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Life firms fire back after Hayne hammering

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AMP, TAL and other life insurers have taken issue with potential misconduct findings identified by the counsel assisting the Hayne royal at the end of the round six hearings.

The commission heard AMP continued to charge premiums after members died and in some circumstances caused non-smokers to pay higher rates by defaulting them into a smoking category.

But the company says in a post-hearing submission that it has always had a policy to refund premiums incurred after a death and no member has been defaulted to smoker status.

“It is inevitable and appropriate that premiums will continue to be deducted after a person’s death and before AMP is notified of that death,” it says.

AMP also says members shifted to a new plan after leaving an employer may become part of a hybrid pool of smokers and non-smokers if no declaration is made. But they are invited to update their status, with premiums based on actuarial calculations for each specific risk pool.

“The inclusion of members who have not declared their smoker status into a combined pool with declared non-smokers would increase the premiums for the declared non-smokers,” the submission says. “It is not to the point that, statistically, there may be more non-smokers than smokers in the general population.”

TAL’s submission disputes systemic breaches of utmost good faith in its surveillance investigations and says the royal commission placed too much weight on an admission, under cross-examination, that general reviews of medical information amounted to fishing expeditions.

“There is a danger and an attendant unfairness in seizing upon a concession given at a high level of generality with respect to a protean term such as ‘fishing expedition’, especially when adopted by a non-lawyer,” TAL says. “There was always a rational trigger of one kind or another for a general review.”

CommInsure rejects misconduct over its use of an outdated radical surgery definition in declining a breast cancer claim, while agreeing its handling of the case fell short of community expectations.

ClearView backs away from evidence that it breached anti-hawking laws between 300,000 and 303,000 times, saying the admission during the hearings was not based on the executive’s direct knowledge of the calls.

“An inability on the part of ClearView to establish positively that in every call there had not been a breach does not, however, establish, that in every call there was a breach,” it says.

Freedom Insurance Group challenges a number of royal commission-proposed misconduct findings, while noting it is under investigation by the Australian Securities and Investments Commission and has made changes.

The sale of insurance to a man with Down syndrome was a conduct failure by the agent rather than the company, it says.