get overwhelmed and end up giving up.