Not upheld: Travel / life insurance claim disputes complaint against Aviva Protection UK Limited

Decision detail

Summary

Mr P and Mrs J complained that Aviva unfairly declined their critical illness claim after Mr P had heart surgery. Aviva declined the claim and voided the policy, refunding premiums, because Mr P had failed to disclose raised blood sugar, raised cholesterol, and family history of diabetes on his application. The ombudsman found that medical evidence clearly showed Mr P knew about these health issues before applying, including a diabetes prevention programme letter and GP discussions about pre-diabetes and raised cholesterol. The ombudsman concluded this constituted a qualifying misrepresentation under CIDRA and that Aviva's actions were fair and reasonable. The complaint was not upheld.

The Ombudsman's reasoning

The ombudsman applied CIDRA, which requires consumers to take reasonable care not to make misrepresentations when taking out consumer insurance. The ombudsman found that Mr P knew about his raised blood sugar, raised cholesterol, and family history of diabetes before applying for the policy, based on medical evidence including a diabetes prevention programme letter, GP appointment discussions, and consultation notes. The questions asked were clear about what information was required. The misrepresentation was qualifying because Aviva's underwriting data confirmed they would not have offered critical illness cover if Mr P had answered accurately. The ombudsman concluded the misrepresentation was deliberate or reckless, though even if categorised as careless, the outcome would be the same as CIDRA permits policy cancellation and Aviva had already refunded premiums.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website