Insurance
TAL refutes duty of good faith breaches

TAL has refuted claims made by the Royal Commission that it systemically breached its duty of utmost good faith to policyholders when investigating claims.

In a submission to the Royal Commission, the group insurer says it did not breach its duty of utmost good faith by calling for every kind of report from a policyholder's medical practitioners.

According to TAL, its general manager of claims Loraine van Eeden did not concede in cross-examination to calling for every kind of report from a policyholder's medical practitioners - including seeking out medical information extending well beyond the claimed condition - until at least 2013.

TAL said van Eeden's evidence concerned calling for every type of record if a "if a claim was very early ... in terms of the policy duration period."

TAL also clarified that van Eeden confirmed the process later formalised in the group insurer's Underwriting and Disclosure Review Guide for Claims was already in place.

The group insurer said that process did not apply to all claims, but rather was limited to claims where either the information presented at the time of the claim was inconsistent with that presented at policy application, or where a claim was made very early in the life of the policy.

TAL said claims made very early in the life of the policy, could properly and reasonably prompt an inquiry as to whether all relevant matters were disclosed at the time of application, which according to the group insurer is therefore not a breach of its duty of utmost good faith.

It added the approach to investigations was the process adopted throughout the industry at the relevant time, adding it was a fact van Eeden was not challenged about.

"The practice, accordingly, cannot constitute conduct that contravened a professional standard or a recognised and widely adopted benchmark for conduct," TAL said.

"To the contrary, the practice was accepted industry-wide."

Read more: TALRoyal CommissionLife insuranceLoraine van Eeden
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