Not upheld: Travel / life insurance claim disputes complaint against Openwork Limited trading as The Openwork Partnership

Decision detail

Summary

Mr O complained that Openwork mis-sold him income protection insurance by failing to disclose his medical history (migraines, back and neck pain) to the insurer, resulting in his 2025 claim being declined and cover cancelled. Mr O claimed he had told the adviser about his medical history and even shown photographs, but Openwork argued there was no evidence of this disclosure and that Mr O was given multiple opportunities to check and amend the information provided. The ombudsman found the photographs were dated after the October 2022 meeting, making it impossible for Mr O to have shown them to the adviser, and noted inconsistencies between Mr O's claims and his later statements to the insurer. The ombudsman upheld Openwork's position that proper procedures were followed and that Mr O did not disclose his medical history when asked, therefore rejecting the complaint.

The Ombudsman's reasoning

The ombudsman found that the crux of the issue was whether Mr O disclosed his medical history to Openwork and whether the adviser failed to pass it on. Based on contemporaneous evidence, the adviser completed a thorough fact find, produced a detailed recommendation, and provided Mr O with multiple opportunities to check and amend the information provided. There is no documentary evidence supporting Mr O's claim that he disclosed his medical history. The photographs Mr O submitted were taken two months after the meeting, making it impossible for him to have shown them to the adviser. Additionally, Mr O's inconsistent statements to the insurer in 2025 (claiming symptoms began in April 2024 when he had an extensive prior history) undermined his credibility. While the illustration was issued after the application (a technical breach), this caused no detriment to Mr O. The ombudsman was more persuaded by Openwork's position that Mr O did not declare any past medical history when asked and did not request amendments despite being sent copies of his answers.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website