The corporate watchdog has cleared CommInsure of allegations its managers pressured doctors to alter medical opinions so it could deny insurance claims but says some of its practices were “clearly out of step with community expectations”.
The Australian Securities and Investments Commission said on Thursday the outdated medical definitions the Commonwealth Bank-owned insurer used to determine heart attack and severe rheumatoid arthritis claims were not illegal but risked customers not getting the cover they expected.
ASIC said CommInsure has agreed to apply its updated heart attack definition back to October 2012 and will now start identifying affected consumers and making payments where appropriate.
In its long-awaited report into allegations of deliberately denied or delayed claims, ASIC said it had identified areas where CommInsure needs to improve its claims handling processes.
The regulator said it had found “no evidence to support allegations that CommInsure claims managers applied undue pressure on doctors to change or alter their medical opinions”.
It said it will work with Comminsure to ensure better communications with consumers as well as improved training and assistance for claims managers.
An independent expert will assess the insurer in mid-2018.
ASIC reviewed 60,000 documents following the allegations by CommInsure’s former chief medical officer, Dr Benjamin Koh, and said it still has work to do on the case.
“ASIC is continuing to investigate concerns that CommInsure’s advertising and promotion of life insurance policies to consumers contained potentially misleading or deceptive information in the period before March 2016,” ASIC said in a statement.
“We will provide a further update on this aspect of our investigation when appropriate.”