Not upheld: Travel / life insurance claim disputes complaint against Quilter Mortgage Planning Limited

Decision detail

Summary

Ms V and Mr A sought advice from Quilter in spring 2023 to have their life insurance policies paid for by their company and to review coverage levels. Quilter recommended Ms V take out a new policy, which was applied for on 4 April 2023 and scheduled to start on 6 April 2023. The day after the application, Ms V consulted her GP about weight loss and was referred for tests, which led to a cancer diagnosis. Ms V died in early 2024, and the insurer declined the claim because Ms V failed to disclose the GP consultation and referral. Mr A complained that Quilter had advised Ms V not to disclose certain medical conditions and that she did not understand the 2023 policy was new. The ombudsman found the complaint not upheld, as Quilter was unaware of the GP consultation and subsequent tests, and therefore could not have made a misrepresentation on Ms V's behalf.

The Ombudsman's reasoning

The ombudsman focused on whether Quilter made a misrepresentation on Ms V's behalf. The key issue was the timeline: Ms V's answers to the medical questions were accurate on 4 April when the application was completed. However, on 5 April (after application but before policy start), Ms V consulted her GP about weight loss and was referred for tests, making her previous answers inaccurate. The insurer's covering letter explicitly requested notification of any health changes between application and policy start. There is no evidence that Ms V informed Quilter of the GP consultation or tests. Therefore, Quilter could not have made a misrepresentation because they were unaware of these subsequent medical developments. While the ombudsman sympathised with Mr A's position, Quilter could not be held responsible for information they did not know about.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website