Types of complaints we see
When a customer makes a claim, an insurer may find something which they think suggests that the customer misrepresented information when they took out a policy.
The insurer might argue that if the customer had given true answers, it would have acted differently. As a result the insurer might then alter the terms of the policy by:
- retrospectively applying a restriction to the policy – which means the claim may be declined
- settling a claim proportionately
- cancelling the policy – which means the claim will be declined
Customers complain to us that:
- they haven’t made a misrepresentation
- their insurer has treated them unfairly by either not meeting their claim, or by altering the terms of their policy
What we look at
We want to know that you acted fairly if you decide there’s been a misrepresentation. So if a customer complains to us that they haven’t been treated fairly, we’ll consider your obligations under The Consumer Insurance Disclosure and Representations Act 2012 (CIDRA) and look at whether:
- the questions you asked were clear and specific
- the information you were given was inaccurate
- you would have done anything differently if you’d been given accurate information
- you’ve been fair in the way you’ve handled the misrepresentation
Was there a misrepresentation?
If the information given to you by the customer was incorrect, we’ll look at whether the customer took reasonable care when answering the question.
You need to provide evidence showing:
- what question was asked
- what answer was given
- that the answer was incorrect
Examples of evidence we’ll accept include:
- recordings of the sales call
- copies of the application form (also called a proposal) completed by the policyholder
- screenshots of the online application
The questions you ask should be clear. If questions aren’t clear, this could lead the customer to give an incorrect answer.
Sometimes it’s acceptable that customers haven’t told insurers certain information. This could be when the information:
- is something the customer doesn’t know or couldn’t reasonably have been expected to know
- is something you should reasonably be expected to know – like where a customer answers ‘see your records for claims history’
- isn’t relevant because you have waived your right to know it
- reduces the risk to be covered by the policy
- is covered under the Rehabilitation of Offenders Act 1974
Did the misrepresentation make a difference?
If the information you’ve been given wasn’t accurate, we’ll look at whether you would’ve offered the insurance policy on different terms. But you’ll need evidence to prove that the misrepresentation made a difference. Evidence you could use includes:
- your underwriting guide (or underwriting guidelines) which outlines what you would’ve done in certain situations
- an explanation of the sales process
- a written statement from an underwriter explaining what you would’ve done
The evidence we’ll accept will differ from case to case. We might be persuaded by a written statement from an underwriter in one case, but not in another.
Did the customer take reasonable care when answering the question?
We take the approach that whether or not the customer took reasonable care depends on a number of factors including:
- the exact question asked
- the circumstances of that specific customer at the time they answered the question
Customers are only expected to answer questions to the best of their knowledge and belief. It might not be reasonable to expect a customer to remember exactly when certain events happened, or to know off the top of their head the answer for a joint policyholder. In some cases, it might not be reasonable to expect a customer to know the answer to a question at all.
But the customer still has to take reasonable care not to make a misrepresentation. So if a customer is unsure of the answer to a question, it's reasonable to expect them to find out the answer.
When a customer doesn’t take reasonable care
CIDRA sets out that when a customer fails to take reasonable care, the insurer should take a 'proportionate' response. This means you should base your approach on what you would’ve done if the customer had taken reasonable care and given the correct information at the time the policy was taken out.
Charging more for a policy
If you would still have offered a policy but would’ve charged more for it, you should still consider the claim. If the claim is valid, you should settle it based on the proportion of premium the policyholder paid compared to what they should’ve paid.
So if the customer paid £100 premium, but they should have paid £150, they’ve actually paid
two-thirds of the premium. This means you should pay two-thirds of the claim.
Offering different terms
If you would still have offered the policy, but on different terms (apart from charging more), you may retrospectively apply those terms. If there’s an ongoing claim, you may consider the claim subject to those amended terms. This might mean the customer's claim isn't now covered because you’ve applied extra conditions to the policy, and the customer didn't meet them.
If you would’ve charged more and altered the terms, you can consider the claim based on the revised terms, and then settle it proportionately. For example, if you would’ve applied a limit for valuables of £10,000 and charged double the premium, it might be fair to apply the £10,000 limit if the valuables claimed for are over £10,000 and then pay £5,000.
But where you offer consumers the option of paying an additional premium to continue cover, throughout the lifetime of the policy, we’re only likely to think that’s fair if the consumer has understood that this is optional and has agreed to pay it. Otherwise, the usual remedies under CIDRA will be the only ones available to you.
Voiding the policy
If you wouldn't have offered the policy at all, you’re entitled to void the policy. This means the policy will be cancelled from the date the misrepresentation occurred – either the start of the policy or a later renewal. If there’s an ongoing claim, you won’t have to pay it because the voidance will mean that there was no policy in force when the damage occurred.
In these cases, you’ll need to refund the customer’s premiums back to the date of cancellation. That’s because the policy wasn’t in force for that time anymore. We wouldn’t expect a customer to pay for a policy they didn’t have.
If we think the customer deliberately gave you incorrect information, we might say it's reasonable for you to void the policy and keep all the premiums. This type of misrepresentation goes beyond carelessness and indicates the customer was trying to obtain a benefit they weren't entitled to.
Misrepresentation after the customer applied for the policy
Before the policy starts
It may be that your customer didn't tell you about something that happened between signing the application, and the policy starting.
If you made it clear to your customer that you needed to know if any of the information they’d given you had changed, we might consider it fair for you to later retrospectively amend the terms of the policy.
After the policy starts
We also sometimes see cases where the insurer says the customer didn’t tell it about something that happened after the policy started. Usually, the only time a customer has to give the insurer information is when they buy a policy or when they renew it. So, if something changes after the policy has started, the customer won’t usually have to tell the insurer about it until they renew the policy.
You may find out there was a misrepresentation when the policy was taken out and it’s been a year or more since it happened. The policy may well have renewed one or more times since then. If you wouldn’t have offered cover originally, you may avoid the original contract and reject any claims in that first period of insurance. But you can only avoid later contracts if your customer misrepresented again at the later renewals and this would have made a difference to you.
Some insurers will cancel all the policies back to when they started as a result of a careless misrepresentation. But you should consider each policy individually under CIDRA for each policy year. The only exception could be where the original misrepresentation was deliberate.
Waiving the right to void a policy/affirming the contract
When you find out that information the customer gave you was incorrect, you can:
- retrospectively amend the terms of the policy
- carry on with the contract you’ve entered into
Generally, if you choose to carry on with the contract, we think it’s unfair for you to later change your mind. We believe that if you carry on with the contract, you’ve essentially affirmed it and have waived your right to later retrospectively amend the terms of the policy.
However, if you choose to carry on with the contract, but then discover the incorrect information, you’ll still have the option to retrospectively amend the terms of the policy.
Handling a complaint like this
You need to use The Consumer Insurance Disclosure and Representations (CIDRA) Act 2012 when dealing with complaints about misrepresentation. When a customer buys or renews an insurance policy, CIDRA says the customer needs to “take reasonable care not to make a misrepresentation”. When you’re deciding if a customer has taken reasonable care, you’ll need to think about:
- the type of policy taken out
- any documentation you gave to the customer
- how clear and specific the questions were
- whether an agent was involved, like an insurance broker
If the customer didn’t take reasonable care and misrepresented some information that affected the policy, you’ll then decide whether the misrepresentation was careless or deliberate.
If the customer did take reasonable care, then even if there was a misrepresentation, you can’t take any action against the customer.
Putting things right
If we decide that the customer hasn’t made a misrepresentation and that you’ve unfairly voided or changed the terms of a policy, we need to make sure the customer is put back into the same position they would have been in. This means you may need to:
- reinstate a voided or cancelled policy
- remove any retrospectively applied terms, so that the terms are the original ones
- reduce the price to what it was originally, and refund the difference, plus interest
We’ll also consider whether there are grounds for compensation for any stress and inconvenience experienced by the customer.
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