CommInsure’s round six submission to the royal commission has been published and the insurance group has denied one suggestion of misconduct.
The Hayne royal commission has published the submissions from round six of the commission which focused on insurance. CommInsure was one of many groups that made a submission.
CommInsure, a registered business of Commonwealth Bank, accepted most of the commissions findings in its submission.
It did not accept however that it had engaged in misconduct in its handling of the second insured’s claim around radical surgery.
The commission heard that CommInsure denied the insured, known as the second insured, claim because it held the view that “radical breast surgery” in its policy definition denoted a mastectomy.
CommInsure said that the opinion of its medical officer was that radical surgery meant a mastectomy and when the original claim was denied, CommInsure caused its medical officer to reconsider the position.
“Consequently, CommInsure does not accept that it engaged in misconduct in relation to the second insured’s claim,” the submission reads.
CommInsure also reiterated that they had recognised that their handling fell short of community standards and had repaid the second insured.
CommInsure accepted that the publication of webpages and brochures may have breached s12DB of the ASIC Act which is a penalty provision; however, it dismissed the commission’s suggestion that it had not been adequately penalised.
CommInsure argue in their submission that there was no intention to mislead and that it had co-operated with ASIC in its investigation and implemented several recommendations without ASIC being involved.
“For these reasons, CommInsure submits that, on the evidence before the commission, it should be accepted that it has responded appropriately, and has been punished accordingly, in answer to the concerns ASIC raised with it in relation to the publications,” the submission reads.
The rest of CommInsure’s submissions accepted the findings of the royal commission, including that by failing to update its heart attack definition in 2012 and 2014 it had failed to meet community standards.
CommInsure accepted that it misleads FOS by not informing FOS of the reasons why it decided to apply its revised heart attack definition retrospectively in May 2014.
CommInsure also accepted that it breached the ASIC Act by publishing the four documents about its heart attack policy.
“CommInsure accepts that conduct contravened s12DA of the ASIC Act and, therefore, constituted misconduct,” the submission reads.
CommInsure has remedied the misconduct in an amendment and retrospective application of its definition.
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