Not upheld: Travel / life insurance claim disputes complaint against Vitality Life Limited

Decision detail

Summary

Miss H complained to the Financial Ombudsman Service after Vitality Life Limited declined her claim on an income protection policy taken out in August 2023 and cancelled the policy from inception, retaining premiums. Vitality asserted that Miss H had failed to disclose that she had been signed off work before the policy was taken out, contrary to her application responses about medical history. Miss H claimed the GP had made an error in backdating a sick note to August 2023, but the ombudsman found her supporting evidence unconvincing. The ombudsman concluded that Miss H had made a qualifying misrepresentation under the Consumer Insurance (Disclosure and Representations) Act 2012, which was deliberate in nature, and therefore Vitality was entitled to cancel the policy and retain premiums. The complaint was not upheld.

The Ombudsman's reasoning

The ombudsman applied The Consumer Insurance (Disclosure and Representations) Act 2012 (CIDRA), which requires consumers to take reasonable care not to misrepresent information. The ombudsman found it reasonable for Vitality to conclude that Miss H was already experiencing symptoms and off work before the policy was taken out, and therefore should have answered 'yes' to the medical history questions. The ombudsman rejected Miss H's claim that the GP made an error, finding the supporting email lacked credibility. As the misrepresentation was qualifying (Vitality would have applied an exclusion had they known the true position) and deliberate, Vitality was entitled under CIDRA to cancel the policy from inception and retain premiums.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website