Not upheld: medical disclosure omission in insurance application; alleged failure in duty of care during application process complaint against London & Country Mortgages Limited

Decision detail

Summary

Mr and Mrs C complained that L&C acted improperly when arranging income protection cover for Mr C by failing to disclose his arthritis diagnosis, despite Mr C having mentioned the condition during a September 2023 fact-find call and having disclosed it in a 2021 life assurance application. During the October 2023 application call with a different adviser, Mr C answered 'no' to a question about arthritis contact with health professionals. The insurer subsequently reissued the policy with an arthritis exclusion. The ombudsman found the complaint not upheld, determining that Mr C bore the responsibility under CIDRA to answer the medical question accurately, that the question was clear, and that L&C provided appropriate opportunities for Mr C to review and correct his application before submission.

The Ombudsman's reasoning

The ombudsman applied the Consumer Insurance (Disclosure and Representations) Act 2012 (CIDRA), which requires consumers to take reasonable care not to make misrepresentations. The ombudsman found that Mr C had a clear duty to answer the medical question accurately, and that the question was clear and not misleading. Although Mr C had previously discussed his arthritis with L&C, this did not supersede his obligation to answer the specific application question truthfully. The adviser was not responsible for correcting Mr C's answer, and L&C took appropriate steps by sending reminders for Mr C to review his application for accuracy. The adviser could not have known the answer was inaccurate without being informed by Mr C.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website