Not upheld: alleged non-disclosure in life insurance application; complaint handling; investigation process fairness complaint against Aviva Life & Pensions UK Limited

Decision detail

Summary

Mr N and Mrs N complained to the FOS about Aviva's investigation into alleged non-disclosure in their 2018 life insurance application. Aviva had discovered a 2023 GP report containing a note about a medical procedure Mrs N underwent, which it initially believed occurred in 2016 (within the two-year disclosure window of the 2018 application). The complainants argued the procedure actually occurred in 2012 and therefore did not require disclosure. The ombudsman found that the procedure did occur in 2012, the complainants answered the 2018 question correctly, and Aviva's investigation was justified based on the conflicting information available at the time. While Aviva should have communicated the investigation earlier and the official was poorly prepared for a December 2025 call, the ombudsman found no unprofessional conduct and determined the policy remained active throughout with no adverse effects on coverage or premiums. The complaint was not upheld.

The Ombudsman's reasoning

The ombudsman found that while the 2023 GPR note created an apparent conflict with the 2018 application answer, the error originated from a non-clinical third party (111 call handler) and was not apparent to Aviva without correction from the complainants or GP. Therefore, Aviva's decision to investigate was justified. However, the ombudsman determined that the procedure occurred in 2012, outside the two-year disclosure window (2016-2018) required by the 2018 question, meaning no disclosure was required and the complainants answered correctly. The investigation process itself was legitimate and due process was followed. While Aviva should have explained the investigation earlier and the official was poorly prepared for the 2 December call, the policy remained active throughout, no adverse effects occurred, and the official's conduct did not amount to unprofessionalism. The ombudsman could not definitively conclude the investigation was unnecessary as Aviva retains exclusive remit to conduct its own investigation, but found sufficient evidence to suggest the complainants did not commit non-disclosure.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website