Legitimate payout claims of sick & dying rejected;
Doctors pressured to change opinions & diagnoses;
Medical files disappear from internal system;
Claims deniers cherry-pick evidence;
Denial is systemic among most Australian insurers
The insurance arm of big-4 bank CBA has been exposed for systematically and unconscionably denying life insurance and disability payments to sick and dying Australians.
Former chief medical officer Dr Benjamin Koh yesterday publicised the pressure doctors face to change opinions and diagnoses, the customised medical definitions relied upon to deny claims and the disappearance of medical files to deliberately frustrate policy holders.
The dishonest practices stem from a deeply entrenched culture of prioritising profit over clients’ interests and have reportedly resulted in thousands of legitimate claims being denied.
Policy holders are lining up with accounts of repeated denials of claims during times of severe illness and crippling stress.
We now know the deliberate denial of payments – disguised on medical grounds – is systemic.
Overview: The disingenuous claim deniers
According to veteran injury and insurance litigator Peter Carter, “An unscrupulous denial culture is well entrenched in most Australian insurance houses.”
“Insurers rely on their economic power and a weakened legal system to hold out legitimate claims,” he explains.
In order to claim life insurance under its TPD (Total Permanent Disability) cover, you must meet a definition of permanently disabled, which means a medical practitioner has certified that you meet one of the following criteria:
- Loss of function
- Loss of independent existence
- Unable to work
- Unable to perform home duties
In determining whether you meet CommInsure’s criteria and can therefore claim TPD cover, it assesses your medical and personal history.
Medical assessments are done by practitioners for the claimant and practitioners for the insurer, and it is these assessments that are being called into question as inaccurate and dishonest, among other CommInsure practices.
Carter Capner Law has today received calls from denied claimants and intends to file proceedings against the company in the coming weeks in the Federal Court for breaches of the Insurance Contracts Act, the Australian Consumer Law and the ASIC Act.
Claimants against Comminsure or any other life or general insurer can register their interest on the Carter Capner Law website or call Peter Carter on 3210 3444.
Please don’t hesitate to contact us on (07) 3210 3444 for more information.