Australia's CBA rejected heart attack insurance claim using outdated model

Send a link to a friend  Share

[September 12, 2018]   By Jonathan Barrett and Paulina Duran

SYDNEY (Reuters) - The insurance arm of Commonwealth Bank of Australia rejected a trauma payout to a customer using outdated criterion that found his heart attack was not severe enough, a powerful public inquiry into the financial sector heard on Wednesday.

The inquiry or the Royal Commission, which can recommend criminal prosecutions and tougher regulations, also heard that CBA's CommInsure withheld relevant medical information when the claims dispute was brought before a complaints tribunal.

Details of the 2014 case started emerging in media reports in 2016, sparking concerns that the sector was relying on outdated medical definitions to avoid paying out claims.

[to top of second column]

Practices such as this, as well as the sector's high-pressure tactics to sell and retain policies, have come under intense scrutiny with the inquiry turning the spotlight on insurers in its latest round of hearings.

Insurers, such as AIA Group and the Australian unit of Allianz, have already told the inquiry they overcharged customers.

CommInsure's original rejection of the A$100,000 ($70,990) trauma claim was based on its in-house doctor's recommendation that the patient's troponin levels did not meet the "specified severity", the inquiry heard on Wednesday. Troponin are proteins released into the bloodstream after a heart attack.

[© 2018 Thomson Reuters. All rights reserved.]

Copyright 2018 Reuters. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.  Thompson Reuters is solely responsible for this content.

Back to top