Not upheld: non-disclosure of material medical information / claim decline / policy avoidance complaint against Royal London Mutual Insurance Society Limited

Decision detail

Summary

The trustees of the late Mrs D's estate complained that Royal London unfairly declined a life insurance claim and avoided the policy after the policyholder died of breast cancer in August 2024. The late Mrs D had applied for the policy on 29 March 2022, one week before being diagnosed with breast cancer. However, she had visited her GP in February 2022 with symptoms of underarm swelling and a breast lump, received an urgent referral for investigation, and underwent a biopsy on the day of application. The ombudsman found that the late Mrs D should have disclosed these medical facts in response to clear application questions about lumps, breast disorders and medical investigations. Although the non-disclosure was careless rather than deliberate, the ombudsman upheld Royal London's decision to decline the claim and unwind the policy under CIDRA, as the insurer would not have offered cover while investigations were ongoing and would not have offered cover until five years after cancer treatment.

The Ombudsman's reasoning

The ombudsman found that the questions asked at application were clear and should have been answered differently. The late Mrs D should have disclosed the February 2022 GP visit, symptoms of underarm swelling and breast lump, and urgent referral for investigation, as these fell squarely within the scope of questions Q29, Q37 and Q40. Although the non-disclosure was careless rather than deliberate, under CIDRA this entitled Royal London to reassess the offer of cover. The ombudsman was satisfied that Royal London would not have offered a policy in March 2022 while investigations were ongoing, and would not have offered cover until at least five years after treatment for the subsequently diagnosed breast cancer. Therefore, there would have been no active policy to claim against had the information been disclosed, making Royal London's decision to decline the claim and unwind the policy reasonable and compliant with CIDRA.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website