Not upheld: claim decline - deliberate misrepresentation on medical history disclosure complaint against Vitality Life Limited

Decision detail

Summary

Mr S complained that Vitality Life Limited unfairly declined his income protection insurance claim, alleging he had misrepresented his medical history by answering 'no' to questions about recent medical problems and specialist referrals. In fact, Mr S had experienced right wrist pain in June 2024 with treatment and investigations shortly before applying for the policy in July 2024. The ombudsman found this was a qualifying deliberate misrepresentation, as the application questions were clear and a reasonable consumer would have disclosed the recent wrist condition. Under the Consumer Insurance (Disclosure and Representations) Act 2012, Vitality was entitled to decline the claim and cancel the policy. However, the ombudsman upheld compensation of £700 for customer service delays and agreed to a refund of premiums from May 2025 with 8% interest, which was considered fair and reasonable.

The Ombudsman's reasoning

The ombudsman found that Mr S failed to take reasonable care in answering the medical history questions, as a reasonable consumer would have understood the need to disclose recent wrist pain and investigations. The questions were clear and Mr S had recently received treatment and investigations for the wrist condition. Given the proximity of multiple medical appointments to the application date and the recent x-ray, the ombudsman concluded the misrepresentation was deliberate rather than careless. Under CIDRA, Vitality was entitled to decline the claim, cancel the policy and retain premiums. The £700 compensation for customer service delays and premium refund with interest was considered fair.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website