Upheld: Home insurance claim disputes complaint against Vitality Life Limited

Decision detail

Summary

Mr and Mrs B complained about Vitality Life Limited's decline of a terminal illness claim on their life assurance policy following Mrs B's diagnosis of a neurological condition. Vitality declined the claim despite the condition having no known cure, citing insufficient objective evidence that life expectancy was less than 12 months. However, Mrs B's consultant, a Professor with 15 years' specialist experience, provided a definite prognosis on 7 March 2026 that life expectancy was less than one year. The ombudsman found that the policy definition for terminal illness was fully met and that Vitality had no right to reject the consultant's prognosis. The complaint was upheld, and Vitality was directed to pay the claim (subject to a proportionate misrepresentation deduction), interest, and £500 compensation for distress and inconvenience.

The Ombudsman's reasoning

The policy definition for terminal illness requires a definite diagnosis by the attending Consultant that the illness is expected to lead to death within 12 months. Mrs B's consultant, a Professor and specialist with 15 years' experience, provided exactly this on 7 March 2026. The policy terms do not require Vitality's claim management team or Chief Medical Officer to agree with the consultant's prognosis. Both elements of the policy definition were satisfied, making the claim payable. Vitality's unfair decline caused considerable distress and inconvenience to Mr and Mrs B during a difficult time.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website