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An inquiry into the conduct of CommInsure and 12 months of public scrutiny has resulted in the life insurer back peddling on its trauma policy definitions for ‘Heart Attack’ and ‘Severe Rheumatoid Arthritis’.

CommInsure has been under fire since news broke 12 months ago that the life insurer was using out-of-date trauma definitions to deny legitimate claims.

Denied claims could be eligible for reassessment

The life insurance arm of the Commonwealth has announced that it will align its trauma definitions for ‘Heart Attack’ and ‘Severe Rheumatoid Arthritis’ with prevailing medical practice. This will also bring them in line with industry change in the form of Standardised Medical Definitions, which the Financial Services Counsel anticipates will be applicable to all trauma policies commencing 1 July 2017.

For those that have had their claims denied under the former trauma definitions, there is a glimmer of hope as CommInsure declared it would backdate its definition of ‘Heart Attack’ to claims from October 2012.

“This is a very small step in the right direction. It opens the door for consumers who have had their trauma claims rejected based on out-dated Heart Attack definitions to have their claims reassessed and paid.”

Rejected Severe Rheumatoid Arthritis claims can now be reassessed

Consumers with rejected trauma claims for “Severe Rheumatoid Arthritis’ can also have their claims reassessed, but to a not so generous time period of 2014.

While many will remain sceptical about the likely outcome of many rejected claims, the fact that the insurer has already paid out in excess of $1.37 million on reviewed claims leaves some room for optimism.

“We would urge anyone who has previously had a Trauma claim rejected by CommInsure or any other life insurer for either of these two definitions to urgently seek legal advice.”

The contents of this blog post are considered accurate as at the date of publication. However the applicable laws may be subject to change, thereby affecting the accuracy of the article. The information contained in this blog post is of a general nature only and is not specific to anyone’s personal circumstances. Please seek legal advice before acting on any of the information contained in this post.

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