2015 - 2016

Insurance

Other insurance

Ms R wanted to switch life insurance provider and successfully applied to her bank for life insurance with critical care cover.  When she was told her application was successful, she cancelled her existing insurance.  About six months later Ms R suffered a heart attack and claimed for critical care under her new policy.  

But the bank declined the claim and cancelled her insurance because she hadn’t disclosed information about her medical history, which included high blood pressure, diabetes and weight problems.  It explained that if she had disclosed this information, her application would have been declined.

Ms R complained to us at this point, saying the bank hadn’t asked any medical history questions and told her it would contact her doctor for information before approving her application.  She complained that she had lost the opportunity to be paid out under her previous insurance’s critical care cover. 

We looked at Ms R’s completed and signed insurance application, along with medical notes supplied when she made her policy claim.  There was nothing to suggest she was told her doctor would be contacted before her insurance was approved.   The application form had made clear she had to disclose all relevant medical history to the bank, and clearly recorded that she had been asked whether she had received medical advice on a range of different medical issues to which she answered “no”. 

Ms R’s medical records showed she had a significant medical history (and family medical history) and should have answered “yes” to a number of application form questions to disclose this.  We concluded there was no evidence that the bank was responsible for Ms R’s non-disclosure.  It had also sought a medical review which showed had it been aware of her medical history it would have declined her insurance application.

Because Ms R complained she would have been better off claiming under the policy she cancelled, we looked at that and found it was likely any claim under it would also have been declined and the policy cancelled because Ms R hadn’t disclosed her medical history when applying for that insurance either.

We told Mrs R there was no evidence for us to take further action on her complaint, which she then withdrew.