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07 April 2015

Scam means thousands were sold useless insurance by salesmen from Combined Insurance

Victim: Truck driver Riadh Zora was sold the wrong insurance cover.

When the two suit-wearing insurance agents knocked on his door in January 2013, Riadh Zora welcomed them into his Greenvale house.
"They looked very nice, so I let them in," says Mr Zora, an Assyrian immigrant who arrived in Australia in 1984 and supports his three children and wife by driving a truck 11 hours a day, six days a week.

The two salesman were from Combined Insurance, an insurance company that has operated since 1959 and which in 2008 was bought by giant US financial services firm ACE.

Whistleblower: Alison Moore.

As the pair entered Mr Zora's spotless house, they would have noticed its huge flat screen television and Christian religious iconography. To Mr Zora, his home is a testament to the successful life a blue-collar immigrant can build in Australia.

His journey has been especially arduous because he and his wife have both suffered illnesses in the previous five years. He insists he told this to the two Combined agents as they urged him to buy various insurance products that precluded people with a medical history similar to that of Mr Zora and his wife.

He says one of the two agents reacted by leaning forward and whispering, "Shhhhh."

"He [one of the agents] said, 'Don't worry about mentioning that. Leave it to us. We will make it all OK."

Sure enough, the Combined documents lodged after Mr Zora agreed to buy sickness policies for himself and his wife (who has asked for her name to not be published) failed to disclose their medical history, making the policies they bought potentially useless. Mr Zora says when he later attempted to claim when his wife fell ill, he was refused.

"I bought the insurance for peace of mind, to help look after my kids," says Mr Zora, who remains furious that he was scammed. He was also not told by the agents that they were working on commission. They wouldn't get paid unless they sold him a policy.

Mr Zora is not alone. Internal Combined Insurance files and whistleblowers reveal large numbers of the firm's customers across Australia have been the subject of similar alleged mistreatment.

They include a NSW couple subjected to "false and misleading conduct" when advised to buy a policy that was useless because they were on a disability pension, a NSW man who Combined found was subjected to "twisting" when he was sold a new policy he did not need "in contravention of the rules", and a family who were charged for insurance they never bought after an agent fraudulently submitted their bank account to pay for a policy.

Fairfax Media reveals today that ASIC has launched a major probe and Assistant Treasurer Josh Frydenberg says the alleged misconduct of the firm's agents show why reform is needed across the financial services sector.

Whistleblower Alison Moore, who worked for the firm between 2003 and 2014, has alleged corrupt behaviour is not only endemic in parts of the company but has been covered up by the company and its internal audit department that "inexplicably fails to detect vast numbers of fraudulent applications/sales".

Information from Ms Moore and another internal whistleblower reveals a hot-house sales environment in the massive American-owned Combined Insurance and a lack of action from regulators which has encouraged agents to adopt illegal sales practices that dupe policyholders, and even sign up fake people for life insurance.

A practice called "tomb-stoning" involves agents signing up dead or non-existing clients and then secretly paying for their initial premiums in order to pocket the even larger commissions.

An insider who asked to remain anonymous has estimated that at least 10 per cent, and as many as 60 per cent, of the company's estimated 70,000 policy holders may have been misled, sold incomplete or ineffective accident, sickness and disability policies.

Leaked company documents back up these claims and also reveal how agents are pressured into selling as many policies as possible not only to maximise their commissions but to win promotions, prizes and trips overseas.

The Combined cases, contained in leaked confidential company documents, detail allegations that agents falsified or omitted information about policyholder's medical condition, income, occupation, date of birth or welfare status in order to obtain "new" sales and maximise their commissions.

Insurance companies can refuse to pay out a policy if the holder has a pre-existing condition or pension that was not properly disclosed or has otherwise misled the company in documentation. At Combined, whistleblowers say, aggressive agents encouraged customers not to disclose problems or failed to record them in order to boost sales.

Combined is a mid-tier player in the nation's multibillion-dollar insurance market, usually charging customers premiums of several hundred or thousands of dollars a year.

Combined's agents were previously divided into teams, with names including the "crusaders" and the "gladiators", and are encouraged to fiercely compete for trips overseas and bonuses. The model is now different, with the company increasingly subcontracting out its agent teams to smaller insurance firms.

Agents still make money by earning a commission, leading to what one insider described as a "sales culture on steroids".

A top salesman or woman can make $250,000 a year including bonuses. But the leaked documents suggest the firm's aggressive sales culture encourages bad practices.

When Alison Moore first joined Combined, the former social worker was looking for a new challenge. She'd just returned from a sabbatical in India, and the idea of helping ordinary people create their own financial safety net appealed to her.

The Combined Insurance Company of Australia was also appealing, with its long history dating back to 1959 and the potential for its agents to make a reasonable wage depending on their success selling policies. During the first few years at Combined, Ms Moore says, she had few complaints. But around 2005, she began to notice an unpleasant culture beginning to permeate some parts of the company.

"It was a 'greed is good' attitude," says Ms Moore, referring to a core of agents who appeared intent on maximising their commissions, regardless of whether it meant breaking company rules or the laws that govern how insurance should be sold.

Over the next few years, Ms Moore says, she began to uncover cases in which other agents appeared to have actively misled customers in order to get them to buy as many policies as possible. Some of these policyholders ended up with insurance they were ineligible to claim on or simply didn't need.

Ms Moore noticed something else. Agents who were caught selling dud policies or misleading clients were not sacked or even disciplined. Instead, some were actually rewarded for their high sales with bonuses and trips overseas. Internal complaints seemed to disappear.

"Heaps of people have been sold a shonky policy," she says. "But nothing has been done about it."

One of them is welder Ray Radford, a long-term Combined client. In Mr Radford's case, it was information about his income which wasn't properly recorded by a Combined agent who approached him in 2013 and encouraged him to alter his existing policy.

Mr Radford didn't know it, but he was being subjected to "churning" or "twisting", a corrupt industry practice which involves a person with an existing policy being sold a new insurance product they don't actually need in order for a salesman to generate a commission. Even worse, the policy Mr Radford was "upgraded" to was useless because the agent had not recorded accurate information about his income and other personal issues.

After he discovered he had been dudded, he says, he felt betrayed by the firm he had loyally paid premiums to for many years.

"You can't trust anyone any more. I was going to bed at night thinking if I got hurt in the shed or was killed, my wife would get a certain amount of dollars.

"But if something happened to me, my wife would not have got one cent. I just don't want the bloke next door to have the same thing happen to him."

Mr Radford's fears are very real. Combined documents back up whistleblower Ms Moore's claims that agents who engage in repeated misconduct are rarely brought to account.

For instance, the leaked files reveal that in the last quarter of 2013, 17 agents from a single Combined Insurance team were reported for serious malpractice, including selling people "overlapped" insurance that they didn't need, misleading clients, breaching ASIC requirements and "alleged misrepresentation." In early 2014, 14 Combined agents from the same team, including many of those previously complained about, were subject to fresh internal reports of improper behaviour.

The first time another long-time Combined customer, Victorian deer farmer Mary Lang, learned that she might be another victim of Combined's poor practices was when she was called by Fairfax Media. Ms Lang was also a victim of "churning," having been signed up to a raft of new policies by a commission-hungry agent. Some of her new insurance cover appears to be worse than that provided by her existing policies. Ms Lang's personal details also appear to have been tweaked on the Combined database in a manner that suggests the agent sought to falsely portray she was a new customer, allowing him to collect a bigger commission.

Many of the Combined rorts detailed by Ms Moore and in the files are known to ASIC. In fact, an ASIC investigator called Mr Zora last year and told him he was one of dozens of people who had been duped by Combined. But Mr Zora also says ASIC didn't bother to travel to his house to collect the files needed to thoroughly examine his case. "They wanted me to come to the city but I am too busy working," he says. He has not heard from ASIC since the initial call.

"No one has done nothing," he says.

Ms Moore first contacted ASIC in 2013. At first, ASIC appeared uninterested.

"I had to nag them [ASIC]. I just kept sending them stuff ... I told ASIC this is bigger than you realise. There is fraud going on!"

It's understood that ASIC has recently ramped up its investigation, although Ms Moore is concerned that Combined, and its parent company, ACE, will simply shrug off any penalties that may flow from ASIC's probe. A recent decentralising of Combined's insurance selling network may also make it harder to hold shonky agents accountable.

In a statement, Combined said it had a strong system to deal with misbehaviour by its agents and that it was "troubled and concerned to learn when any of our customers have not been treated appropriately."

The firm also stated it "receives complaints from only a very small percentage of its policyholders" and that is was working with ASIC to "determine whether any additional changes may be necessary".

Ms Moore left Combined in 2014, but is speaking out now because she believes Australians are still being targeted by some of the shonky agents she uncovered during her time with the firm.

"What's needed is some pro-active enforcement by ASIC and a system shake-up. At the moment, the crooks in the insurance industry are writing their own rules."