Non-disclosure rightly resulted in rejection of insurance claim 2015-2016

Categories:
Insurance policies
Summary:
Tani wanted to switch life insurance provider and applied to her bank for life insurance with critical care cover. When she was told her application was successful, she cancelled her existing insurance. Six months later, Tani 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 said it would have declined her application if she had disclosed this information.

Our investigation

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

We looked at Tani’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. It 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". 

Tani’s medical records showed she had a significant medical history (and family medical history) and should have answered “yes” to many of the questions in the application form.  We concluded there was no evidence that the bank was responsible for Tani’s non-disclosure. It had also sought a medical review, which showed it would have declined her application if made aware of her medical history.

We also found that Tani hadn’t disclosed her medical history when applying for her previous insurance, and that it was likely any claim under it would also have been declined and the policy cancelled. We could not, therefore accept her complaint that she would have been better off under the previous policy.

Outcome

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

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