A senior executive had fired off an urgent email to the highest levels of the company warning about a potential media storm brewing over the denial of a terminal-illness claim.

"This matter is being referred to you as it's been identified as a serious media threat," the executive wrote.

The case revolved around a 57-year-old nurse called Nicholas Bishop, a father of four, who had been diagnosed with a serious lung condition and given, in the opinion of two specialists, 12 months to live.

Bishop's was one a number of cases revealed in a joint Fairfax/Four Corners investigation into CommInsure, the Commonwealth Bank's insurance arm, last year.

His claim should have been a textbook case and he never suspected it would be a problem getting paid.

"I couldn't see any reason that it wouldn't be paid," Bishop says. "It met all the criteria under what they required and then some. There was no reason not to pay out."

CommInsure's policy criteria was simple enough - at least one doctor and one specialist needed to certify that an illness or injury would result in Bishop's death within 12 months.

"My doctors never indicated that I wouldn't [be] eligible," he says. "They took the questions that were presented to them and made it very clear that I would fit the criteria."

But a doctor inside CommInsure decided to include the possibility Bishop would receive a lung transplant, which had the effect of boosting his life expectancy beyond 12 months, which meant CommInsure could decline the claim.

Trying to predict the likelihood of an organ transplant is a risky business. Only two out of five patients on the transplant waiting list are lucky enough to get an organ each year. Some die, some fall off the list, some are rolled over to the next year.

The odds are slightly better - at three out of five - if you need a lung transplant, but there are no guarantees.

The wait for an organ can vary from between six months to four years. According to Bishops' doctors, he had just 12 months left.

Bishop was lucky enough to receive a transplant, but he remains furious that CommInsure considered rolling the dice.

"I was a joke, it was a complete joke, a travesty of justice," he says.

CommInsure settled Bishop's case after he threatened to go to the media. Chief executive Ian Narev later apologised for the bank's behaviour.

Bishop still feels he was treated unfairly when his claim was originally rejected and believes CommInsure cherry-picked the advice to justify the initial denial.

But deciding between competing medical opinions is the bread and butter of the insurance industry.

Col Fullagar used to be a director of a life insurance company and now assists claimants. He says there is a fine line between cherry picking and opportunism.

"When you use the word cherry picking my interpretation is you are deliberately going to a particularly doctor because you are somewhat confident they will come up with the right answer ... There's also opportunism, meaning I can go to a range of doctors, and I can opportunistically hope they give me the 'right' or a different answer," he says.

"Whether it is opportunism or cherry picking, I don't think it matters."

Last month the corporate regulator, the Australian Securities and Investments Commission released the findings of its 12-month report into CommInsure, which found "no evidence" of cherry picking. The regulator told Fairfax Media it also looked at the use of medical experts as part of this report.

Likewise, the Commonwealth Bank's own independent review did not identify "any systemic issues relating to historically declined claims".

The Commonwealth Bank told Fairfax Media it has conducted exhaustive reviews into its files and has found no evidence to support claims employees cherry-picked doctors to provide medical opinions for the purpose of declining claims.

"We've taken these concerns very seriously, commissioning thorough reviews and investigations led by experts including Deloitte, DLA Piper and EY," the bank said.

"The reviews of CommInsure have been extensive, involving more than 5 million email messages and documents, 80 interviews and the manual review of more than 200,000 individual emails."

The bank has previously pointed out its reviews have been backed by the banking regulator Australian Prudential Regulation Authority.

But the experience of having a claim denied can feel quite different.

When Matthew Attwater, a former call room worker at the bank, had his TPD claim denied he says it certainly felt like it was cherry picking.

'It felt like they were calling me a liar,' says former CBA employee Matt Attwater. Photo: Supplied

He had already been assessed by the Commonwealth Bank by a psychologist who found he was not capable of returning to the workforce "at any foreseeable time in the future or in any ongoing manner" in a report which was used to justify his retirement from the bank on health grounds.

But when it came to assessing his Total Permanent Disability claim he was sent to a second psychologist, this time organised by CommInsure, who found "he may well improve to the degree that at some time in the future he may be able to return to some form of employment".

Attwater was featured in Fairfax's investigation into CommInsure last year. He was eventually paid out but only after he challenged the claim denial through lawyers. The Commonwealth Bank's chief executive Ian Narev ended up meeting with Attwater to apologise for his treatment personally.

He remembers reading the second psychologist's report in December 2013. "I was devastated," he says. "It really painted a picture that was not true. It contradicted what all the evidence I had to me, it felt like they were calling me a liar."

He says it was based on a half-hour examination and ignored the mountains of evidence and expert testimony he had amounted.

Attwater's psychiatrist was hired by CommInsure as an Independent Medical Examiner or IME.

In some cases CommInsure now asks customers to choose their own IME from a list which it sources from a provider.

IMEs are supposed to act independently of the claimant and the insurer, providing an objective third-party view on a medical claimant.

But this isn't always the case according to some who say the system can be guns for hire, or used to deliberately string out a claim for years.

Will Barsby, Principal of Superannuation & Life Insurance at Shine Lawyers, says while IMEs are an important part of assessing claims, the system has been abused.

"A case I had in the last two weeks, the life insurer sent the claimant to four medical examiners," he says. >

"This was a big retail life insurer, and in this case it was four doctors and they weren't getting the answers they want so they just continued, continued and continued."

"In the face of a treating specialist, a surgeon, a GP, one or two independent reports, insurers will say 'this still isn't enough evidence' in this claim."

Barsby says he has watched the use of IMEs expand into a lucrative industry in the past five years, with companies now specialising in connecting insurers with doctors.

"We have seen more doctors want to be in life insurance case. We see these [IME] companies, largely unregulated, pooling together experts," he says.

Working as an IMEs can create a lucrative income stream. Lawyers say they have seen IMEs paid as much as $4000 for a consultation enough to allow them to retire from general practice.

One IME working for CGU Insurance, processing claims for WorkSafe Victoria, earned $1.25 million, according to a state government report.

Barsby says IMEs are generally paid upfront by insurers which he says gives them an incentive to offer opinions that might win them more work.

"One average they [IMEs] are paid between $3000-$4000, these are expert doctors and that's all that they do," he says.

"Particularly if you look at the doctors who align themselves with an insurance company, the insurance company pays them up front.

"If it is a claimant they have to negotiate terms of payment. I'm no economist but if you look at an analysis, if you have experts getting paid up front for work from the insurer it naturally follows they become a mouthpiece for their customers."

IMEs are big business. One of Australia's biggest suppliers of IMEs is MlCoa, owned by the MedHealth group, which last year earned almost $70 million in revenue, which represents a 2000 per cent increase in five years.

In April MedHealth's parent company, American IME provider ExamWorks, was bought out by US-based private equity firm Leonard Green & Partners LP for $US2.2 billion ($2.8 billion).

Questions have been raised about MlCoa's record-keeping and privacy practices when a leaked internal memo asked MlCoa's IMEs to "check their rooms/homes/offices etc for any MlCoa Hobart patient files that have not been returned to us".

At the time MlCoa said it was just a general reminder to doctors to be careful with files.

Authorities have long held serious concerns about the use of IMEs. In September last year the Victorian Ombudsman Deborah Glass released a scathing report into the use of IMEs by WorkSafe Victoria. The 174-page report looked at 65 cases and was highly critical of how IMEs were being used.

Victorian Ombudsman Deborah Glass. Photo: Simon Schluter

"We found agents cherry-picking evidence to support a decision to reject or terminate a claim - as little as one line in a medical report - while disregarding overwhelming evidence to the contrary," the report found.

"We found IMEs - whose opinions agents use to support their decision-making on compensation - receiving selective, incomplete or inaccurate information. We also saw evidence that some IMEs were used selectively to advantage the insurers - including those described by agent staff as 'good for terminations'."

One psychiatrist quoted anonymously in the report said disabled patients had been "abruptly terminated on the basis of one examination by a so-called independent medical examiner ... my contrary opinion, based on seeing the patient on a regular basis often over a period of years was ignored as was that of their general practitioners".

There was also evidence of staff going on "fishing exercises" requesting multiple supplementary reports from IMEs in an attempt to get the "right" answer.

Elevator repairman Dave White suffered a fractured skull and crushed vertebra when a three-metre tall piece of glass crashed onto his head in March 2012.

'My mind started changing and I got angrier than I used to be', says elevator repairman Dave White. Photo: Supplied

The 55-year-old spent around 30 years working as an elevator repairman - a job he loved where he would regularly be called to rescue people who became stranded inside faulty lifts across Queensland.

"It was an exciting job, you could go to work and you get a call saying there's a pregnant lady trapped in a lift and you would help them out," he says.

His employer decided to expand its business into repairing glass-sliding doors.

In 2012 he was sent to Townsville's Flinders Street to repair a glass door.

While holding the lower half of the three-metre glass door it "exploded" with three heavy shards cutting his head to the bone and compressing his spinal column.

Dazed and covered in blood, he stumbled to a nearby medical clinic. He was later told if the angle been slightly different, it could have snapped his neck.

"The glass had cut my head open to the skull," he says.

"Later I found out it chipped a piece of my skull. It broke the skull and chipped a piece off the skull itself ... It wouldn't be no bigger than a fingernail - it's a triangle piece. It's still inside me."

In the weeks after the accident, he began experiencing numbness and debilitating headaches. His mood changed too, he became more aggressive and, out of character for him, began to be accused of bullying.

"At the time I just thought it was a normal accident but my mind started changing and I got angrier than I used to be, I would be angry at people for no reason, and the company saw that and the people around me didn't like that," he says.

He also had trouble walking or sitting still for even short periods of time experiencing a creeping numbness throughout his body. He says his back was so brittle doctors refused to operate on him.

In June 2015 WorkCover accepted his claim. Three months later, after making an application for Total Permanent Disability with MLC Life, he was asked by the insurer to see more doctors to justify the claim.

MLC sent White to six more IMEs which included two trips to Brisbane on flights that caused him "agony".

On one occasion an appointment was cancelled without his knowledge, leaving him in severe pain while he waited in the foyer.

"It was just over and over, it's so tiring it just drains the life out of you. You just say 'let me die'. It's a revolving, going around and round, in a massive circle and you don't see any future in it," he says.

"They have it in your head you are not injured, and then they try to prove it."

MLC said it did not comment on individual claims, but had a long history of paying insurance claims "in a timely manner".

"We strive to make the right decisions and support ethical and fair outcomes. We aim to support each customer with integrity, fairness, and compassion," the company said in a statement.

"IMEs provide a valuable role in helping us to understand the nature of the condition(s) suffered by the applicant, the treatments appropriate for them and, generally speaking, the prospects of them returning to work in the future."

The Australian Medical Association has strict guidance for doctors acting as independent experts emphasising the requirement to remain independent and unbiased.

"The weight of your opinion may be diminished if it is shown to be biased. Your role is to assist the court by providing an independent opinion, even though your opinion may be used to diminish one side's case," the advice reads.

Maurice Blackburn's National Head of Superannuation and Insurance Claims Kim Shaw says visiting multiple IMEs can be "overwhelming stressful" for claimants, already under stress or suffering depression.

She's come across consultations with IMEs lasting less than 15 minutes, then selectively relied on to justify the rejection of a claim.

"Where it becomes overwhelming is where, if the [doctor] appointed doesn't get the answer they want, the claimant gets sent to a second and a third doctor and the last one is always the one the insurer relies on," she says.

About an hour's south West of Melbourne in Geelong, 59-year-old Bernadette Richert worked as a pharmacy assistant. In May 2013 she had to step down from her job after suffering depression and fibromyalgia - a condition which results in widespread pain across the body.

Three days after Christmas last year her insurer Zurich Australia denied her Total Permanent Disability claim. According to her lawyers Maurice Blackburn, the rejection relied exclusively on evidence from an IME, ignoring two medical reports from her treating doctors.

She was devastated.

"I'm sure there are thousands of other unfortunate people who pay for these covers, but when it comes to paying out any money they [the insurance companies] will worm their way out of it," she says.

Richert says her consultation took only 15 minutes with the IME down playing her complaints and belittling her.

"When I went to see their doctor, he was too busy asking me about my family, my background, how I was letting my family down. He was absolutely belittling me," she says.

"I've got nothing against them sending me to another doctor to get another opinion, but not a doctor that's chosen by them ... I'm just emotionally depleted by the whole thing."

Richert's lawyers Maurice Blackburn wrote to Zurich Australia accusing the company of "erroneously omitting relevant evidence in place of a more favourable opinion of a non-treating doctor to decline the claim".

Zurich said it tries to pay "all genuine claims as quickly as possible, with as much empathy and transparency as possible".

The company wouldn't comment on Richert's situation directly, but said total and permanent disability cases were complex and the company considers a broad range of evidence before making a decision.

"Decisions on claims are not weighted to a single report."

Barsby says he's seen cases where clients have committed suicide while they are bounced between IMEs, waiting for a determination.

"I've seen that. The claimant give us a heads up and communicates with us in writing or email and say things like 'I can't take this any more. I can't cope, it's taking too long' ... then you hear from a family later on what happened," he says.

"Then the life insurer will pay the death penalty quickly."

Do you know more? Contact the author mario.christodoulou@fairfaxmedia.com.au