Not upheld: mis-selling of serious illness cover insurance policy complaint against Vitality Corporate Services Limited

Decision detail

Summary

Miss R complained that Vitality mis-sold her a serious illness cover insurance policy in January 2023. After Miss R made a claim, the underwriter declined it on the basis that she did not meet the policy definitions for benefit payment. The ombudsman reviewed the sales calls and documentation and found that Vitality provided an advised sale complying with industry rules, with clear and fair information. The requirement to meet specific policy definitions is a standard feature of serious illness cover not requiring additional highlighting. The ombudsman did not uphold the complaint and found no mis-selling had occurred.

The Ombudsman's reasoning

The ombudsman found that Vitality provided an advised sale and complied with industry rules by providing clear, fair and not misleading information. The requirement to meet specific policy definitions for serious illness claims is not an unusual, restrictive, onerous or significant term that should have been highlighted in more detail. It would not be practical to discuss detailed definitions for over 150 covered illnesses when the specific illness to be claimed is unknown. The relevant test is whether Vitality complied with industry rules, not whether Miss R understood the information.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website