Not upheld: Other regulated complaint complaint against Cirencester Friendly Society Limited

Decision detail

Summary

Ms U complained that Cirencester Friendly Society Limited unfairly stopped paying her income protection claim and demanded repayment of benefits already paid. Ms U had taken out the policy in December 2014 and claimed in July 2015 due to ill health. During a claim review, Cirencester discovered that Ms U had sought medical advice for gynaecological problems a couple of months before the policy was taken out but had not disclosed this on her application form. The ombudsman found that Ms U's answer to the application question was incorrect, as the question specifically asked whether she had sought any advice for such problems, regardless of severity. Although Cirencester agreed to refund premiums taken after the claim stopped, the ombudsman did not uphold the complaint, finding Cirencester acted fairly in stopping the claim based on the non-disclosure.

The Ombudsman's reasoning

The ombudsman found that the application form question specifically asked whether Ms U had sought any advice for gynaecological problems, not whether such problems were severe or caused time off work. Ms U's medical records clearly showed she had sought advice, making her answer of 'no' incorrect. Although the GP confirmed the problems were minor and unrelated to her current illness, the question's wording required disclosure of any advice sought. Cirencester acted fairly in accepting the claim based on information provided and then reviewing it when further information came to light. The ombudsman recognised Ms U received payments she was not strictly entitled to, but expected Cirencester to allow a repayment plan rather than immediate recovery.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website