Chair Commonwealth Bank
Dear Mr. Turner
Would you like to comment, please?
Dr. Koh is to be congratulated for his honesty.
If you consider The Commonwealth Bank has learned its lesson, then Comminsure should give Dr. Koh’s job back.
Looking forward to hearing from you soon.
Unity Party WA
Save the trees – Please use email
UPWA is the only political Party that calls a spade a spade.
Money For Nothing
By Adele Ferguson, Klaus Toft and Mario Christodoulou
Updated March 8, 2016 10:50:00
“It’s defer, deny and sit back and wait and see if someone takes them on.” Lawyer
It’s the bank that’s spent two years rebuilding its reputation after being exposed for ripping off its customers in a devastating financial advice scandal. The Commonwealth Bank is adamant that it’s learned its lesson.
“We will be the ethical bank, the bank others look up to for honesty, transparency, decency, good management, openness.” David Turner, Chair Commonwealth Bank
Now, the reporter who broke open the financial advice scandal, Adele Ferguson is back, with another investigation into the Commonwealth Bank.
Six months in the making, this joint Four Corners/Fairfax investigation focuses on the insurance arm of the bank, CommInsure.
They’re in the business of selling the kind of insurance policy you hope you never have to claim. Insurance to cover you or provide for your family if the worst should happen, like a serious health condition or death.
But this investigation will reveal how CommInsure uses unscrupulous tactics to take consumers’ money and avoid insurance payouts, leaving customers paying money for nothing at the most difficult moment of their lives.
“They are extraordinary allegations. They are certainly the biggest thing I’ve heard as a litigation lawyer working in the insurance world.” Lawyer
The findings will be released in a series of stories through Fairfax Media and ABC platforms culminating in the Four Corners broadcast on Monday night, detailing the full revelations.
Money For Nothing, reported by Adele Ferguson and presented by Sarah Ferguson, goes to air on Monday March 7 at 8.30pm EDT. It is replayed on Tuesday March 8 at 10.00am and Wednesday at 11pm. It can also be seen on ABC News 24 on Saturday at 8.00pm, ABC iview and at abc.net.au/4corners.
‘Deeply shocking’: Turnbull government demands urgent ASIC report on life insurance industry | SMH | 8 Mar 2016 – www.smh.com.au/business/banking-and-finance/deeply-shocking-turnbull-government-demands-urgent-asic-report-on-life-insurance-industry-20160307-gnd0pj.html
CommInsure: Government must consider royal commission into ‘disgraceful’ practices, Labor says | ABC News | 8 Mar 2016 – www.abc.net.au/news/2016-03-08/comminsure-scandal-cause-for-royal-commission-labor-says/7228136
Money for Nothing – 7 March 2016
SARAH FERGUSON, PRESENTER: Hello and welcome to Four Corners. I’m Sarah Ferguson.
Which bank cheats some of its most vulnerable customers in their hour of need?
Which bank? The Commonwealth Bank.
Imagine you’ve paid life insurance premiums for years on the promise that, should you be diagnosed with a serious or terminal illness, you and your family will be taken care of. Then, at your weakest moment, your claim is denied.
Tonight the former chief medical officer at CommInsure, the bank’s insurance arm, blows the whistle on a culture where doctors are pressured to change medical reports, patients’ files are deleted and claims delayed in a deliberate strategy to avoid expensive pay-outs.
In the 2014 financial planning scandal, the Commonwealth Bank was accused of defrauding its customers and covering it up. After that scandal, CBA’s bosses pledged to make it “the ethical bank”.Adele Ferguson’s investigation for Four Corners and Fairfax reveals a clear failure to live up to that pledge.
(Footage of Adele Ferguson in car outside Wee Waa, New South Wales)
ADELE FERGUSON, REPORTER: We’re on our way to outback New South Wales to meet a man who’s lucky to be alive.
James Kessel has been paying his life insurance premiums for more than 20 years, but thought he’d never need it.
JAMES KESSEL: I, I thought it was a waste of time, you know: “I, I’m never gonna need this. I’m not gonna get sick. I don’t get sick. I’m not gonna have a heart attack.” Noth… (laughs) Yeah. But it happens.
(Footage of James Kessel in shed, repairing tractor engine. He starts it up.)
JAMES KESSEL: Beautiful!
(He turns the engine off)
JAMES KESSEL: Sweet! It lives again. Whoa.
ADELE FERGUSON: September 19, 2014 was meant to be a new start for James Kessel, as he set out to begin a new job on a building site as a diesel mechanic.JAMES KESSEL: Great trip: three blown tyres on the way over. A lot of fun, a lot of swearin’.
So I get out and open the gate. And I thought, “Ooh, I’ve pulled a muscle or something.” And I thought, “Hm.”
The heat that came over me: it was… instant.
I sort of thought I knew what was happening but I was in denial. I thought I was, you now, OK, bullet-proof.
So I thought, “Right, James, get in the car and get down to the workshop.”
(Re-enactment of James’ heart attack: James is in the passenger seat of ute, speaking into mobile phone)
JAMES KESSEL (re-enactment): How ya doin’?… Not far.
ADELE FERGUSON: One of the men at the job site realised that something was wrong.
JAMES KESSEL: He said, “You’re havin’ a heart attack.” I said, “Oh, yeah. Maybe.” Threw me into the ute, got me into town. He rang the hospital on the way into town.
(Re-enactment of James Kessel being helped out of ute)
CO-WORKER (re-enactment): That’s it. That’s right.
JAMES KESSEL: And they put me in the wheelchair, got me in there and got me on the table and they started squirtin’ some stuff into my arm and I said, “Well, what’s that?” They said that’s the anti-, um, clogging agent: like, a bit like Drano.
I’m looking at the nurses and I’m thinking, “This is… I’m finished. I’m dying here.”
DOCTOR (re-enactment) OK, he’s going into arrest.
ADELE FERGUSON: Moments later, his heart stopped pumping.
JAMES KESSEL: Last thing I heard ’em say was, “He’s gone.” And I heard the thing go (makes buzzing noise). And then it was, then there was nothing.
NURSE (re-enactment): Open your eyes, James.
THAMPAPILLAI JEYKUMAR, DR., GUYRA PUBLIC HOSPITAL: If he was not, ah, given shock – or we call it defibrillate – eh, he would be dead. By no means, ah, he could have survived.
JAMES KESSEL: The doctor came over and he said, “James, you remember me?” He said, “I’m Doctor Jey.”
You know, I grabbed him by the arm with both hands, said, “Thank you, thank you, thank you. Thank you so much.” I mean, this guy just saved my life.
ADELE FERGUSON: So you died?
JAMES KESSEL: Yeah. Oh, y- my heart stopped. But, um, if I wasn’t at the hospital I wouldn’t be talking to you now.
ADELE FERGUSON: James was 46. Since he was in his early 20s, he’d been paying life insurance premiums for a trauma policy which covered him if he had a heart attack.
JAMES KESSEL: I got this policy when I was, I think, in my early 20s. So I had a, you know, I had big debts back then with, um, business. So I thought, “If I… yeah, um, something happens to me, I don’t want to leave all this mess to someone else.”
ADELE FERGUSON: In the weeks after he was discharged from hospital, he lodged a trauma claim which entitled him to a lump-sum payment.
James Kessel had no way of knowing it at the time but, here at CommInsure’s headquarters, his claim would set in train a series of events that exposed scandalous and unethical conduct within the bank.
DR KOH, CHIEF MEDICAL OFFICER NOV. 2013-AUG. 2015, COMMINSURE: I was never naïve to the fact that big business is about profits. But I think I’m a little bit disappointed when it’s profit at all cost.
ADELE FERGUSON: This man is the former chief medical officer of CommInsure, Dr Koh. He’s decided it’s time to blow the whistle on an entrenched culture of dishonest and unethical treatment of sick and dying people – his bank’s policy holders.
He agreed to be interviewed on condition we don’t show his face for privacy reasons.
DR KOH: How can someone go to bed at night with a clear conscience, knowing that somewhere in Australia there’s someone that’s dying… in their darkest hour?
You have s- an organisation that throws up difficulties, hide behind technicalities, bully their way with their medical and legal experts… against a helpless and defenceless claimant. How can that be right?
ADELE FERGUSON: Mr. Narev, does CommInsure put profit before people?
IAN NAREV, CEO, COMMONWEALTH BANK: CommInsure is a business that, hopefully like all the businesses of the Commonwealth Bank, thinks about the long term. And the long-term recipe here is that satisfied customers are good for shareholders as well.
ADELE FERGUSON: Ian Narev, the CEO of CommBank, has proclaimed ethics a core value.
IAN NAREV: Being ethical is not the same as being perfect. We need to realise we’re going to mistakes – do our best to minimise them, but realise we will make them. And one test of how ethical we are is how we respond to those mistakes when we make them. And that’s something which we will focus a great deal on.
ADELE FERGUSON: Dr Koh joined CommInsure as its chief medical officer with great fanfare in November 2013. An eminent medical practitioner with a PhD and 20 years of clinical experience, his appointment was written up in numerous industry magazines.
DR KOH: My role was chief medical officer. I lead a team of medical specialists and I also assess risks for the company.
ADELE FERGUSON: In November 2014 Dr Koh was asked to review James Kessel’s trauma claim, which entitled him to a payout of $1.1 million.
Dr Koh was startled to discover that part of Kessel’s file had gone missing.
DR KOH: It was the first instance where we had documented proof where a file was there one day and the next day it was gone.
Prior to that case there were er- always, ah… suggestions and talk in the background that medical r- records were not properly kept. Ah, files might have gone missing. Potentially it could be open to, uh, adulteration without the original author knowing about it.
ADELE FERGUSON: And that’s what prompted you to go to: who?
DR KOH: Well, before I went, ah, to my manager I did a very quick search of the record database to find out if there were similar files, uh, that’d gone missing. And I c- uncovered a few files that had blank documents. So that got me really concerned. But that is also in the context of claims assessors coming to the medical team, asking us to either delete opinions that we have given or to change an opinion that we have actually given, because it ran counter to a claim strategy.
ADELE FERGUSON: That’s pretty incredible, what you’re saying?
DR KOH: Yes. Um… so…
ADELE FERGUSON: So you’re saying that claims managers or assessors were coming to the doctors and asking them to go in and change opinions?
DR KOH: Yes. They were quite blatant about it: “Can you please change it or delete it, so that we can go to someone else to provide another opinion that’s more favourable?”
MICHAEL BATES, LAWYER, LEONARD AND WELCH: He’s clearly a man of integrity. Um, you know, he is as brave as, as they come.
DR KOH (to Michael Bates): So in prior incidents….
ADELE FERGUSON: Lawyer Michael Bates is representing Dr Koh, who was sacked by the bank after raising allegations internally.
MICHAEL BATES: There are allegations simply of unethical behaviour: people within the organisation asking these doctors to, um, delete their medical records, change their medical records, cherry-picking which doctor they go to, um, to get a report, and if they’re not happy with that, ah, they, ah, will look outside and, and obtain a report from somewhere else, where hopefully they will get the answer that they are seeking.ADELE FERGUSON: These are bombshell allegations?
MICHAEL BATES: They are extraordinary allegations. Ah, they are certainly, um, the biggest thing I’ve heard, ah, as a litigation lawyer working in the insurance world.
ADELE FERGUSON (to Ian Narev): We have evidence of a culture in CommInsure where doctors are bullied and pressured to change or delete medical records and opinions to avoid paying claims. Are you aware this happens?
IAN NAREV: Well, let me say at the outset that I’m aware and, and we’ve discussed individual cases where the outcomes that the customers have received for policies that they took out have not been good enough.
ADELE FERGUSON: But what about the allegation that doctors are being bullied by claims managers to change their opinions?
IAN NAREV: The culture…
ADELE FERGUSON: And files being deleted?
IAN NAREV: The, the culture that we’re building throughout the Commonwealth Bank – and CommInsure is no exception – is one with the customer at the centre of what we do. And..
ADELE FERGUSON: Are you aware of those allegations?
IAN NAREV: Tho- those sorts of claims would be completely inconsistent with the culture that we are building at the Commonwealth Bank and inconsistent with the way that we run the bank.
ADELE FERGUSON: Missing files, in Dr Koh’s opinion, were a huge risk.
DR KOH: I think it’s just a part-and-parcel of any kind of major institution to have robust records, because that is a documentation of history: a documentation of what transpired.
MICHAEL BATES: His allegations are that either the, ah, ah, software program at CommInsure is not robust, it’s not secure; ah, or, indeed, somebody is destroying documents.
DR KOH: When you have someone potentially going into change it without our knowledge, that draws in a whole different category – and, I would venture to say, even criminal.
ADELE FERGUSON: Dr Koh reported the missing file to IT and asked them to investigate.
MICHAEL BATES: In fact, he spoke with somebody in the bank’s IT department who confirmed that, if you had enough IT savvy, you could manipulate the information in the system.
DR KOH: I put in an IT request and I was hoping for it to be approved. I thought it was quite straightforward.
But it got declined
So I assumed initially that was a human error; that it was declined unknowingly, so I placed another request. That was declined. And I think I might have- must have placed about three different requests for it to be declined.
Then I went up to my manager, who was in a different office, to speak to him personally and say, “Why are we, why are you cancelling my request to find out?”
ANDREW ROBERTSON, REPORTER (ABC TV News, Jul. 2014): An embattled bank chief finally emerges, pledging to stop the rot.
IAN NAREV (Jul. 2014): To all the customers who received poor advice, I apologise unreservedly.
ADELE FERGUSON: Dr Koh’s disquiet came amidst an ongoing scandal in Commonwealth Bank’s financial planning division, which included forgery, fraud, missing files and a management cover-up.
A Senate inquiry was calling for a royal commission.
Dr Koh feared unscrupulous behaviour was also happening in CommInsure.
After reviewing James Kessel’s claim, Dr Koh was in no doubt that Kessel had suffered a severe heart attack. Despite this, a week before Christmas Kessel was told his claim had been rejected.
(Footage of James Kessel reading letter from CommInsure with a magnifying glass)
LETTER EXCERPT: Our Decision.
On the basis of the information obtained during the assessment of your claim, it is CommInsure’s opinion that the above definition has not been met as your Troponin I levels did not reach the threshold (2.0 mcg/L) that is required within the ‘Heart attack of specified severity’ definition as stated in the policy document.
Therefore, it is with regret, and without prejudice to any other defences we may have, that we have declined your claim for Trauma benefits.
JAMES KESSEL: I’m thinking, like, “You mongrels.” You do this for how many years: like, I w- I would have been better off saving the money and putting it into something else and, um, and would still have the money.
It’s supposed to make a difference. That’s why it’s called ‘trauma policy’. It’s supposed to relieve the trauma. Creates more.
ADELE FERGUSON: James Kessel’s claim had been knocked back, based on the amount of a substance called troponin in his bloodstream. This is a measure used by CommInsure to determine the severity of a heart attack.
(Footage of Andrew MacIsaac in operating theatre)
ANDREW MACISAAC, ASSOC. PROF., PRESIDENT, CARDIAC SOCIETY OF AUSTRALIA AND NEW ZEALAND: So it’s quite possible you can put a stent in; something like that
ADELE FERGUSON: Four Corners has sought the opinion of one of Australia’s most respected cardiologists to discuss the use of troponin as an indicator of heart attack severity.
(To Andrew MacIsaac) What is troponin, exactly?
ANDREW MACISAAC: Ah, troponin is a protein that is inside all heart cells. And when heart cells are damaged or under stress, it’s released into the blood and can be measured through a blood test.
ADELE FERGUSON: Is troponin a good indicator of the severity of a heart attack?
ANDREW MACISAAC: You can’t consider troponin in isolation. I think that a cardiac arrest – which means that someone’s heart stops, isn’t functioning properly; they’ve collapsed and they need resuscitation – by any reasonable criteria, that’s a serious occurrence.
(Footage of Andrew MacIsaac in operating theatre)
ANDREW MACISAAC: Er, hasn’t he had angiograms before?
ADELE FERGUSON (voiceover): Professor Andrew MacIsaac believes the emphasis placed on the troponin test in the CommInsure policy is questionable.
ANDREW MACISAAC: It’s a bit odd, isn’t it?
(To Adele Ferguson) In the last 10 years there’s been big advances in the understanding of the role of troponin in diagnosing heart attacks. If we’re going to use two, ah, micrograms per litre as our threshold for diagnosing a heart attack, that’s certainly out of date and not the standard that we’d apply now.
IAN NAREV: I’m aware of the issue around the troponin levels and it’s a very good question, a very fair question. What I will say is that the policy needs to be updated and is being updated and th- that, that work has, ah, been undergoing now for a number of months and we’re going to make sure we accelerate it now to update the definition.
CAPTION: Heart Attack Insurance Definition: A Review
ADELE FERGUSON: In June 2014, Dr Koh conducted a random audit of 40 recent heart attack claims.
CAPTION: …arbitrarily disadvantages potentially more than 50 per cent of legitimate cases.
ADELE FERGUSON: Shockingly, he found that potentially more than 50 percent of legitimate claims could be knocked back. He recommended bringing the definition into line with clinical advances.
CAPTION: Our current definition of heart attack should be reviewed in order that it is signed to clinical advances.
DR KOH: I’m not sure how you got that document. But yes, I can confirm that I did a very limited sampling of 40 cases, because that was the resource I had. And… I did find that claimants could potentially be disadvantaged by an out-of-date definition.
ADELE FERGUSON: What was the outcome?
DR KOH: The consensus was: if we were to change the definition, it would mean that legitimate heart attack claims would be paid out and there’ll be more claims that are admitted, which has a pricing impact. So for purely profit purpose, purely for the bottom line, they didn’t want to change the definition.
JAMES KESSEL: And they sent me a letter, which is… I’ve got in a pile there. It’s just simply states, ah, that: “Your troponin levels were not at the right level so you, you don’t, you don’t get it. See ya. Goodbye. Have another heart attack. Better luck next time.”
See, if I would’ve died, which – well, well, completely – and buried, um, it makes me wonder: would, would they have found a, a way to get out of that as well, you know? Like, “Nup, he’s not dead enough.” Um… (laughs). You know, like, gee.
CAPTION (letter to James Kessel): We wish to advise that you are eligible for a partial payment of $25,000 for coronary artery angioplasty for which you meet the definition.
ADELE FERGUSON: James Kessel’s rejection letter said he was only entitled to $25,000. It said his heart attack wasn’t severe enough.
(To James Kessel) Would you be surprised to learn that the chief medical officer at CommInsure had concerns about your case?
JAMES KESSEL: Ah, I know nothing about that, but that’s, um… what, what did he say?
ADELE FERGUSON: Can I show you some documents?
JAMES KESSEL: Mm. For sure.
ADELE FERGUSON: OK. So this is a committee meeting…
JAMES KESSEL: Yep.
ADELE FERGUSON: So just have a read.
JAMES KESSEL: So he’s, he’s the guy that says “yay” or “nay” to policies?
ADELE FERGUSON: This is him, plus several of his colleagues.
JAMES KESSEL (reads): “The insured, ah, had very, had a very significant heart attack.” Very significant.
ADELE FERGUSON: James Kessel reads the internal assessment from CommInsure, which admits that denying his claim, based on an “unobtainable threshold”, would not be acting in “utmost good faith”.
JAMES KESSEL (reads): “‘We believe that the declining this claim, based on a now unobtainable threshold…” See, you’ll never reach the figures needed. Like, what?
Fair dinkum. And they… so, who… Someone above all these guys says, “Nuh. Stuff him. Let him be miserable. We’ll keep the money.”
Have you spoken to these guys?
ADELE FERGUSON: Yes.
JAMES KESSEL: Mate…
IAN NAREV: Well, the first thing I want to say here is that, whenever I hear a case like that, as the CEO of the Commonwealth Bank – and a customer in his time of need who hasn’t received the assistance he needs: I- it saddens me. And the first thing I want to say to the customer – and I will write to the customer and say this – is to apologise and to offer to meet personally, so I can hear about those circumstances.
JOHN BERRILL, INSURANCE LAW SPECIALIST: CommInsure’s response in what we’ve seen in these claims has been outrageous. And they need to be held account f- for it.
ADELE FERGUSON: John Berrill is one of the country’s leading life insurance lawyers. He’s been watching the industry for years.
JOHN BERRILL: It’s defer, deny and sit back and wait and see if someone takes them on.
DR KOH: You can make a profit the legitimate way and you can make a profit by some h- underhanded way. I want no part of the latter.
ADELE FERGUSON: Early last year Dr Koh elevated his concerns to the board of CommInsure.
DR KOH: When they failed to progress my concerns any further, I went to the board of directors of CommInsure.
ADELE FERGUSON: The Bank assured him his concerns would be investigated.
DR KOH: They felt that there were sufficient ground to at least get an external auditor to come in to find out what’s happening. Unfortunately I never knew the outcome of that external audit, because every time I asked who the firm was that was investigating or what were the outcomes, I was never told.
ADELE FERGUSON (to Ian Narev): These allegations went to the CommInsure board. Did anything happen to them?
IAN NAREV: If such an allegation is made to the CommInsure board, the CommInsure board must investigate it. The CommInsure board would not be expected to – and indeed could not – let me know of those findings. And I shouldn’t make enquiry as to those findings.
ADELE FERGUSON: CommInsure is a life insurance giant. It has more than 4 million policy holders, but most people don’t know they’re with CommInsure because they’re sold insurance and they pay for it through their super.
Funds such as CARE, Kinetic and HESTA have subcontracted life insurance to CommInsure.
Nicholas Bishop’s policy is through HESTA. He has just returned to hospital after developing a virus in his lungs. He lodged his life insurance claim in October 2013, after two doctors diagnosed him with a terminal lung condition.
NICHOLAS BISHOP: They both came to the opinion that, ah, my condition was terminal and so I developed the secondary illness and, um, I, um… have less than 12 months to live. Yeah.
ADELE FERGUSON: CommInsure rejected Bishop’s claim on the grounds that, if he had a lung transplant, his condition would no longer be terminal.
The Nicholas Bishop case also passed across Dr Koh’s desk.
Dr Koh was unimpressed and wrote to his manager that “undue influence was placed on our medical team to provide an opinion that they seek.” He went on: “There was no reasonable basis, but for the manufactured medical opinion, to question the expertise and views of two treating doctors.”
DR KOH: The person has an organ failure. If we take the insured as he is at that point in time when he’s submitted the claim, he fulfils all the requirements of the terminal illness benefit.
I don’t think it’s by any stretch of the imagination to say that that is not “utmost good faith”. I think that incident bring into sharp focus this culture of profit above all else.
ADELE FERGUSON: An internal document reveals CommInsure only acted after Nicholas Bishop threatened to go to the media. It said, “The circumstances surrounding his medical condition, and the fact that he won’t present well in front of the camera, will attract the attention of the general public.”
(To Ian Narev): It’s just grotesque: that sort of wording in an email about a human being who is at that time dying.
IAN NAREV: The reason to do the right thing by customers is because we’re here to do the right thing by customers. The reason to do the right thing by customers is because we care about them.
If that happens, it is absolutely contrary to the ethics of the organisation and to the values that we are emphasising in the organisation.
NICHOLAS BISHOP: How many people are out there that are suffering every day; you know, who are probably going through similar situations to what myself and my family had to go through when I was so unwell? Um, it just makes you sick.
ADELE FERGUSON: CommInsure decided to settle Bishop’s claim. He later underwent a lung transplant
(To Michael Bates) Without the threat of media attention, do you think they would’ve settled?
MICHAEL BATES: Ah… No, no, probably not in this instance. Um, we would’ve issued proceedings against them.
IAN NAREV: If you are a customer who is in a situation where your claim has not been well handled, in these situations in particular, the outcome is very distressing for the customer…
ADELE FERGUSON: But what do you think is going wrong here?
IAN NAREV: …and that must be unacceptable for us.
ADELE FERGUSON: What do you think is going wrong with the culture, where we’re having examples that are really quite disturbing?
IAN NAREV: That is not good enough when a customer is in her or his time of need. That is, I think, at the root cause of a couple of the problems that you have mentioned.
(Footage of Michael Bates and Evan Pashalis in a meeting)
MICHAEL BATES (to Evan Pashalis): There’s a few steps in this process.
ADELE FERGUSON: It seems that, often, only the threat of media attention or legal action pushes CommInsure to settle claims. For that reason, Michael Bates has encouraged another client to tell his story to Four Corners.
MICHAEL BATES (to Evan Pashalis): If you provide them with two medical certificates, confirming that, ah, you’ve got a terminal illness as defined in the policy, then, um, the claim should be accepted.
ADELE FERGUSON: Thirty-seven-year-old IT consultant Evan Pashalis was struck down by leukaemia in November 2014.
EVAN PASHALIS: I, ah, was feeling a bit ill and went to the doctor’s and they told me to go to the emergency department. And, ah, they diagnosed me with acute myeloid leukaemia
Ah, they said it was 97 per cent of my blood system has… is cancerous and I needed, um, immediate treatment. It’s kind of ironic ’cause, like, two days before we were booking airline tickets to travel overseas. And, um, yeah: 24 hours later being told that you’ve got to plan for your funeral, so..
ADELE FERGUSON: CommInsure life insurance is payable if a policy holder becomes terminally ill and is likely to die within 12 months, despite reasonable medical treatment.
Two doctors diagnosed Evan as terminally ill. A third doctor said his life expectancy is less than 12 months.
Evan has a policy with CommInsure, through his super fund CARE. He lodged a claim. It was rejected.
EVAN PASHALIS: I honestly believe they were delaying to make sure that I passed away before they paid me out. They figured, “Well, there might be a slight chance he survives, so why pay him?”
ADELE FERGUSON: Four Corners was with Evan Pashalis three days before Christmas. He is waiting on a call from lawyer Michael Bates, who has lodged a fresh claim.
(Evan Pashalis moves to pick up his daughter from the living room couch. She cries)
EVAN PASHALIS: It’s all right, it’s all right, it’s all right, it’s all right.
(Evan’s phone rings; he answers)
EVAN PASHALIS: Hi, Michael… Not too bad, buddy, Yourself?.
- Yep. They rejected the claim: right.
- Thanks again. Appreciate it, Michael. No worries. Thank you. Bye.
(Evan finishes the call)
EVAN PASHALIS: Yeah, it looks like, ah, they rejected it again. So… there we go. No surprise. Yeah, they, they rejected it.
ADELE FERGUSON: How do you feel?
EVAN PASHALIS: Disappointed, yet I’m not surprised. Unfortunately, I, I’m not surprised at all.
It’s just so frustrating. Why would you torment a dying person and their family? Why? What, what do they… what do they gain out of this? A few hundred thousand dollars?
I would have put funds aside for my daughter’s future, had something. I could plan for her schools, place deposits, do what I needed to do for my family once I’m gone.
This is just outrageous. I don’t know how, ah, what we need to do. But I’ll tell you one thing: before I leave this planet, I’ll fight with every energy I can muster. I will.
(Footage of Ian Narev and Adele Ferguson watching interview with Evan Pashalis)
EVAN PASHALIS (video): But I’ll tell you one thing: before I leave this planet, I’ll fight
ADELE FERGUSON: We showed this part of our interview with Evan Pashalis to Ian Narev.
(To Ian Narev) What do you say to Mr Pashalis?
IAN NAREV: Well, first of all, that is an extremely distressing video to see in relation to any customer of the Commonwealth Bank.
So the first thing I will say to him is how sorry I personally feel. And I will be conveying my apologies to him personally and inviting him to have the opportunity to come to speak to me personally, so I can make sure I understand at a human level exactly what he’s gone through.
ADELE FERGUSON: Despite Mr. Narev’s claims, the way CommInsure treats its staff speaks volumes about its culture.
Helen Polydoropoulos was a customer service rep at CommInsure until late 2011, when she got sick.
HELEN POLYDOROPOULOS: I used to get hot rushes up and down my legs. And I’d be sitting at, you know, at my desk and it’d feel almost like someone would pour a boiling kettle of water over your leg.
ADELE FERGUSON: She was diagnosed with multiple sclerosis, a condition that affects the central nervous system. It’s painful, can be debilitating – and there’s no cure.
When she told her superiors, CommBank’s chief medical adviser, Dr Colin Johnston, gave her a call. He advised her to claim against her CommInsure policy for ‘total and permanent disability’ or TPD.
HELEN POLYDOROPOULOS: He did get on the phone to me and also spoke to my partner, um, and said, “You’re one of us, so we’ll treat you the best as we can. Um, you need to access funds that you have in your TPD. Um, you know, multiple sclerosis is something that TPD does cover for and your insurance covers for.”
ADELE FERGUSON: As a CommBank employee, Helen’s insurance was naturally with CommInsure. Dr Colin Johnston assured Helen the bank would look after her.
HELEN POLYDOROPOULOS: Basically he said, “Look, being one of us,” he goes, “you’re not anyone external to the bank. You’re one of our own. Rest assured that that will be treated as,” you know, a- I mean, I guess, better and, and a lot quicker than, than other cases.
ADELE FERGUSON: On November 21, 2011, Helen was “ill health retired from the bank”. Dr Colin Johnston signed the letter. She then lodged her total permanent disability claim.
HELEN POLYDOROPOULOS: Put in a claim: it got denied. I thought maybe I’d filled in the forms wrong because they’re not, you know, a little two-page form or anything. They- they’re quite full-on.
ADELE FERGUSON: Since Helen was “ill health retired” from CommBank four years ago, CommInsure has knocked back every claim.
HELEN POLYDOROPOULOS: Well, I feel like they’ve taken the piss out of me, I guess. Like, you know, it’s, it- I’m at my lowest and now, what: you’re going to take the piss out of me as well and make me feel… you know, waste my time and my doctor’s time?
ADELE FERGUSON: Her physical and emotional state has deteriorated.
HELEN POLYDOROPOULOS: Ah, there’s times where I’m pretty much bedridden most of the time, which is quite sad. It’s very unpredictable, actually. You don’t know when something’s going to come on and what part of your body it’s going to affect.
ADELE FERGUSON: The rejection of Helen’s claim seems to defy logic. CommBank retired her from its call centre, but the life insurance arm continues to deny her claim on the basis she had capacity to do other jobs.
Four Corners contacted Dr Johnston, who said: “We act on the advice of specialists.”
ADELE FERGUSON: When you got the letter of rejection and you looked at the bottom of the signature, were you surprised at the name that you saw?
HELEN POLYDOROPOULOS: Yeah, absolutely. Absol…
ADELE FERGUSON: Can you tell us who that was?
HELEN POLYDOROPOULOS: Yeah: um, Dr Colin Johnston and, and, and the medical… being the chief medical adviser.
Um, you tell me that I’m not fit for work and you made me “permanently ill health retired”, but then I put in my claim and you tell me that “it’s denied on the basis that you’re fit for work”. So why get rid of me, then?
You know, so it’s like ‘Catch 22′, I guess. It’s just- you’re screwed either way, I guess. I’m not- I don’t know what they’re trying to achieve. I guess they’re trying to achieve me giving up, maybe?
ADELE FERGUSON: Helen tried to ring Dr Johnston several times.
HELEN POLYDOROPOULOS: I tried many a times. He never came to the phone again. Email: he’d never respond. It wa- al was always his secretary, Um, and that P’d me off and upset me quite a bit, quite, quite a bit, (blows nose) ’cause I just felt that they were just misleading me and just… they had every intention of not paying me to begin with.
ADELE FERGUSON: For four years Helen’s claims have been denied, pushing her to the brink financially.
HELEN POLYDOROPOULOS: I’ve had to, you know, sleep on people’s couches and I’ve slept in my car countless nights.
ADELE FERGUSON: And where are you living now?
HELEN POLYDOROPOULOS: I have moved back to Mum’s, um, and… it’s hard sometimes. I don’t want to be here but I can’t live on my own either. It’s impossible.
ADELE FERGUSON (to Ian Narev): Four years she’s been getting knocked back. And she’s hired lawyers and the bank is challenging her. Can you imagine the stress this woman is under?
IAN NAREV: I can’t imagine the, the stress that she’s under. I haven’t been in that stress. I say the same thing again: which is, as you’ve outlined that, that is an unacceptable outcome for a customer and we’ll put it right.
(Footage of Helen speaking with her mother in Greek in the kitchen)
ADELE FERGUSON: Helen is not the only employee to feel betrayed by the country’s biggest and most profitable bank.
A customer service representative, Matthew Attwater was given an “Ultimate Success” award and praised on the night by former CEO Ralph Norris in 2010.
MATTHEW ATTWATER: I won employee of the year. Best of the best: “Ultimate Success” award.
ADELE FERGUSON: A year later he developed a major depressive disorder after being brutally bashed.
Matthew told his boss. He was later medically retired from CommBank and the workforce in general.
MATTHEW ATTWATER: “Sorry, you can no longer work – not only for the bank, but for the general workforce.” It was a massive blow. It was scary at just how… how much impact that one report had on my view of the future, my… my everything. It was- eh, my world stopped that day.
ADELE FERGUSON: CommBank dismissed Matthew as being permanently unfit for work, but then the bank’s insurance arm rejected his claim for total and permanent disability.
MATTHEW ATTWATER: How can one department say, “No, sorry. You’re s- you’re so disabled that you can no longer work for us” and that “You’ll never, ever be able to work in any industry”; and then for an insurance assessor to look at that and say, “Well, no, not really. You can… there’s, there’s more things that you can do”?
ADELE FERGUSON: Four Corners interviewed beyondblue chairman Jeff Kennett about CommInsure’s handling of mental health cases like Matthew Attwater’s.
JEFF KENNETT, CHAIRMAN, BEYONDBLUE: I find, er, the bank’s attitude so totally wrong. If you’re saying to an individual, “You’re no good” or “Your illness can’t be treated,” ah, you’re doing great psychological damage to that individual.
For the Commonwealth Bank in 2013 to be doing this sort of thing to one of their own employees is disgraceful. Why do they get away with it? Because they’re big.
ADELE FERGUSON: Jeff Kennett described the bank’s attitude to mental illness as “disgraceful”. I just wanted to know what your response is?
IAN NAREV: We have got a long way to go on mental illness. And I’ve in fact spoken myself to Jeff Kennett about mental illness, about the work he’s done in beyondblue. And I accept that we, like many big businesses, have got much more work to do to bring our understanding of mental illness up to the level it ought to be at.
ADELE FERGUSON: A week after Matthew Attwater’s interview with Four Corners, but three years after he first began his battle, CommInsure finally settled his claim.
CAPTION (CommInsure advertisement, YouTube): Almost one in five Australians will experience a mental disorder.
With 583 diagnosed with cancer every year.
Around 4 million Australians are living with a disability.
Last year, we paid out over $1.9 million a day in claims. That’s over $13 million a week and over $702 million a year.
For the times of your life. CommInsure.
ADELE FERGUSON: Life insurance is a highly troubled industry. It’s dominated by commissions of up to 130 per cent of the first year’s premiums.
According to the corporate watchdog, ASIC, a massive 37 per cent of product advice is in breach of the law.
The industry has been told to lift its game.
JOHN BERRILL: They’re being dragged kicking and screaming at the moment to a code of practice. But they are, they are getting there and we’ve got to hold them to account.
JEFF KENNETT: I would not, with due respect, trust a life insurance organisation to develop a code that puts the public’s interest first.
We shouldn’t waste time. Whatever they come up with will be there for self-interest and it is better someone else develop the code for them.
ADELE FERGUSON (to Ian Narev): So it just gets back to ethics. In November, chairman David Turner talked about CBA wanting to be “the ethical bank”. Does that fit with what we’re seeing here?
IAN NAREV: Our chairman said at the AGM we wanted to be “the ethical bank”. I have emphasised now for quite some time the importance of ethics and values. And that is an aspiration we stand by.
We’ve got record levels of customer satisfaction. We’ve got record levels of people engagement, relative to any time of the Commonwealth Bank’s history. So we’ve got a culture that we’re proud of.
ADELE FERGUSON: Dr Koh isn’t convinced. He suggests CommBank doesn’t understand ethics.
DR KOH: It’s like trying to explain the colour blue to a blind person. How do you start, when it’s never crossed their consciousness?
With the leaders in the organisation: I expect more from them. They talk the talk… but I’ve yet to see them walk the walk.
ADELE FERGUSON: The clients of CommInsure don’t buy it, either. They continue to battle the bank.
JAMES KESSEL: They’re making so much money, these mongrels. Like… like- and the guy- oh, mate. They’re just… they’re just ripping people off blind.
(Footage of James Kessel and Senator John Williams in hotel bar)
JAMES KESSEL: Yeah, I don’t get sick.
(John Williams laughs)
ADELE FERGUSON: A powerful figure has taken an interest in James Kessel’s case. Senator John Williams drove a Senate inquiry into CommBank’s financial planning scandal.
(James and John shake hands)
JAMES KESSEL: Thanks, mate.
JOHN WILLIAMS, NATIONALS SENATOR: All the best, mate.
JAMES KESSEL: Ta, bud.
JOHN WILLIAMS: Good on you.
(To Adele Ferguson) And I think what this will lead to is another Senate enquiry, this time into the insurance industry.
I think eventually we’ll get a royal commission.
(Evan Pashalis walks into hospital waiting room)
ADELE FERGUSON: Evan Pashalis is still fighting as CommInsure demands even more tests.
EVAN PASHALIS: I’ve had so many blood tests, I’ve lost count. I- I just think they, um, they might see a chance that I might survive. And they want to be 100 per cent sure that I’m dead and buried before they pay me out.
(Helen takes medication, swallowing pills down with water)
ADELE FERGUSON: Helen Polydoropoulos has lodged legal proceedings in the NSW Supreme Court. The bank says it will fight her claim.
HELEN POLYDOROPOULOS: They want me to give up. And that made me angry. That made me really P’d off.
You’re taking people’s funds from them. You’re, you’re not d-, you know, taking any less of a premium or anything like that. Those premiums keep getting higher and higher every year but you’re denying people.
ADELE FERGUSON: They’re still taking your premiums?
HELEN POLYDOROPOULOS: Oh. yeah. Yeah, the premiums are still being taken, there’s no question about that. They’ve never stopped at any point in time. Yeah.
ADELE FERGUSON: Taking on the CommBank can be career-destroying, as Dr Koh discovered.
In August 2015 he was summoned to a meeting with CommInsure’s CEO, Helen Troup.
Koh was sacked.
The key reason given for his dismissal was that Koh had breached CommBank’s policies by forwarding work files to his personal email account – an action he took because he was afraid files would go missing.
MICHAEL BATES: The reasons for his dismissal are farcical. He sought from his then manager, ah, the approval to send records to his personal, ah, email account as, ah, a way to keep that secure, um, and was- was given permission to do that.
DR KOH: These people do not understand that you can’t buy integrity. And with those words, I walked away and told myself, “I don’t need your money. I’m not going to be silenced by your gag order. And you can choose to say whatever you want to my colleagues. I have no control over that. But damn if I’m going to be silenced.”
ADELE FERGUSON: Dr Koh wrote to Ian Narev after he was sacked.
DR KOH: I was very disappointed with the whole process, because here’s the CEO of the- the company publicly proclaiming to the world that: “We want to do better. We want to be the ethical bank.”
But my experience of this whole process is that it’s just a lot of words and whatever’s been… proffered in, in the media has any substance.
CAPTIONS: …I have raised various concerns about unethical practices… under whistleblower protection and they were dismissed…
It is with much disappointment that your public proclamation of doing the right and ethical thing is only that: a public proclamation.
ADELE FERGUSON: In his letter, Dr Koh outlined his concerns of unethical practices within CommInsure. He said he’d raised them under whistleblower protection guidelines, but they were dismissed. He expressed his disappointment that Narev’s public proclamation of doing the right and ethical thing was just that – a public proclamation.
ADELE FERGUSON: Dr. Koh wrote to you in August last year, outlining some of his concerns. Um, did you respond to him?
IAN NAREV: I need to emphasise again what I said before, which is: when specific complaints are raised anywhere from inside the insurance business, there are certain prescribed procedures in terms of how to deal with those sorts of concerns.
ADELE FERGUSON: He became a whistleblower and was eventually sacked. What does that tell us about CommBank’s attitude to speaking up about the truth?
IAN NAREV: As part of the, ah, emphasis that our board has put, I have put, ah, over a period of time on ethics and values, we are emphasising the importance of people speaking up when they see something wrong, but actually also when they’ve got good ideas, because that’s a big part of being in an innovative culture.
It’s essential in a big organisation that, if somebody sees something they don’t think is right, they have a safe place to raise it.
ADELE FERGUSON: On August 11, 2015, Dr Koh was escorted off the CommInsure premises.
DR KOH: I think, while I’m not naïve to how business works, I’m terribly disappointed by how senior executives in CommBank have behaved.
In my view: as long they project the right brand image, say the right words, bombard the media with… their side of the story, everything else can go on, business as usual.
SARAH FERGUSON: Since we approached the bank last week, CommInsure has offered settlements to Evan Pashalis and Helen Polydoropoulos.
James Kessel is still waiting.
See you at the same time next week. Good night.