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Major bank misled ombudsman on insurance claim

Adrian Flores
Adrian Flores
13 September 2018 1 minute readShare
fake news, misleading

A life insurance business owned by one of the major banks has admitted to the banking royal commission that it misled the Financial Ombudsman Service in order to deny the payout of a trauma insurance to one of its customers.

On Wednesday, CommInsure managing director Helen Troup was questioned by counsel assisting Rowena Orr about whether the bank had misled the Financial Ombudsman Service (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 CBA-owned 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.

Major bank misled ombudsman on insurance claim
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Adrian Flores
Adrian Flores

Adam Zuchetti is the former editor of MyBusiness and a senior freelance media professional, specialising in the fields of business, personal finance and property. In 2020, he also embarked on his own business journey – inspired in part by the entrepreneurs and founders he had met through his journalistic work – with the launch of customised pet gifting and subscription service Paws N’ All.

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