Not upheld: Travel / life insurance claim disputes complaint against Liverpool Victoria Life Company Limited
Financial Ombudsman decision DRN-5695546 of 2025-09-17T00:00:00+00:00. Travel / life insurance claim disputes complaint against Liverpool Victoria Life Company Limited. Outcome: Not upheld.
Decision detail
| Reference | DRN-5695546 |
|---|---|
| Decision date | 2025-09-17T00:00:00+00:00 |
| Firm | Liverpool Victoria Life Company Limited |
| Product | Life / income protection |
| Claim type | Travel / life insurance claim disputes |
| Outcome | Not upheld |
| Remedy | LV's offer to settle by either: (1) cancelling the policy and providing a premium refund, or (2) continuing the policy with a hepatic adenoma exclusion and reduced critical illness cover to £73,837.50 and life cover to £146,022.95. Miss B and Mr L must indicate their preference by 15 October 2025. |
Summary
Miss B and Mr L complained that LV unfairly declined Miss B's critical illness claim in 2024. LV declined the claim on the basis that Miss B had failed to disclose a liver adenoma diagnosed in 2017 and confirmed in February 2019 when answering application questions in June 2019. The ombudsman found that the application questions were clear and unambiguous, and that Miss B's medical history fell squarely within their scope. Applying the Consumer Insurance (Disclosure and Representations) Act 2012, the ombudsman determined this was a careless misrepresentation and that LV had demonstrated it would not have offered the policy on the same terms had correct information been provided. The ombudsman upheld LV's position and found its settlement offer—either cancellation with refund or continuation with exclusions and reduced benefits—to be fair and reasonable.
The Ombudsman's reasoning
The ombudsman applied CIDRA, which requires consumers to take reasonable care not to misrepresent facts when taking out insurance. The questions asked were clear and unambiguous regarding liver conditions and medical follow-up in specified timeframes. Miss B's medical history clearly fell within the scope of these questions, as she had a liver adenoma diagnosed in 2017 and was under follow-up review with scans prior to the June 2019 policy inception. The ombudsman found this constituted a careless misrepresentation (not deliberate or reckless). LV demonstrated it would have offered different terms (postponement initially, then later with exclusions and loading) had the correct information been provided. Therefore, LV's offer to either cancel with refund or continue with exclusions and reduced benefits was fair and reasonable under CIDRA.
How this compares
| Group | Decisions | Uphold rate |
|---|---|---|
| Liverpool Victoria Life Company Limited, all decisions | 24 | 33% |
| Travel / life insurance claim disputes, all decisions | 20,052 | 31% |
| Life / income protection, all decisions | 10,704 | 20% |
Source
Read the original decision on the Financial Ombudsman Service website