Saviour or Saboteur? In insurance, intent is everything.

For an industry founded on helping people during the worst moments of their lives, insurance suffers surprisingly poor PR. Research conducted by Roy Morgan indicates that the insurance industry is among the least trusted professions in Australia, rating barely ahead of car salesmen in terms of public perceptions of trustworthiness.

This reputation persists despite insurance being crucial for the quality of life for the vast majority of Australians, not to mention for the successful function of society, removing as it does the catastrophic loss which circumstance can easily visit upon any person. For professionals in this field, such a negative regard for their work must seem ungrateful at the least, and potentially lead to depression and resentment where it becomes acute – surely providers of such an essential service should be granted some modicum of respect?

But perhaps it is that very essential nature of insurance itself which leads to the disrespect the field is shown – after all, no one wants to have to rely on institutions that they do not trust. And given that the insurance industry’s financial interests are explicitly against paying out on claims by their customers, it is very easy for those customers to assume that their insurer is more interested in their money than they are their welfare. In fact, if we are to be frank, it could be argued that the insurance industry has a direct conflict of interest against fulfilling any positive role within society whatsoever.

However, this same accusation could also be made with equal accuracy against highly regarded, even venerated professions; doctors, firemen, police, paramedics, and even nurses (consistently ranked the #1 most trusted profession each year) all have careers that depend on the pain and suffering of their clients in order to exist. Indeed, unlike insurance, one could argue that the ultimate goal of the medical or emergency services professions is to make themselves redundant – the largest conflict of interest it is possible for a profession to have.

And yet despite several instances of firefighters starting blazes in order to see some action, these professions are still held in significant esteem, while insurance is dismissed as untrustworthy.

There has been significant discussion surrounding this poor reputation, with most commentators focussing on communication with customers to demonstrate insurers’ commitment to their welfare, and to address any concerns or distrust that may exist. But these methods only address the problem on a superficial level, are likely to be seen as insincere at best, and may even worsen customer opinions if sufficient distrust already exists.

Addressing this level of distrust in the industry requires a more fundamental approach; to put it simply, it requires demonstrated proof. This is not simply a question of practical outcomes but rather of how insurers interact with their customers over a period of time – and this raises the question of intent.

The goals an organisation sets determines how it conducts itself. A focus purely on financial outcomes for the organisation will therefore encourage behaviours that lead to financial outcomes alone – all other factors, including customer satisfaction, operational sustainability, health outcomes, ethicality and even legality, become secondary. Complicating factors that must be managed perhaps, but not metrics for the successful operation of the organisation, to be rewarded on par with achieving financial outcomes. And so, they are neglected, because there is little incentive to care about them, and plenty of disincentive for a lack of focus on the purely financial.

The irony of this is that such an exclusive focus inevitably undermines itself, as the CommInsure scandal in 2016 so clearly demonstrated. There is no question that redefining medical conditions to prevent paying out claims was great for the financial performance of CommInsure, at least in the short term. However, such flagrant disregard for the welfare of its customers, not to mention the profound harm it caused in terms of their health, and the subsequent legal consequences, has significantly damaged their brand, and thus the financial performance of the business in the mid- to long-term.

Such results serve as rock-solid proof to the public that the insurance industry is not trustworthy. While it may not be fair to tarnish the entire industry with that brush, the lack of a counter-example demonstrating insurers wilfully sacrificing profit to protect customer interests, means this narrative cannot be countered effectively – hence the failure of the communication approach recommended by some.

To rebuild confidence in the insurance industry, insurance businesses and professionals must demonstrate that the welfare of customers is a core objective, not just a factor to be managed where necessary. And demonstrating such a commitment comes down to the question of intent – by making customer outcomes a core objective, held on par with financial outcomes, the conduct of a business will shift to reflect this prioritisation.

The concept of ‘shared value’, as pioneered by Harvard academics Michael Porter and Mark Kramer, provides an excellent framework for this paradigm shift. This concept states that no business or industry can be viewed as separate from the social context they operate within, and that social progress must therefore form a core component metric for the success of any business.

As an institution founded on helping people during the worst moments of their lives, the insurance industry is ideally placed to adopt this approach, working not only to profit financially, but for the betterment of its clients and society as a whole. And while the process of re-establishing trust with the public will be a gradual one, requiring demonstrated effort from the industry. But if doing so can gain it the same esteem as other professions that help the public, then that is worth the effort.

Finding the boundaries of personal ethical responsibility

Published by the Australian Association for Professional and Applied Ethics

Gordon Young – Principal, Ethilogical Consulting

CommInsure logo

The question of where one’s ethical responsibilities begin and end has been a long-standing question for professional ethics, particularly within the context of employment. As globalization extends the influence and potential impact of businesses, the question must be asked whether individual employees can be held accountable for the actions of the businesses they work for, and if so, to what degree?

The recent CommInsure scandal, whereby the health insurer sought to deny legitimate claims by redefining what qualified as a claimable health condition, illustrates this problem clearly. These unethical activities were revealed by whistleblower Dr Benjamin Koh, a highly credentialed physician and CommInsure’s appointed chief medical officer. Mr Koh’s decision to act has enabled the media, consumers and the government to begin to correct CommInsure’s transgressions, however the question must be asked why Mr Koh was the only one to do this. CommInsure is a department of the Commonwealth Bank, a modern business employing 52,000 individuals – yet only one of these took public action to end this clearly unethical and harmful behaviour.

While Mr Koh’s actions have been effective, it cannot be denied that they would have been more so if more employees had objected to these activities, refused to participate in them, or revealed them publically. This could have prevented considerable harm to CommInsure’s clients. But is it reasonable to hold individual employees responsible for the action of such a large organisation which they do not directly control? After all the decision to take these unethical actions was not theirs, and refusing to participate in them and/or going to the media could seriously threaten their careers.

This brings us to the ethical question of responsibility; is it reasonable to hold individuals responsible for decisions/actions that they are not directly responsible for? And if not, how can such unethical actions ever be corrected without individuals willing to confront or expose them?

Peter Singer’s pond analogy, published as part of his ‘Famine, Affluence, and Morality’ essay, offers a compelling solution to this problem. The analogy asks whether, on discovering a child drowning in a shallow pond, whether we as an individual have a responsibility to aid the child, even if doing so ruins our clothes. While Singer acknowledges that this would pose costs to us in dirtying our clothes, the benefits of saving the child’s life significantly outweigh those costs – therefore it is clearly our ethical responsibility to save the child.

While this analogy was intended to illustrate the ethics of international aid, it also demonstrates that there is no significant difference between an action and an inaction. That we had nothing to do with the child drowning in the first place is irrelevant; the potential harm is clear, inaction will clearly allow that harm to occur, and we know that the cost of preventing that harm is minimal to us. Knowing all this, it could be argued that failure to assist is little different from actively pushing the child into the pond to prevent them from messing up our outfit – the costs, benefits and our awareness of both are identical, so what different does the action/inaction distinction make?

If we extend this argument to individuals within CommInsure, or any organisation, then the implications are significant; if inaction doesn’t excuse them from responsibility then the scope of their responsibilities becomes effectively unlimited. Furthermore taking action on every problem within that business becomes a clear ethical imperative.

This is clearly unreasonable and unsustainable, overloading individuals with responsibility for an overwhelming number of activities, most of which they will have little control over, and interference with which could expose them to severe damage to their careers, finances and mental health.

Singer’s pond analogy demonstrates that inaction does not excuse one from responsibility, however practical application of this idea demonstrates it is too simplistic to be effective, simply punishing and exhausting those who try to follow it. To better respond to this problem I propose a comprehensive method for individuals to establish where their ethical responsibilities begin and end, comprising of four tests:

  1. Awareness of the ethical problem

If an individual is not aware, and cannot realistically be able to be aware of unethical behaviour taking place, it is not reasonable for them to be responsible for it. The scope of ‘reasonable ignorance’ is of course greatly limited in this Information Age, but events kept secret from the employee or completely out of their understanding are beyond their ability to reasonably intervene in.

  1. Proximity to the problem

The closer an individual is to the behaviour and those conducting it, the greater their capacity to be aware of it, understand it, and influence it. The general public has limited proximity to the unethical behaviour in CommInsure, low-level employees are closer, managers are closer still, and executives and are likely intimately involved. Increased proximity enables action to address the problem, and thus increases responsibility.

  1. Ability to intervene

Specific skills, organisational influence, psychological resilience, and relationships with pertinent people will all determine each individual’s ability to affect unethical behaviour occurring nearby. As a highly credentialed physician occupying a senior role at CommInsure, Mr Koh was in a strong position to influence the unethical decisions within the company, whereas low-level employees outside of the department would be significantly less able to do so.

  1. Consequences of intervention

Inevitably intervening in unethical behaviour will have consequences for any individual. The more serious the problem, the more widespread it is, and the more senior those causing it, the greater those consequences may be for the individual. These costs of intervention, combined with each individual’s ability to withstand or manage those consequences must be considered in deciding whether that individual can be held responsible for intervening.

These tests offer individuals a far more nuanced way of determining their ethical responsibilities, both acknowledging that inaction does not excuse them, and respecting the practical realities that intervention involves. Ultimately all four of these tests can be summarised in one broader phrase: ‘capacity to intervene’. If one’s capacity to intervene in unethical behaviour is high, one is responsible for intervening, regardless of the behaviours of others, lack of direct involvement, or personal reluctance to do so.