Non-disclosure justifiable grounds to decline insurance claim

Insurance policies,
Eamon suffered serious injuries in an accident and was deemed unable to return to work. Life insurance he had taken out with his bank five years earlier included cover for permanent disability, so soon after the accident he made a claim under the policy. The bank reviewed his medical history as part of its claim assessment. It revealed Eamon had not disclosed his full medical history to the bank when he applied for insurance.
June 2020

The bank then assessed what it would have done if Eamon had made a full disclosure and concluded it would have offered him permanent disability cover, but subject to exclusions for his pre-existing conditions. The medical evidence was that his disability was due to a combination of the excluded pre-existing conditions and so it declined the claim. 

Eamon did not accept he had failed to disclose relevant information to the bank. He said he thought he was required to disclose information dating back only five years from the time of making the application. In those five years he had been leading a full and healthy life, working with heavy equipment and playing sport. He said he relayed this to the bank employee concerned, who told him he would be covered.

Our investigation

We examined a recording of a tele-interview between Eamon and the bank employee who carried out the application process. The employee asked Eamon specific questions about his medical history that were not limited to the previous five years. Also, based on Eamon’s medical history, the employee asked him some questions that required “yes” answers. He answered “no” to those questions. In the recording, the employee clearly stated that Eamon had to disclose anything else about his health or lifestyle that might affect the bank’s decision to provide insurance. After the tele-interview, the bank sent Eamon a copy of the questions and his answers. 

We gave Eamon a copy of the call and told him we would find there had been no five-year grace period and he had not answered the bank’s questions correctly.


Eamon withdrew his complaint.

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