You may be aware of the recent media coverage, including ABC’s Four Corners program on Monday evening, alleging a particular insurer used outdated definitions to assess claims for trauma events. There was a specific focus on the Heart Attack definition and the criteria used to deny a particular claim. There were other allegations included in the media coverage, however we will not comment on those as they do not relate to ALI Group or our policies.
We would like to reassure you that our policies are managed according to the terms and conditions of each policy. This includes the assessment of claims. The policy document provided to each client outlines the definitions of the events that they are covered for under their policy.
Our insurer, Hannover Life Re Australasia, has reviewed our Loan Protection Plan definition for Heart Attack in consultation with their Chief Medical Officer, and they have confirmed they are comfortable that it provides a fair and reasonable diagnosis of Heart Attack. Further, in undertaking the assessment of any claim for Heart Attack, they look for multiple measures and clinical features (as included in the Heart Attack definition), taking into account advice from their medical advisers. The level of Troponin is one measure that may be considered, however they do not base any claim decision on one measure only. If a single test is inconclusive, a claim is considered based on other conclusive evidence.
We therefore are comfortable in the knowledge that our claims assessments are based on sound medical definitions and with the utmost good faith.
In ALI’s 13 year history, we have not had any claim rejected based on similar circumstances to those outlined in the Four Corners program.
That said, this investigation has further motivated us to see if we can improve our policy definitions to provide confidence to our brokers and clients in our products and service. To that end, we note that we are currently working with our life and trauma insurers to ensure that our medical definitions are relevant and reflective of medical advancements.
The staff, management and board of ALI Group are passionate about the protection we provide to Australian home buyers and their families, and are truly saddened by the allegations about improper conduct in our industry.
Should you have any concerns, we encourage you to reach out to me directly.
CEO, ALI Group