Not upheld: misrepresentation on insurance application; claim decline; claims handling complaint against Aviva Life & Pensions UK Limited

Decision detail

Summary

The estate of Mr H complained that Aviva Life & Pensions UK Limited unfairly declined a life benefit claim and handled the claim poorly. Mr H had applied for a life insurance policy and died shortly after it was issued. Aviva declined the claim, concluding that Mr H made a misrepresentation by failing to disclose a lump and symptoms he was experiencing at the time of application. Medical records showed Mr H had a lump present for approximately 2 weeks before applying and was experiencing nausea, weight loss, and stress. The ombudsman found that Mr H made a careless qualifying misrepresentation under CIDRA and that Aviva fairly and reasonably cancelled the policy and declined the claim, offering a premium refund. The complaint was not upheld.

The Ombudsman's reasoning

The ombudsman concluded that Mr H made a careless qualifying misrepresentation by failing to disclose a lump and symptoms he was experiencing at the time of application. Medical evidence showed Mr H had identified a lump approximately 2 weeks before applying for the policy and was experiencing nausea, weight loss, and stress. The lump question was reasonably clear and asked about lumps in the last four years regardless of medical consultation. Under CIDRA, Aviva was entitled to cancel the policy and decline the claim because it would not have offered the policy at the time if the questions had been answered correctly. The misrepresentation was careless rather than deliberate or reckless, so Aviva appropriately offered a premium refund.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website