CBA denies misconduct in breast cancer claim

CommInsure had rejected the customer's breast cancer claim because she didn't meet their medical definition – one that was found to be out-of-date.

In a written submission to the Hayne commission, CommInsure said there was no evidence that it acted “less than honestly, or capriciously or unreasonably”, and that the documents before the commission and the evidence of CommInsure managing director Helen Troup do not support such a finding.

“Rather, the evidence suggests that CommInsure acted honestly and upon the opinion of its medical officer, who took the view (which was not, on its face, unreasonable) that ‘radical surgery’ for breast cancer meant a mastectomy,” the submission said.

“When the original determination of CommInsure was challenged, CommInsure caused its medical officer to reconsider the position having regard to further and other information provided by the [customer].

“In so doing, CommInsure acted consistently with the duty of utmost good faith.”

CommInsure said it accepts that, in failing to give adequate consideration to differences in medical opinions concerning the nature of the surgery undertaken by the customer and failing to escalate her claim for review, its conduct fell below community standards and expectations.

“CommInsure has acted to remedy those aspects of its handling of the [customer’s] claim that fell short of community standards and expectations,” it said.

“In particular, CommInsure paid the [customer’s] claim plus interest in 2017, recognised that the claim ought to have been met earlier and has apologised for the shortcomings in the way in which the [customer’s] claim was handled.”

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].