Not upheld: misrepresentation on insurance application; claim decline; policy cancellation complaint against Legal and General Assurance Society Limited
Financial Ombudsman decision DRN-6359136 of 2026-05-26T00:00:00+00:00. misrepresentation on insurance application; claim decline; policy cancellation complaint against Legal and General Assurance Society Limited. Outcome: Not upheld.
Decision detail
| Reference | DRN-6359136 |
|---|---|
| Decision date | 2026-05-26T00:00:00+00:00 |
| Firm | Legal and General Assurance Society Limited |
| Product | life insurance and critical illness cover |
| Claim type | misrepresentation on insurance application; claim decline; policy cancellation |
| Outcome | Not upheld |
| Remedy | No additional remedy required. L&G's existing offer of choice between life-only cover continuation or policy cancellation with premium refund is appropriate. The £250 compensation already paid for claim handling delays and contradictory updates is reasonable and in line with FOS guidance. |
Summary
Mr H complained that L&G unfairly declined his critical illness claim and cancelled his critical illness cover after he was diagnosed with multiple sclerosis in September 2025, just two months after purchasing the policy. L&G discovered through medical records obtained during a second application process that Mr H had failed to disclose neurological assessments (2012, 2016) and blurred vision (2022), despite answering 'no' to specific questions about such conditions. The ombudsman found this constituted a qualifying careless misrepresentation under CIDRA, as the application questions asked about symptoms not just diagnoses, and included explicit instructions to disclose if unsure. L&G's confidential underwriting data confirmed they would not have offered critical illness cover had the true medical history been disclosed. The ombudsman upheld L&G's decision to decline the claim and offer the choice of life-only cover or premium refund, and found the £250 compensation for claim handling delays to be reasonable.
The Ombudsman's reasoning
The ombudsman applied CIDRA to determine whether Mr H made a qualifying misrepresentation. The medical records clearly showed he had experienced vision issues and neurological assessments, which should have been disclosed despite no formal diagnosis being made. The application questions explicitly asked about symptoms, not just diagnosed conditions, and included a warning to disclose if unsure. The ombudsman reviewed L&G's confidential underwriting data and confirmed that L&G would not have offered critical illness cover had the true information been provided, making it a qualifying misrepresentation. The misrepresentation was categorised as careless rather than deliberate/reckless, and the remedy offered (choice of life-only cover or refund) was appropriate under CIDRA. The £250 compensation for claim handling delays and contradictory updates was reasonable and in line with FOS guidance.
How this compares
| Group | Decisions | Uphold rate |
|---|---|---|
| Legal and General Assurance Society Limited, all decisions | 1,103 | 18% |
Source
Read the original decision on the Financial Ombudsman Service website