LODGING YOUR COMPLAINT WITH ASIC

 

“I have learned that success is to be measured not so much by the position that one has reached in life as by the obstacles which he has overcome while trying to succeed"
 --Booker T. Washington--

 

This paper is a short outline of how to mount our campaign against the Insurance Companies and their persistent refusal to pay legitimate ME/CFS claims to the innocent victims of an illness that they never chose to get.   The focus of this campaign is upon the Australian Security and Investment Commission (ASIC).   The only way to make progress is to make our individual voices heard – to combine our individual cases and keep making ASIC aware of our plight via an individual officer at ASIC.

 

It is easy to believe that we cannot, as an individual, make a difference here.   I do not believe that to be the case.   We can act individually towards a common purpose.  If we all act, then there is a genuine opportunity to succeed.   Our task is to act unselfishly for the benefit of others and take our case to the most appropriate body.

 

Please do not ignore this opportunity.   Every voice counts.

1.     FRAMING YOUR COMPLAINT

The first step in this task is to obtain a complaints form from the ASIC website, and fill it out accordingly.   I have attached a WORD version of it next to the link so that people can down load it to their computer for email submission.   Please be aware that this is not the official form, but it does cover all the necessary points that ASIC are after.   Furthermore, if you have several companies, then you need to detail them a separate form and attach it to the same document.

 

2.     CONSTRUCTING THE LETTER TO ACCOMPANY THE COMPLAINT.

Take some time to properly organize yourself.   It is essential to have a clear idea of what you want to tell the ASIC about your case, and to define what you need to achieve an appropriate outcome.

 

Each and every case will be different.   The companies will be different.   The type of policy will be different.   The Doctors used will be different.   The medical evidence you have will be different.   You need to summarise what your case is in brief.   Try and highlight where the Insurance Company has attacked you, where it has failed in its obligations under the contract, and in assessing your claim.

 

The purpose of this letter is to provide ASIC with a brief outline of your case.   Do not get bogged down in detail – they will not read it.  

 

  1. Tell them who you are, where you are from, and why you are writing to them;

 

  1. State what your illness is and when you were affected, and when you were diagnosed.   State your cognitive and physical limitations, and any impact it may have upon your ability to write the letter;

 

  1. Briefly list your policy/ies, when you got sick, when you claimed, the outcome of the claim, how long it ran for, the Doctors you’ve seen on your side, on their side, and what reason they gave for cancelling/denying the claim;

 

  1. Demonstrate briefly how their cancellation/denial breaches the policy;

 

  1. Outline the biological/psychological tests and reports that you’ve had, and who they were with, and their outcome;

 

  1. Outline where the insurance company sent you, who they were, and, if applicable, highlight how they carry out no testing, and seek out a Doctor that supports the case of the company that sent them.   Maybe highlight how many hours you’ve spent with your Doctors versus how many with theirs;

 

  1. If they have been paying, detail how long they paid, and on what evidence.   Highlight their change in view if evidence is not different or stronger, but the opinion changes when an opposing view is paid for;

 

  1. If they send you to a Psychiatrist, highlight how they pre-diagnose what is wrong with you, and do not look at the facts of the case;

 

  1. Highlight any denial of natural justice that may occur via the company’s refusal to provide access to the file, and/or Insurance Medical Reports (in accordance with the principle of fairness and right of reply guaranteed under Beverley v Tyndall Life Insurance Co Ltd (1999) 10 ANZ Insurance Cases 61-453 and the Financial Industry Complaints Service’s rules);

 

  1. Assert that the Insurance Company has not discharged its contractual responsibility, not its duty under Section13 of the Insurance Contracts Act 1984 (utmost good faith – or breaches of Trade Practices Act 1974 [See section on TPA in the Insurance Section] such as Section 51AB [Unconscionable conduct], Section 52 [Deceptive and Misleading Conduct], Section 53 [False or Misleading Representations], and Section 58 [Accepting payment without intending or being able to supply as ordered]);

 

  1. Explain that Section 55A of the Insurance Contracts Act 1984 allows ASIC to take up cases where a breach of the Act occurs, and it would be in the public interest to take action.   Section 13 of the Act imposes a duty of utmost good faith.   Breaches of the policy, breaches of case law, and breaches of other Acts (eg Trade Practices Act 1974) are a breach a utmost good faith.

 

ASIC is not currently enforcing their right under Section 55A because they assert that “ASIC’s consumer protection mandate focuses on apparent systemic issues within an insurance company and/or issues that raise broader industry concerns”.   They will only act if ASIC can “identify issues that appear to be systemic or widespread”.

 

Obviously this is not an exhaustive list.   I am open to suggestions from the experience of others and welcome suggestions for inclusion into this information site.

 

The whole point of this action is to supply ASIC with the pattern it allegedly needs to take action.   It also provides me with a database of people affected by the illness so that I can go to ASIC and show them the patter if they refuse to see it themselves.   Moreover, hitting one person with this information allows the one person to begin to see the pattern.


The current HIH debarcle indicates that ASIC is clearly under funded.   It required a $ 5 million injection in order to do the job that it is supposed to be doing at the moment.   Clearly it cannot investigate our claims, unless we show good cause.   Furthermore, ASIC should be more sensitive to the signs of an Insurance Company being in trouble.   Could it be that these refusals to pay legitimate claims are an indication of an internal financial problem?   We do not know, but it will be our task to get them to question that possibility and to do their job.

 

Don’t get into too much detail or evidentiary information.   Make reference to the fact that you have evidence.   If they want it they will ask for it later.

 

Lodge your complaint with:

 

ASIC Officer - Suzanne Halas – Email  suzanne.halas@asic.gov.au

 

Keep copies of the letter and any further correspondence you receive or send to them.   Furthermore, record all conversation in notes with time and date and the person you talk to.

 
It is unlikely that they will take action until they have a reasonable number of claims. It can be done irregardless of where court actions or complaints are as it will most likely not influence a case in action at the moment.   The law states that they have the power to take over a case if they feel there is a public interest to be served and you agree to allow it.   They have deep pockets and will out do these insurance companies.
 
The most likely response to peoples case for a while will be to reject a representative action, but it will add to the cases citing the reasons they have given above.
     
I written to all the Societies again and ask them to hone in on this one person. Please do this and do this now ... even if it is only brief.   This has to begin somewhere if CFS people are to have any chance of justice in the future.   Moreover, please acknowledge to me that you are taking this seriously and let others know that this action exists.   Only by acting as one can we ever hope to make the appropriate powers sit up and take action.   I cannot do this alone.

 

3.     Following Up The Complaint

The submission of the complaint is not the end of it.   You need to follow up your complaint with FICS.   Ask them for an explanation of why action is not being taken.   Ask how many people it takes to create a pattern.

 

Good Hunting.   I would like you to lodge your case with my database by sending it to my email address so that I am aware of the number of people making these submissions.   I will guarantee confidentiality, and only utilize this information for statistical purposes.   If I would like to use your case, I will ask for permission.   Anonymity is assured if desired.

 
My suggestion to you is to have people contact her and lodge a complaint with her.   I would hit this one person over and over with anyone who has complaints about AXA and non payments for CFS claims. I believe that if we pass this through out every contact we ahve and every person who has been refused by AXA or another company, we can get this person motivated to act against insurance companies.