Not upheld: Travel / life insurance claim disputes complaint against Liverpool Victoria Life Company Limited

Decision detail

Summary

Mr H and Miss J complained that LV= unfairly declined a critical illness claim after Mr H was diagnosed with multiple sclerosis in June 2020. LV= declined the claim because Mr H failed to disclose leg weakness and medical investigations in his application and Declaration of Health. The ombudsman found that Mr H experienced significant right leg weakness with foot drop in June 2019 and consulted his GP in February 2020, both of which should have been disclosed. Although Mr H was unaware of his MS diagnosis at the time, his symptoms were significant enough to warrant disclosure under LV='s clear questions. The ombudsman upheld LV='s decision to avoid the policy and decline the claim, finding it was a qualifying misrepresentation under CIDRA, and noted that LV= appropriately refunded premiums.

The Ombudsman's reasoning

The ombudsman found that Mr H failed to take reasonable care when answering LV='s clear questions about health symptoms. Although Mr H attributed his symptoms to excessive driving and believed they were resolved, his medical records demonstrated he experienced significant muscle weakness and foot drop causing frequent tripping in June 2019, which should have been disclosed. Additionally, Mr H consulted his GP on 5 February 2020 and underwent an x-ray, which he should have disclosed in his Declaration of Health on 17 March 2020. The ombudsman rejected Mr H's simulated online application as evidence, finding it did not accurately reflect the severity of his symptoms. Under CIDRA, LV= demonstrated it would not have offered cover had it known about the limb weakness, making this a qualifying misrepresentation. LV= acted fairly by avoiding the policy and refunding premiums, which is the most favourable remedy available.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website