A nurse diagnosed with an anxiety disorder was followed by a private investigator, tracked on social media and bullied by insurer TAL, as part of its campaign to deny her income protection claim. The banking royal commission heard how a three-year dispute with TAL did not end when the Financial Ombudsman Service (FOS) ordered the insurer to pay out her claim, with interest. Instead, staff within TAL stepped up efforts to discredit the claimant and ordered intense surveillance, which lasted at least four months. TAL executive Loraine van Eeden, who only joined the company in January, was questioned about the case — which she repeatedly described as “inappropriate” — for several hours on Thursday. The customer at the centre of the case worked as a nurse and also cared for her partner, who suffered from mental health issues. In 2009, several months after taking out an income protection policy with TAL, she developed anxiety symptoms as a result of workplace stress. After being diagnosed with a “generalised anxiety disorder” by her GP, she made a claim on her TAL policy. She also submitted a workers’ compensation claim for the same condition but it was denied, despite her GP saying she had a good case. The GP specified to TAL that it was a “new onset illness” and not an exacerbation of any existing condition. Senior counsel assisting the commission Rowena Orr QC outlined a “fishing expedition” to gather evidence in an effort to cast doubt on the claim. This included suggesting the customer’s two visits to an employee assistance program constituted a history of seeking treatment for work-related stress that should have been disclosed at the time of taking out the policy. In fact, the customer had been using the visits to seek advice about her rights in the workplace, as she was caring for her partner. TAL eventually denied the claim and cancelled the policy on the basis of non-disclosure by the customer. “The claimant was never given an opportunity to provide additional information before a decision was made,” said Ms van Eeden. The customer then took her case to the Financial Ombudsman Service (FOS) and a lengthy back and forth between the three parties began. FOS eventually found in favour of the customer and ordered TAL to reinstate her policy, assess her claim and pay her any benefits owed, including interest. More than three years after the initial claim, TAL told the customer it had accepted her claim. Ms Orr told the inquiry that a TAL case manager then googled the customer and discovered she had written a book and engaged in some related speaking events. This set off a coordinated campaign designed to discredit the customer and stop her income protection payments. A case manager emailed a private investigator with the subject line “OMG, here is another one for you, I want results”, outlining proposed surveillance activity. The investigator commenced tracking the customer and provided reports to TAL, which shared them with an external psychiatrist who had also been enlisted to assist in discrediting the customer. In one instance, the investigator spied on the customer for an entire day and issued a report with intimate details, including her undressing before a swim at a local pool and showing affection to her partner. TAL paid the investigator $20,000 for his efforts. The income protection payments to the customer were $2,750 per month. In another escalation, TAL asked the customer to complete a “daily activity diary”, claiming it was a condition of her policy. The customer obtained medical certificates stating the requirement to fill out the diary was worsening her condition. The TAL case manager continued to pursue her for the diary and said her payments were at risk if she did not return the pages. When the diary was eventually supplied, it contained references to self-harm, including as result of having to write the diary. “I think it just goes all in the inappropriateness of the way this claim was handled,” said Ms van Eeden. “Are we getting a bit beyond the ‘inappropriate’ stage now?” replied Ms Orr. A claims decision committee, which the claims manager was a member of, formed the opinion that the claim was “spurious” and decided that the customer no longer met the definition for total disablement, citing a section of legislation that applies to claims that are made fraudulently. In a letter informing the customer of the decision, TAL revealed its surveillance campaign for the first time and said she would no longer receive benefits and would be required to pay back nearly $70,000. Ms van Eeden will return to give further evidence on the case today.
