Not upheld: claim decline and policy cancellation for non-disclosure and misrepresentation complaint against Aviva Life & Pensions UK Limited

Decision detail

Summary

Mrs K claimed income protection benefits after a workplace fall in March 2025 caused hand and foot pain, leading to work absence from May 2025. Aviva declined her claim, stating medical evidence did not support incapacity for her role or other suited occupations, and subsequently removed her from the policy after discovering social media evidence of greater functional capacity and an undisclosed online business. The ombudsman upheld Aviva's decisions, finding that objective medical testimony did not support incapacity under a suited occupation policy, alternative seated work was feasible, and Mrs K had misled the insurer about her functionality and withheld information about work activities when directly questioned.

The Ombudsman's reasoning

The ombudsman found that the medical evidence during the deferred period did not satisfy the policy's definition of incapacity for a suited occupation policy, as objective medical testimony did not support Mrs K's self-reported symptoms and specialists found normal power in her limbs. Additionally, social media evidence demonstrated Mrs K had greater functional capacity than disclosed, including driving, walking on uneven ground, cycling extensively, and travelling abroad. The ombudsman was satisfied that Mrs K misled Aviva about her functionality and withheld information about her online business when directly asked on the declaration form, justifying Aviva's reliance on policy terms allowing cancellation for failure to disclose information.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website