Tomasz’s insurer declined his income protection claim – saying he’d misrepresented his medical history

Insurance Income Protection

Tomasz’s insurer declined his income protection claim and cancelled his policy, telling him he’d misrepresented his medical history. We found he hadn’t given the insurer the information it had asked for – and that it wouldn’t have covered him if he had. We decided Tomasz had made a careless misrepresentation, and that the insurer had acted fairly.

What happened

Tomasz contacted us after his insurer turned down his income protection claim on the basis he’d misrepresented his medical history.

He told us that he’d taken out an income protection policy a number of years previously, for extra security in case he couldn’t work.

He said he’d later been unable to work for six months as a result of a serious accident. But his insurer had declined his claim, cancelled his policy and returned his premiums. It told him he hadn’t correctly disclosed previous medical issues when buying his policy.

Tomasz felt the insurer had acted unfairly, and asked us to look into his complaint.

What we said

When we asked Tomasz and the insurer for more information about what had happened, it was clear Tomasz hadn’t answered all the insurer’s questions accurately. In particular, he hadn’t disclosed that he’d previously been treated for high blood pressure and cholesterol, or that he’d had abnormal test results relating to his heart.

Tomasz accepted he hadn’t given the right information about his test results, but said he hadn’t had the results to hand, and didn’t remember they’d been abnormal. He said he hadn’t taken medication for these conditions for some time, and that they weren’t relevant to his claim.

We explained to Tomasz that, in our view, he hadn’t taken reasonable care to answer the insurers’ questions correctly. Though he might not have remembered his test results, he could have tried to find out if he wasn’t sure. So we agreed with the insurer that he’d made a “qualifying misrepresentation” under The Consumer Insurance (Disclosure and Representations) Act 2012 (CIDRA).

CIDRA sets out that when a customer fails to take reasonable care, the insurer should take a proportionate response. This means we’d expect the insurer to base its approach on what it would have done if Tomasz had taken reasonable care and given the correct information at the time he took out his policy. And the insurer provided evidence to show it wouldn’t have offered Tomasz the policy if he’d answered the medical questions accurately.

Given what we’d seen, we thought the insurer had acted fairly – and didn’t uphold the complaint.