CommInsure: Who’s who in the Commonwealth Bank’s life insurance scandal?

Dr Koh has said he and his staff were told to change or delete their medical assessments if they did not suit the claims manager. In 2014, Dr Koh examined 40 other heart attack claims and concluded more than 50 per cent of legitimate claims could be rejected, based on CommInsure’s Troponin levels. Dr Koh recommended the definition be changed, but the outdated definition remains in use.

Photo: Dr Koh says he and his staff were told to change or delete their medical assessments. (Four Corners)

An internal email obtained by Four Corners/Fairfax reveals CommInsure did not dispute the severity of Mr Kessel’s heart attack. However it rejected his claim because he did not have enough of a substance called Troponin present in his bloodstream.

Cardiologists say CommInsure’s heart attack definition was out-dated and that Troponin, on its own, should not be used to diagnose severity. The email reveals CommInsure knew this, but still denied Kessel’s claim.

Photo: James Kessel’s $1.1 million trauma claim was refused despite suffering a major heart attack. (Four Corners)

In 2014, Evan Pashalis, 37, found out he had leukaemia and he was diagnosed as terminally ill. Two doctors found he was unlikely to live more than 12 months and a third gave him a 30 per cent chance of living a year.

When Mr Pashalis lodged a terminal illness claim with CommInsure and was rejected, he went to lawyer Michael Bates to help him overturn the decision. Since his diagnosis, Mr Pashalis has undergone further medical tests.

Since Four Corners approached the bank last week, CommInsure has offered a settlement to Mr Pashalis.

Photo: Evan Pashalis found out he had leukaemia in 2014. (Four Corners)

In 2013, Nicholas Bishop was diagnosed with a terminal lung condition and was given 12 months to live. He got in touch with lawyer Michael Bates after his life insurance claim had been rejected — on the basis that if he received a lung transplant he might live longer than 12 months.

After CommInsure discovered he intended to take his story to the media, Mr Bishop’s claim was finally settled.

Photo: Nicholas Bishop was diagnosed with a terminal lung condition and given 12 months to live. (Four Corners)

Helen Polydoropoulos was a customer service representative at CommInsure until she was diagnosed with multiple sclerosis in 2011. She was “ill-health retired” from the bank and was advised by the bank’s chief medical adviser, Dr Colin Johnston, to claim for “total and permanent disability”.

But when she lodged her claim she was rejected by her insurers, on the basis that she was fit for work.

Ms Polydoropoulos tried to get in touch with Dr Johnston, who signed both her letter of medical retirement and the rejection letter from CommInsure. He never returned her calls. Four Corners contacted Dr Johnston who said: “We act on the advice of specialists.”

In the four years since her diagnosis, Ms Polydoropoulos’ condition has deteriorated. She was financially struggling, and even became homeless. She now suffers from depression and has moved in with her mother.

Since Four Corners approached the bank last week, CommInsure has offered a settlement to Ms Polydoropoulos.

Photo: Helen Polydoropoulos’ condition has deteriorated in the four years since her diagnosis. (Four Corners)

When Commonwealth Bank employee Matthew Attwater developed a major depressive disorder, he was told he was permanently unfit for work, and was “medically retired” from his job as a customer services representative at the bank.

The bank commissioned a psychiatric report on Mr Attwater which found he was not fit for work.

But when he lodged his claim for Total and Permanent Disability, CommInsure relied on a phrase from the same psychiatrist to argue that he was indeed fit for work.

It took three years for CommInsure to settle Mr Attwater’s claim — shortly after he was interviewed by Four Corners. BeyondBlue chairman Jeff Kennett described the bank’s attitude to its employees as a disgrace.

Photo: Matthew Attwater was told he was permanently unfit for work, and was ‘medically retired’. (Four Corners)

Former Victorian premier Jeff Kennett is the founding chairman of mental health advocacy group BeyondBlue. In an interview with Four Corners, Mr Kennett spoke out against CommBank’s attitude to mental illness, calling it disgraceful. In relation to Michael Attwater’s case, he said that retiring an employee based on their mental health illness could do further psychological damage.

Mr Kennett has strongly questioned the life insurance industry’s ability to develop its own code of conduct and has called for outside intervention. He says he does not trust companies to self-regulate and believes a code of conduct might have to be imposed on the industry.

He has urged those with mental health issues who do not feel supported by their life insurance companies to seek support from BeyondBlue.

Photo: BeyondBlue chairman Jeff Kennett has strongly questioned the life insurance industry’s ability to develop its own code of conduct. (AAP: Joe Castro)

Ian Narev, chief executive of the Commonwealth Bank, has said ethics are a core value of the bank, and states that the claims made against CommInsure are inconsistent with CommBank’s culture, values and management style.

Mr Narev has admitted to using an outdated definition for heart attacks but says CommInsure is in the process of amending it. He has apologised and promised to personally meet with customers, brought to his attention by Four Corners. He said their experience, while unfortunate, does not reflect the experience of the vast number of CommInsure customers.

It is not the first time Mr Narev has been forced to apologise. In 2014, when accusations of forgery, fraud and a high-level cover up were levelled against the bank’s financial planning division, he made a public apology to customers and promised to clean up the mess.

Mr Narev did not comment directly about accusations made by CommInsure’s former chief medical officer, Dr Koh. Photo: Commonwealth Bank CEO Ian Narev says ethics are a core value of his bank. (Four Corners)

Litigation lawyer Michael Bates has three clients involved in the CommInsure scandal.

He represents Dr Koh, the whistleblower and former chief medical officer of CommInsure who raised allegations of unscrupulous and unethical practices by the insurer. Dr Koh was sacked from CommInsure.

Mr Bates also represents two CommInsure policy holders, Evan Pashalis and Nicholas Bishop. Both men were diagnosed with terminal illnesses, and both were declined by CommInsure when they initially filed their claims.

Mr Bates claims the charges against the bank are extraordinary — “the biggest thing I’ve heard as a litigation lawyer working in the insurance world” — even going so far as to compare them to a Hollywood plot.

Photo: Litigation lawyer Michael Bates represents whistleblower Dr Koh. (Four Corners)

Senator John Williams has met and looked into the case of James Kessel, who was denied a trauma payout despite suffering a major heart attack.

The senator has serious concerns about how CommInsure treats its customers. He has raised the prospect of investigating CommInsure’s practices in a Senate committee, which has the power to call senior executives.

In 2014, Senator Williams was also critical of the Commonwealth Bank during the scandal in its financial planning division. At the time, he questioned senior members of the bank in Senate committee meetings. Photo: Senator John Williams has serious concerns about how CommInsure treats its customers. (Four Corners)