Not upheld: Travel / life insurance claim disputes complaint against Aviva Protection UK Limited

Decision detail

Summary

Mr W complained that Aviva unfairly declined his claim on a joint life insurance policy following his wife's death in early 2025. Aviva discovered through medical records that Mrs W had been diagnosed with raised blood pressure in 2016 but had answered 'no' to the application question asking about such conditions. The ombudsman found this constituted a qualifying misrepresentation under CIDRA, as the question was clear and required disclosure of raised blood pressure even if subsequently resolved. Aviva's underwriting guidance confirmed the original insurer would have declined cover if the condition had been disclosed. Although Aviva initially treated the misrepresentation as deliberate/reckless, they refunded the premiums, exceeding statutory requirements. The ombudsman also found Aviva's claim handling and complaint handling to be appropriate and did not uphold the complaint.

The Ombudsman's reasoning

The ombudsman applied the Consumer Insurance (Disclosure and Representations) Act 2012 (CIDRA) to determine whether Aviva acted fairly. The ombudsman found that Mrs W made a qualifying misrepresentation by failing to disclose raised blood pressure, as the application question was clear and required disclosure of any raised blood pressure in the last 5 years, even if it had subsequently returned to normal. Aviva demonstrated through underwriting guidance that the original insurer would have declined cover if the condition had been disclosed, satisfying the requirement for a qualifying misrepresentation. Although Aviva initially treated the misrepresentation as deliberate/reckless, they refunded the premiums, which exceeds what CIDRA requires for careless misrepresentation, therefore acting fairly. The claim handling and complaint handling were also found to be appropriate.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website