Not upheld: misrepresentation and non-disclosure on insurance application complaint against Aviva Life & Pensions UK Limited

Decision detail

Summary

Mrs P complained that Aviva unfairly added a retrospective exclusion for nerve sheath tumour-related claims to her life and critical illness policy in June 2025, after discovering she had been diagnosed with a nerve sheath tumour. Mrs P claimed she had not been aware of this diagnosis when she applied for increased cover in October 2024. However, medical evidence showed Mrs P had a known knee lump that was investigated via ultrasound in September 2024 and was awaiting an orthopaedic appointment on 24 October 2024, the same date she answered the application questions. The ombudsman found Mrs P should have disclosed both the lump and the pending medical appointment, constituting a careless misrepresentation under CIDRA. Aviva's underwriters confirmed they would have applied the same exclusion had correct information been provided, so the retrospective application of the exclusion was fair and reasonable.

The Ombudsman's reasoning

The ombudsman applied the Consumer Insurance (Disclosure and Representations) Act 2012 (CIDRA), which requires consumers to take reasonable care not to misrepresent facts when applying for insurance. The ombudsman found that Mrs P should reasonably have answered 'yes' to the question about lumps/growths, as medical evidence showed the lump had been discussed with her GP in January 2024 and investigated via ultrasound in September 2024. Additionally, Mrs P should have answered 'yes' to the question about awaiting medical appointments, as she was awaiting her orthopaedic surgeon appointment on 24 October 2024 when she answered the questions on 23-24 October 2024. The ombudsman determined this was a careless misrepresentation (not deliberate or reckless) and that Aviva's underwriters confirmed they would have applied the same nerve tumour exclusion had the correct information been provided. Therefore, Aviva was entitled under CIDRA to retrospectively apply the exclusion. The ombudsman also found it reasonable for Aviva to use information from Mrs P's separate insurance application to identify the misrepresentation.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website