A Four Corners and Fairfax investigation aired allegations by former CommInsure chief medical officer Dr Benjamin Koh, as well as four case studies of policyholders who claim they have been poorly treated by the insurer.
Dr Koh alleged CommInsure is pressuring doctors to change their medical evidence so the insurer will not have to pay claims to policyholders.
InvestorDaily sought comment from ten of the industry funds that currently use CommInsure for their group insurance arrangements.
CareSuper chief executive Julie Lander told InvestorDaily her fund is “very concerned” about the allegations and is currently “in dialogue” with CommInsure over the matter.
“We’re very conscious about the businesses that we partner with, and that they demonstrate the right values that are aligned with ours,” Ms Lander said.
While not prompted by this week’s revelations about CommInsure, Care Super is currently undertaking a three-year review of the fund’s insurance arrangements.
“Certainly [the Four Corners allegations] will be [part of the insurance review] now – you can’t ignore those sorts of things,” Ms Lander said.
QIEC Super chair Terry Burke told InvestorDaily his fund immediately “raised the risk level” around its insurance arrangements on Tuesday.
“We put CommInsure on notice that we would be seeking appropriate clarification and explanation,” Mr Burke said.
To date, QIEC Super has not identified any “problematic” issues and, in fact, CommInsure has generally been flexible when QIEC has raised issues about insurance claims, he said.
“At this stage, they are under ‘watch’, which is appropriate from a governance point of view,” Mr Burke said.
NGS Super executive manager of customer Dascia Bennett told InvestorDaily she was in touch with CommInsure at 10am on Saturday morning when she heard the first media report.
“[CommInsure] are in the midst of providing NGS with a full review and update on whether we have any members that are impacted in regard to these media issues and complaints,” Ms Bennett said.
“At this stage, we do not have any NGS members who have come to our attention who are involved in this,” she said.
However, Ms Bennett conceded it is a “massive concern” to any fund or business partner “where you see behaviour that doesn’t meet the ethical standards and the philosophy of putting the member first”.
Kinetic Super has released a statement indicating it is taking a “proactive approach” to the Four Corners allegations.
“We are reviewing all disputed claims made in the last two years to ensure that outcomes were fair and appropriate,” said Kinetic Super.
A HESTA statement indicated the industry fund has “raised our concerns at the highest levels of CommInsure and are conducting a detailed assessment of the issues”.
“HESTA reviews the performance of our insurer and other service providers on an ongoing basis. We will continue to monitor how CommInsure are addressing these issues,” said HESTA.
Vision Super said all of its members’ TPD insurance claims denied by CommInsure were reviewed by the fund’s Benefits Committee.
“Our Benefits Committee has exercised its right to arrange independent medical advice, and a number of claims rejected by the insurer have subsequently been overturned for members,” said Vision Super.
“Because of our right under the Trust Deed to review claims and seek independent advice, Vision Super is confident that our insurance claims process is accountable, transparent and fair.”
Prime Super chief executive Lachlan Baird told InvestorDaily his fund is “very concerned” about the allegations.
CommInsure won a tender to provide group insurance to Prime Super members in January, with the arrangement set to begin on 1 May 2016.
“As we have just undertaken a competitive tender process we have also reviewed the medical definitions for a claim under all circumstances. We are confident that the policy we will shortly have in place is not reliant on out-dated medical definitions, and is appropriate for the product we offer our members,” Mr Baird said.
“Where our experience does not match with our expectations for any insurer, we will look to terminate the arrangement and go to market again to find an insurer that better meets our needs and the needs of the members of Prime Super,” he said.
Club Super said in a statement it is “clearly minding these revelations and as a result will be reviewing the risks associated with CommInsure at the upcoming board meeting”.
“[Club Super] expects all its service providers to uphold high levels of governance and ethical standards. Anything which falls short of this expectation will be reviewed and remedied accordingly,” said the statement.
AustSafe Super did not respond by InvestorDaily’s deadline.
Read more:
Hostplus adds to investment team
Online broking boosted by first-time traders
‘Brexit’ could trigger ‘wave of exits’
