Not upheld: claim decline based on non-disclosure/misrepresentation complaint against Legal and General Assurance Society Limited

Decision detail

Summary

Mr I complained that L&G unfairly declined his claim on a joint life insurance policy following his wife's death in 2025. L&G declined the claim because Mrs I had not disclosed previous alcohol treatment when applying for the policy in 2019, specifically failing to answer accurately about attendance at an alcohol support service and specialist referral. Medical records from 2015 showed Mrs I had been referred to a residential alcohol detoxification unit. The ombudsman found this constituted a qualifying misrepresentation under CIDRA, as L&G's underwriting data confirmed they would not have offered the policy with accurate information. The complaint was not upheld, as L&G acted fairly in declining the claim and offered appropriate remedies under CIDRA.

The Ombudsman's reasoning

The ombudsman applied CIDRA, which requires consumers to take reasonable care not to misrepresent facts when taking out insurance. Mrs I's answer of 'no' to whether she had attended alcohol support or seen a specialist was inaccurate, as medical records clearly showed she had attended a residential detoxification unit in 2015. This constituted a qualifying misrepresentation because L&G's underwriting data demonstrated they would not have offered the policy had the accurate information been provided. The misrepresentation was appropriately categorized as deliberate or reckless under ABI guidance for lifestyle information, as attendance at a residential treatment unit is not easily overlooked. L&G's remedy of offering to keep the policy in sole name or cancel with premium return was fair.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website