Not upheld: misrepresentation in insurance application; unfair claim decline complaint against Legal and General Assurance Society Limited

Decision detail

Summary

Mrs P purchased a life and critical illness insurance policy from L&G in summer 2023 and made a claim following her diagnosis with multiple sclerosis in summer 2025. L&G declined the claim and cancelled the policy, refunding premiums, after determining that Mrs P had not accurately answered health questions in her application. Specifically, Mrs P had failed to disclose joint pain, vision issues, and dizziness that were documented in her medical records in the months before her application. The ombudsman upheld L&G's decision, finding that Mrs P made a careless misrepresentation by not disclosing these symptoms despite the application questions explicitly asking about them and instructing applicants to disclose if unsure. The ombudsman concluded that L&G correctly applied the Consumer Information (Disclosure and Representations) Act 2012 by cancelling the policy and refunding premiums.

The Ombudsman's reasoning

The ombudsman applied the Consumer Information (Disclosure and Representations) Act 2012 (CIDRA), which requires consumers to take reasonable care not to make misrepresentations when taking out consumer insurance. The ombudsman found that Mrs P's answers to health questions were inaccurate because she failed to disclose joint pain, vision issues, and dizziness that were documented in her medical records. The questions specifically asked about symptoms regardless of cause, and included an instruction to disclose if unsure. The ombudsman concluded this was a careless misrepresentation (not deliberate or reckless) and that it was a qualifying misrepresentation because L&G would not have offered critical illness cover if the questions had been answered accurately. Under CIDRA, L&G was entitled to void the policy and refund premiums, which is what they did.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website