Not upheld: claims handling; medical record access and consent complaint against Royal London Mutual Insurance Society Limited

Decision detail

Summary

Mr E purchased a life and critical illness policy from Royal London in January 2021 and was diagnosed with terminal cancer months later. He made a claim in late 2021 but passed away before assessment was completed. Royal London declined the claim and voided the policy, citing non-disclosure of a prior GP consultation about a persistent cough. The executor of Mr E's estate complained multiple times to the FOS, with the final complaint focusing on whether Royal London should have limited medical record access to the oncologist only. The ombudsman found that Mr E had been aware Royal London would obtain records from both his GP and consultant, as evidenced by their correspondence, and therefore Royal London acted fairly and reasonably.

The Ombudsman's reasoning

The ombudsman concluded that Royal London acted fairly and reasonably in obtaining Mr E's consent to access medical records. The evidence showed that Mr E was aware Royal London would be requesting records from both his GP and consultant, as demonstrated by his email exchange requesting copies of the medical requirements for both his GP and consultant. The ombudsman declined to reconsider the original claim decline decision as this had already been investigated and no new material evidence had been provided.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website