By Ross Walker

There was a very disturbing Four Corners program a few weeks ago along with some articles in the Sydney Morning Herald describing the rather concerning compensation or lack thereof by Comminsure and other insurance companies. The Four Corners program highlighted five glaring examples of Comminsure’s inability to adequately compensate for the very legitimate conditions suffered.  The first was a young man who clearly suffered a heart attack and a subsequent cardiac arrest, but because his blood tests at the time (now considered out of date) did not satisfy their rigid criteria, his claim was rejected.

A second man with lung failure was refused compensation because he may have recovered with a lung transplant.

A third man developed acute myeloid leukaemia, a typically terminal illness, again denied compensation because he may have responded to treatment.

Number four, a young woman diagnosed with multiple sclerosis, considered permanently disabled by the Comminsure Chief Medical Officer and then sent a letter by the same doctor, stating her claim had been denied. She, incidentally, was a Commonwealth Bank employee.

Finally, another Commonwealth Bank employee who, before his illness, was awarded by the previous Commonwealth Bank CEO, Commonwealth Bank Employee of the Year, was refused compensation despite a diagnosis of severe endogenous depression.

After publicity, some of these claims were settled but it did require the threat of adverse press.

The response by the current Commonwealth Bank Chief Executive Officer, Ian Narev was robotic and rehearsed and appeared to come right out of the bureaucratic songbook.

To focus on the first case of James Kessell, the heart attack sufferer: he had a very typical heart attack story, arrived at the hospital, a rapid diagnosis was made, he was given immediate treatment with a clot busting drug and soon after experienced what in cardiology is known as reperfusion arrhythmia and had a cardiac arrest.

In other words, because he was seen and treated rapidly, it averted serious heart damage but the rapid breakdown of the clot that formed within the heart attack released toxins into the circulation and irritated an already irritated heart and sent the man into cardiac arrest.

So, because of this very appropriate clot busting drug, a subsequent relatively common cardiac arrest was treated rapidly with a defibrillator otherwise known as a Packer Wacker, Mr Kessell didn’t sustain  enough cardiac damage to suffer a Comminsure heart attack.

In 2012, the criteria for an insurance ‘compensatable ‘ heart attack somewhat changed.

1) the rise and fall of cardiac markers along with one of the following. These markers are called troponins but the more recent troponins are much more sensitive than the old standard tests and pick up even minute amounts of cardiac damage. For example, if you measured the troponins at the end of a marathon a third of runners have a rise in troponins suggesting they have a degree of minor cardiac damage.

So, if you have a Troponin rise you also need one of the following to make the compensation grade

- signs or symptoms of a heart attack

- ECG evidence of lack of oxygen or heart damage

- imaging evidence on either echo or nuclear scanning of cardiac damage.

I fully understand that insurance companies are in the business of making profits but, thankfully  this mean spirited approach by Comminsure has been put under the microscope by the ABC and Fairfax Press and hopefully they will not pull these stunts again.

People pay insurance, strangely to insure against any health challenges they may suffer in the future. One of the major advantages of our modern world is the increasing accountability and media scrutiny of bad behaviour. Let’s hope this continues