‘No systematic decline of claims’, CommInsure says

CommInsure says more than 70 per cent of past declined terminal illness, death, trauma and total and permanent disablement (TPD) claims selected by Deloitte have been reviewed.

“While there is more work to be done, from the work we have done to date there is nothing that supports the assertion of systematic inappropriate decline of claims,” the insurer said.

It said separate independent review of its claims handling processes is also under way and scheduled to be complete by the end of 2016.

CommInsure said following an independent review of key performance indicators (KPIs) for claims staff in 2015 and 2016, it is satisfied the KPIs “did not raise issues that would lead to adverse customer outcomes”.

“KPIs were found to be balanced between good quality decisions and customer experience, along with people and productivity, and incentives generally represent only a small portion of their overall pay,” it said.

“Our claims staff are well-trained and experienced, and have a strong focus on fair customer outcomes and values.”

CommInsure added that it searched for previously declined claims backdated to May 2014 to reassess against its updated definitions of heart attack and severe rheumatoid arthritis that was brought forward in March.

It said it has paid 17 customers who became eligible as a result of the reassessment.

“We have a similarly small number of claims to review where customers have provided more information to us and we are following up with other customers.”