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CommInsure whistleblower suing for wrongful dismissal
Wednesday, 9 Mar 2016 15:50:02 | Rebecca Armitage
Dr Koh says he had permission to send records to his personal mail account. (ABC News: Margaret Burin)
The former chief medical officer at the Commonwealth Bank's insurance division, CommInsure, has filed a wrongful dismissal suit against the insurer, just days after he blew the whistle on the company.
Dr Benjamin Koh told Four Corners and Fairfax, doctors were pressured to change their opinions, outdated medical definitions were used to deny payouts, and medical files disappeared from the internal filing system.
He was sacked by CommInsure last year for forwarding work emails to his personal account.
On Wednesday his lawyer filed a writ in a Melbourne court, claiming Dr Koh suffered loss and damages as a result of his dismissal.
Outdated definitions
Dr Koh told Four Corners he first became concerned about CommInsure's practises when he discovered the company used an outdated testing method when assessing heart attack claims.
CommInsure looks for troponin in a patient's bloodstream — a protein released when heart cells are damaged.
But leading cardiologists said it should no longer be used in isolation to assess the severity of cardiac arrests.
In 2014, Dr Koh conducted a random audit of 40 recent heart attack claims, and found more than half of legitimate claims could be knocked back.
He recommended bringing the definition into line with clinical advances, but CommInsure refused to change the policy.
"The consensus was if we were to change the definition it would mean that legitimate heart attack claims would be paid out, and there will be more claims that are admitted, which has a pricing impact," Dr Koh said.
"So for purely profit purpose, purely for the bottom line, they didn't want to change the definition."
Dr Koh sacked for violating IT policy
In August 2015, Dr Koh was accused of breaching CommInsure's IT policy by sending internal documents to his personal email account.
Dr Koh's lawyer Michael Bates told Four Corners and Fairfax the reason for his dismissal was farcical.
"He sought from his then manager the approval to send records to his personal mail account as a way to keep that secure, and was given permission to do that," he said.
After he left CommInsure, Dr Koh wrote a letter to CBA chief executive Ian Narev outlining his concerns, but never received a response.
Commonwealth CEO admits failings
Mr Narev told Four Corners CommInsure had failed some customers, and he was willing to meet with them to apologise.
He announced on Saturday the bank would update its heart attack definition in line with medical advances and improvements in detection technology.
The Australian Securities and Investments Commission has announced an investigation into CommInsure's approach to heart attack cases.
The Federal Assistant Treasurer Kelly O'Dwyer said she expected a Senate inquiry into the scandal.
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