It was a relief when senior counsel assisting the royal commission, Rowena Orr, QC, called an end to the day's proceedings on Thursday afternoon.
This had been a harrowing afternoon, as witness Loraine van Eeden, the general manager of claims at insurer TAL who joined the company only in January, sat through a case study that went from ugly to abhorrent.
Orr took van Eeden through a case involving a nurse who bought income protection insurance in early 2009, and was then diagnosed with depression.
She stopped working on January 1, 2010, and after her worker's compensation claim was rejected, she claimed under her TAL policy.
TAL Life's Loraine van Eeden leaves the royal commission on Thursday. Eddie Jim
Thus started her nightmare at the hands of the insurer.
TAL launched what it internally described as a "general review" of the claim, but which van Eeden agreed amounted to a "fishing expedition". It grabbed medical reports from various professionals, Medicare records and even tax and financial records for no apparent reason.
The insurer found a reason to reject the claim. The nurse had taken a couple of days off in 2007 and about 10 individual days off during 2008 and 2009 for stress.
Despite her doctors explaining the absences – the days in 2008 and 2009 related to stress in part caused by acting as carer for her partner – and confirming her depression was not related to a pre-existing condition, TAL decided the nurse should have disclosed what it called "workplace stress" prior to taking out her policy. As well as rejecting the claim, it cancelled her policy.
Private investigator
The nurse eventually took the case to the Financial Ombudsman Service, which found in her favour. TAL fought the decision repeatedly but eventually reinstated the policy and agreed to the nurse's claim in May 2013, more than three years after it was made.
But the real bastardry was to come.
In April 2013, with TAL now paying the nurse about $2750 a month, a TAL staff member did a Google search on the nurse and discovered she'd written a book.
Facing a liability of $792,000 over the life of the policy, and apparently feeling it had been duped, TAL made the breathtaking decision to employ a private investigator to conduct physical surveillance over the course of four months.
The TAL claim manager helpfully suggested the PI "do a pretext" at the hospital she used to work at to see what information could be found, and talk to the local cops.
"OMG here is another one for you," the TAL case manager told the PI. "I want results."
The surveillance ran on for four months, and included video and photographs that Orr described as "very detailed and frequently very personal". The reports from the PI included comments about the nurse taking off her clothes to go swimming, and sharing intimate moments with her partner.
"TAL elected to pay $20,000 to a private investigator to try and stop these payments," Orr put to van Eeden, who agreed.
Stress and anxiety
But TAL wasn't done. In late 2013, it asked the nurse to fill out a daily activities diary, which van Eeden agreed was aimed at again finding a way to cease payments.
At the same time TAL went to an external, supposedly independent psychiatrist to review the claim yet again. The case officer told the doctor she would "love to close this one down" – that is, stop making payments – before Christmas.
On Christmas Day, 2013, the nurse provided TAL with a progress claim and yet another medical certificate stating she was getting stressed filling out the diary.
TAL referred the matter to its chief medical officer, stating it did not find the request to fill out the diary unreasonable. In what van Eeden described as bullying, TAL suggested it could stop payments if the diary wasn't filled out.
The nurse complained again to FOS, but she also completed the diary. In it, she mentioned self-harm due to stress over the diary, and anxiety towards TAL.
By the end of January 2014, a doctor for the nurse said she was now suffering panic attacks.
But in early 2014, TAL's claims committee decided it would cease payments. It alleged she had been fraudulent, and, incredibly, attempted to reclaim monies it had paid – some $68,890.
"I was shocked when I saw this," van Eeden said, winding up her evidence for the day and summing up the mood of the court room.
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This article was published and provided by the Australian Financial Review.
https://www.afr.com/business/insurance/banking-royal-commission-exposes-tals-abhorrent-treatment-of-nurse-20180913-h15cjk