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'Profit first, everything else is second.'
Whistleblower Ben Koh was chief medical officer at CommInsure, until he spoke out...
PT1M31S 620 349The Commonwealth Bank's insurance arm CommInsure has appointed three independent members to its new claims review panel as part of its response to a scandal in its life insurance business.
The appointments follow a joint media investigation between Fairfax Media and 4 Corners into unethical practices at CommInsure which included the testimony of a whistleblower, former chief medical officer Dr Benjamin Koh, that claims managers had pressured doctors to change their medical opinion to deny claims.
CommInsure was also caught out using out-dated definitions of heart attacks and rheumatoid arthritis to deny claims. The definitions for those two conditions have since been updated but CommInsure is only backdating the definition to claims made after May 2014.
Michael Gill was declined cover by CommInsure which ruled his rheumatoid arthritis had an out of date definition.
CommInsure has appointed former AMP chief legal officer and former Financial Ombudsman Service board member Chris McRae to the panel.
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He will join Monash University professor Justin Malbon, a representative on the Investments, Life Insurance & Superannuation panel for FOS and a former member of the Superannuation Complaints Tribunal. Dr Stan Goldstein, who was previously head of clinical advisory at Bupa Australia, has also been appointed.
A sub-committee of the CommInsure board will monitor the outcomes of the panel. The subcommittee comprises independent non-executive directors. CommInsure's independent non-executive directors include Geoff Austin, a former CBA executive who worked at the bank in the early 2000s.
Stronger decision making
CommInsure managing director Helen Troup said the appointments of the independent panellists strengthened CommInsure's "decision making process for complex claims".
Only complex claims which have been declined will be referred to the panel. Other panel members will be appointed in coming weeks.
It is not clear how CommInsure defines a complex claim and how it makes that adjudication.
Regarding the updating of decade-old definitions for heart attacks and rheumatoid arthritis, Ms Troup said, "Our product disclosure statements have been updated and we will also write to impacted policy holders by the end of June to tell them about the changes."