Not upheld: Travel / life insurance claim disputes complaint against British Friendly Society Limited

Decision detail

Summary

Mr W complained that British Friendly Society Limited unfairly declined his income protection insurance claim and cancelled his policy, and that they delayed handling the claim. During the application process in March 2024, Mr W failed to disclose material information about recent or current health conditions including back pain, high blood pressure, gout, pre-diabetes, asthma, eczema and mental health issues. The ombudsman found that Mr W's omissions constituted a reckless misrepresentation under the Consumer Insurance (Disclosure and Representations) Act 2012, and that British Friendly's underwriting evidence demonstrated they would not have offered the policy had they known of these conditions. The ombudsman upheld British Friendly's decision to decline the claim and cancel the policy, and found their offer of £50 compensation for claims handling delays to be fair and reasonable.

The Ombudsman's reasoning

The ombudsman applied the Consumer Insurance (Disclosure and Representations) Act 2012 (CIDRA) and found that Mr W failed to take reasonable care in answering medical questions, constituting a misrepresentation. The ombudsman was satisfied this was a qualifying misrepresentation because British Friendly's underwriting evidence demonstrated they would not have offered the policy had they known of Mr W's health conditions. The misrepresentation was deemed reckless given the extent of omitted medical information and the recent or current nature of the conditions. Under CIDRA, British Friendly were entitled to decline the claim, cancel the policy and retain premiums.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website