CBA misled FOS on life insurance claim: RC

On Wednesday, CommInsure managing director Helen Troup was questioned by counsel assisting Rowena Orr about whether the bank had misled the Financial Services Ombudsman (FOS) after one of its customers sent a complaint to FOS about CommInsure denying their trauma insurance claim.

Ms Orr asked Ms Troup whether, in one of CommInsure’s emails, it was fair to say its group customer relations officer misled FOS into thinking it didn’t have a medical report on whether the customer satisfied the updated heart attack definition, when in fact the opposite was true.

“Do you accept that?” Ms Orr asked.

“Yes,” Ms Troup responded.

“Is that acceptable, Ms Troup?” Ms Orr said.

“Absolutely not,” Ms Troup said.

Ms Orr also noted the medical opinion CommInsure sent to FOS in response to their request for justification in rejecting the customer’s claim.

She pointed to a sentence in that medical opinion, and asked Ms Troup whether it conveyed that CommInsure didn’t have an opinion about whether the customer met the updated definition of a heart attack, when in fact it did have an opinion and that it was favourable to the customer.

“That’s right,” Ms Troup said.

Ms Orr then asked whether CommInsure had made a decision to redact the part of the medical opinion favourable to the customer from the version it sent to FOS?

“That’s right,” Ms Troup said.

“And this email to FOS was misleading, was it not?” Ms Orr asked

“Unfortunately, yes,” Ms Troup conceded.

Adrian Flores

Adrian Flores is a deputy editor at Momentum Media, focusing mainly on banking, wealth management and financial services. He has also written for Public Accountant, Accountants Daily and The CEO Magazine.

You can contact him on [email protected].