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

Decision detail

Summary

The estate of Mr A complained that Vitality Life Limited unfairly avoided his life and critical illness insurance policy and refused to pay his claim following his death. Vitality had cancelled the policy based on Mr A's failure to disclose that he had undergone an urgent neurology referral and scans before his application, which was relevant to a health question asked during underwriting. The ombudsman found that Mr A failed to take reasonable care in answering the health question and that Vitality's classification of the misrepresentation as deliberate or reckless was not unreasonable. Applying the Consumer Insurance (Disclosure and Representations) Act 2012, the ombudsman concluded that Vitality's decision to cancel the policy and retain premiums was fair and in accordance with the law, and therefore did not uphold the complaint.

The Ombudsman's reasoning

The ombudsman applied CIDRA to determine whether Mr A's misrepresentation was qualifying and, if so, whether Vitality's remedy was fair. The ombudsman found that Mr A failed to take reasonable care in answering the health question about medical investigations, as he had an urgent neurology referral and scans before his application. The ombudsman concluded that Vitality's classification of the misrepresentation as deliberate or reckless was not unreasonable given the clear wording of the question and the timing of the investigations. Therefore, Vitality's decision to cancel the policy and retain premiums was in line with CIDRA and fair.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website