Not upheld: non-disclosure of material medical information; claim decline; policy unwinding complaint against Royal London Mutual Insurance Society Limited
Financial Ombudsman decision DRN-6164674 of 2026-05-19T00:00:00+00:00. non-disclosure of material medical information; claim decline; policy unwinding complaint against Royal London Mutual Insurance Society Limited. Outcome: Not upheld.
Decision detail
| Reference | DRN-6164674 |
|---|---|
| Decision date | 2026-05-19T00:00:00+00:00 |
| Firm | Royal London Mutual Insurance Society Limited |
| Product | life and critical illness insurance |
| Claim type | non-disclosure of material medical information; claim decline; policy unwinding |
| Outcome | Not upheld |
| Remedy | None - complaint not upheld. Royal London's decision to decline the claim and unwind the policy with return of premiums was upheld as fair and reasonable |
Summary
Mr S complained that Royal London unfairly declined his critical illness claim and unwound his policy after he was diagnosed with a brain lesion in March 2025, shortly after taking out cover in February 2025. Royal London declined the claim on the basis that Mr S had failed to disclose material medical information about hearing loss, tinnitus, and vertigo symptoms in his health screening questionnaire. The ombudsman found that Mr S's GP records documented these symptoms from December 2024 and October 2024, with ongoing treatment and an urgent ENT specialist referral made in January 2025, before the policy inception date. Under CIDRA 2012, the ombudsman determined this was a qualifying misrepresentation, as Royal London's underwriting guidelines indicated it would have postponed the policy offer pending investigation outcomes, meaning no active policy would have existed when the diagnosis occurred. The complaint was not upheld.
The Ombudsman's reasoning
The ombudsman found that Mr S failed to disclose material medical information about hearing loss, tinnitus, and vertigo when completing the health screening questionnaire. The health screening question was clear and should have been answered differently. Medical evidence showed Mr S had experienced these symptoms in December 2024 and October 2024, and was receiving treatment and specialist referral before the policy inception date. Under CIDRA 2012, this constituted a qualifying misrepresentation because Royal London would not have offered the policy had it known the full extent of Mr S's medical history. The insurer's underwriting guides indicated it would have postponed the offer pending investigation outcomes, meaning no active policy would have existed when the brain lesion was diagnosed in March 2025. Therefore, Royal London was entitled to unwind the policy and decline the claim.
How this compares
| Group | Decisions | Uphold rate |
|---|---|---|
| Royal London Mutual Insurance Society Limited, all decisions | 9 | 11% |
Source
Read the original decision on the Financial Ombudsman Service website