Not upheld: non-disclosure of material medical information; claim decline based on misrepresentation complaint against Aviva Life & Pensions UK Limited

Decision detail

Summary

Mr B complained that Aviva unfairly declined his income protection insurance claim on grounds of non-disclosure of medical history. During the application process, Mr B answered 'no' to questions about heart conditions and medical investigations, but medical records showed he had Wolf-Parkinson-White syndrome, an ECG investigation, and high blood pressure due to medication non-compliance during the relevant periods. The ombudsman found Mr B's failure to disclose this information constituted a careless qualifying misrepresentation under CIDRA 2012, and that Aviva's underwriting evidence demonstrated they would not have offered the policy with accurate information. Accordingly, the ombudsman upheld Aviva's decision to decline the claim, void the policy from inception, and refund premiums.

The Ombudsman's reasoning

The ombudsman applied CIDRA 2012, which requires consumers to take reasonable care not to make misrepresentations when taking out consumer insurance. The ombudsman found that Mr B's failure to disclose Wolf-Parkinson-White syndrome, ECG investigation, and high blood pressure readings constituted a qualifying misrepresentation because Aviva's underwriting evidence demonstrated they would not have offered the policy with accurate information. The misrepresentation was classified as careless rather than deliberate or reckless, as Mr B likely overlooked the importance of the information rather than intentionally misleading Aviva. Under CIDRA, Aviva was entitled to decline the claim, void the policy from inception, and refund premiums.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website