Australia's CBA rejected heart attack insurance claim
using outdated model
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 [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using outdated criterion that found his heart attack was not severe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sparking concerns that the sector was relying on outdated medical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.
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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.
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