The Hayne royal commission continues to force banks and, in recent days, insurance companies to score own goals - and to do so in the most public of forums.Yesterday's proceedings featuring CBA's insurance arm CommInsure zeroed in on the internal tug-of-war between adopting an updated and universally accepted definition of what constitutes a heart attack, versus clinging to an outdated definition that allowed the life insurance business to refuse payouts in many cases that would otherwise qualify.Rowena Orr, senior counsel assisting, took CommInsure's managing director, Helen Troup, through a case study based around an (unnamed) trauma insurance policyholder who suffered a heart attack in January 2014.He chose to have stents inserted rather than bypass surgery and found his claim was largely denied because - on the outdated definition used by CommInsure - he failed their definition of heart attack.CommInsure paid him $10,000 for the operation he'd experienced, but refused to pay out the bulk of the $100,000 trauma insurance policy.In an exchange that would have been a dose of black humour in other circumstances, Troup - an actuary by training - and Orr quickly exhausted their medical knowledge in teasing out the crucial definitions, but it came down to this: CommInsure required a reading of 2.0 micrograms per litre of troponin (a protein released into the blood when the heart muscle is damaged) to diagnose a heart attack, and the customer's reading was 1.9 micrograms per litre.The World Heart Federation and associated medical authorities updated the definition of heart attack in 2007, and again - more crucially - in 2011 to essentially disregard the use of troponin in favour of a range of other measures, and to recognise these measures differed between men and women.However CommInsure did not update its definition until 2016, at which time it backdated policies, initially only to May 2014 on the basis that a new PDS (product disclosure statement) had been issued at that time, and against the advice of its own chief medical officer, who said "in an ideal world I would personally move to the universal definition from 2007."The strong implication was that this revision only came about following negative media coverage via a joint ABC/Fairfax investigation.Under heavy questioning by Orr, Troup was unable to point to any reason the policies were not backdated further, although the commission uncovered internal actuarial analysis performed by CommInsure that indicated a May 2014 date could cost between $7 million and $22 million.Ultimately, the payout was just $2.5 million extra to policy holders whose claims had previously been refused.In the meantime, the policyholder who had suffered a heart attack in January 2014 had taken his complaint to the Financial Ombudsman Service, where CommInsure argued it was a matter for commercial judgment by the company.More egregiously, when asked for the evidence it relied upon in refusing the claim, CommInsure provided its in-house medical opinion - although all aspects that went in favour of its policyholder were redacted, causing FOS to rule in favour of the insurer.This was a