FRAUDULENT AND UNETHICAL PRACTICES OF INSURANCE COMPANIES AND THEIR DOCTORS NO SURPRISE TO ATTWOOD MARSHALL PERSONAL INJURY LAWYERS
The latest revelations of a Crown Solicitor working for the Qld Government that it was the standard practice of the Crown Solicitor’s Office to deny liability on all claims lodged against the State of Qld merely confirms what most experienced personal injury lawyers already know – insurance companies and their legal representatives have a standard practice of denying liability on all claims. This is designed to put the injured plaintiff to the maximum amount of legal expense and stress so that this will “soften them up” in order to settle the claim for a lesser than amount than what it is worth or alternatively, in the hope that the claimant will simply give up on their claim due to the delay and stress.
The QLD Government are not the only entities following this practice of mechanical denials of liability. Our experience with the local Gold Coast City Council is similar when it comes to liability claims lodged against them. We have never had an admission or partial admission of liability in any claims lodged against the GCCC in the past 30 years!
These revelations follow on from the explosive claims made by an in-house doctor working for CommInsure (the in-house or insurance arm company of the Commonwealth Bank of Australia) who revealed that it was standard practice within the insurance company to deny claims brought against it on the grounds of total and permanent disability by providing fraudulent or inaccurate medical opinions and subsequently put the claimants to the expense of engaging lawyers to prosecute the claims against them. In many cases, people were unaware of their rights and simply did not proceed with their claims, even though they had genuine grounds to bring a claim and had paid premiums by way of their superannuation contributions (which included a premium for TPD insurance cover).
The issues concerning CommInsure were exposed in a Four Corners program on the ABC which highlighted the attitude taken by insurance companies towards psychiatric claims brought by employees of the Commonwealth Bank. The program exposed corrupt practices within the nation’s largest bank and its insurance arm. Incredibly, for a company and insurer who makes such large profits and are seen as a model corporate citizen, it was shocking to all concerned that these practices were so entrenched in the Commonwealth Bank. This led to calls for a Royal Commission by the Labour Party and a national stoush in the media between the Government and the Labour Party over bringing the banks to heel over these allegations. There was also the string of disastrous financial planning matters with the CBA leading to massive losses by customers caused by fraudulent investment advice.
Once again, the general outrage expressed by politicians and the public were of no surprise to experienced personal injury lawyers operating within this area. We have a tradition of fighting against insurance companies on behalf of our injured clients for the past 70 years and the fact that these practices have been brought out into the open hopefully will shed light on the common plight of people suffering from injuries and illnesses in this country. The Government and insurance lobbies are powerful entities that regularly have their jaundiced views brought out in the media and adopted by politicians and Governments. It is simply unacceptable that so-called reputable and recognised insurance companies would actively defraud their customers by refusing to payout on legitimate claims brought in relation to their insurance policies which the customers have been paying the premiums faithfully for many years.
It is indeed unfortunate that Australian citizens do not have the comfort that claims that they have taken out insurance to protect themselves may not be covered due to the unethical practices of the insurers in relation to claims that are lodged with them. We urge the new Federal Government to call a Royal Commission into the practices of the insurance companies and/or their lawyers so that there are checks and balances in relation to their behaviour and treatment of the consumers.
The applicable legislation concerning personal injury claims and insurance claims made in relation to superannuation and total and permanent disability are quite clear in relation to the obligations of the insurers and their lawyers with respect to claims that are brought against them. The different pieces of legislation that apply in State and Commonwealth matters all require the insurance companies and their representatives to make genuine attempts to resolve claims and admit liability after reasonable investigations. This is rarely put into practice and there is also the issue of insurance companies using “stables” of sympathetic medical specialists who regularly write reports on behalf of the insurance companies. Naturally the reports are usually geared to favour the insurance companies and downplay the significance of the injuries or illness suffered by the claimants. It is not unusual to have completely diametrically opposed views of the treating doctors on behalf of the plaintiff compared with the insurance panel doctors. Although it is not unusual for medical experts to have different opinions in relation to certain claims, it is common knowledge that there are certain defendant insurance company doctors who take certain views in relation to injured plaintiffs with monotonous regularity. It seems that the insurers, along with doctors and lawyers, have become an anti-claim machine with practices designed to minimise payments to genuinely injured claimants.
Injured workers have very similar stories about how they are treated by QLD WorkCover and the claims officers that interact with them. We have many clients who are bullied by the claims officers and forced back to work before they have properly healed. They are sent to WorkCover approved doctors who state there is either nothing wrong with them or their ongoing problems are not related to their work injury! It is not until they have lawyers acting for them that they are treated decently. A common story with most insurance companies.
Much is made by insurance companies of the fraudulent claims that are brought by injured plaintiffs. However, it has been shown that fraudulent claims represent only a very small percentage of all claims made by claimants and it is completely different to the inflexible, callous systematic approach to claims that are used on a day to day basis by many insurance companies.
If clients have been injured or suffer an illness or disability in circumstances which they may be able to bring a claim under an insurance policy or against another party who holds insurance, they should ensure that they obtain timely professional advice from experienced lawyers in this area. If any clients have any queries in relation to this area, please contact our Personal Injuries Department Manager Kelli Costin on direct line 07 5506 8220 or email firstname.lastname@example.org or freecall 1800 621 071.