Total and Permanent Disability claims review outcome

2min read

Key facts:

  • A review was carried out of the 141 denied Total and Permanent Disability claims over a three year period that were provided to ASIC as part of the ASIC Life Claims Review 
  • The review was conducted by an independent legal firm with further oversight from EY 
  •  It reconfirmed that BTFG’s assessment of claims is of a very high standard and stated no Total and Permanent Disability claim had been incorrectly denied 
  • It recommended that a further review of one claim take place given its medical complexity and case background. This claim has now been paid 
  • Review underscores the urgent need for standardised industry reporting and definitions.

BT Financial Group (BTFG) today confirmed the independent review of its declined Total and Permanent Disability claims has been completed.

The review states that “decisions were evidence based, transparent and there were no material or systemic issues identified.” It further says BTFG “adopted reasonable positions having regard to all of the available evidence open to it and the declines were appropriate.”

EY said the findings were consistent with its previous review of BTFG’s claims management practices including Total and Permanent Disablement claims, in August 2016, which found that the “assessment of claims is of a very high standard” and all claims reviewed “demonstrated a broad minded, objective and good faith approach.”

The review has confirmed that no Total and Permanent Disability claim had been incorrectly denied.

BTFG said Total and Permanent Disability insurance provides cover for a person who is unable to work again for the rest of their lives. It can often be a very traumatic experience with customers potentially experiencing a wide ranging difficulties such as major accidents, cancer and severe depression.

The review suggested due to the medical complexity and case background BTFG could have potentially exercised more discretion in one of the claims. BTFG has subsequently looked at it again and paid the claim in full with interest.

BTFG General Manager Insurance, Sue Houghton, said “we are committed to ensuring our claims practices are fair and we are pleased that two independent organisations have confirmed the right claims decisions are being made.”

Since the claim was declined, and prior to the independent review, BTFG has put in additional steps when reviewing Total and Permanent Disability claims. This now includes all denials having a third layer of internal review before a customer is notified of the outcome.

“We believe the review underscores the need for standardised reporting and increased transparency across the industry to allow customers to make meaningful comparisons.

“We have been open about our claims data, this review and the outcome. We strongly believe the same level of transparency is needed across the industry so consumers are not misled by confusing and misleading headlines.

“All insurers need to report claims outcomes using common definitions and data to help restore consumer confidence in an essential financial product for many Australians,” Ms Houghton said.

In its submission to the Parliamentary Joint Committee on Corporations and Financial Services BTFG has further highlighted the current reporting distortions that exist in the industry.

BTFG has shared the results of its review with ASIC.

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Information is current as at 5/1/2017.

Nicole Webb
nicole.webb@btfinancialgroup.com
0466 479 673

Lisa Parrett
lisa.parrett@btfinancialgroup.com
0432 933 796