Accused of Insurance Fraud (Income Protection)

MissWorried

To give a brief background.

I took out an income protection policy 10 years ago, and I recently made a claim on the policy recently following an injury to my neck.

They have played hardball, and requested my full medical records from the GP, this had revealed that when I was younger I had experienced some back pains, I saw a few consultants over some years as a child and nothing much was discovered, I grew up and continued with a normal life.

When I applied for the policy I didn't disclose it as quite frankly I had forgotten about it and didn't think I needed to disclose and old resolved issue. They have claimed that had they known this they wouldn't have covered me, and voided my policy. I complained, and two weeks ago received their final reply.

They said they stand by their decision, and as I have received money from a previous claim they are "considering" looking into this as fraudulent (even though it was nothing to do with joint pains!)

Now I accept that I was at fault to a degree for not disclosing these pains, but it was an oversight of an issue many years earlier, rather than any attempt at Fraud! I've been left quite upset and shaken by the whole incident and their heavy handed tactics.

I don't really know where to go from here and would appreciate any thoughts or advice.

jonesMUFCforever

If they have given their final decision you are left with two options - go to the ombudsman or sue them.
Obviously the Ombudsman is the cheaper option.

stator

I think you have a good chance at the Ombudsman. A LOT of people have back problems at some point in their life.
If you had a back pin implant or something then obviously their case would be strong.
But if it was just general, unexplained, short term back pain, then I think it's worth making a complaint.

BooJewels

The ABI and the Ombudsman have guidelines about such matters where there was an inadvertent failure to disclose material that was either so insignificant or far in the past to have been forgotten and not even considered as pertinent.

Similarly, you can only give them information they actually ask for during the application process. So I'd look through your application form and see what was actually asked and answered.

There are various documents online covering this area, from the ABI and financial ombudsman, so worthy of a bit of research.

peterbaker

Barstewards - name them. Like far too many companies they give insurance a very bad name by being unscrupulous. It used to be quite a decent industry in the main, thirty odd years ago.

MissWorried

Thank you all for replying. To be honest I have been so unwell I do not feel I have the strength to fight them. And considering their behaviour, I frankly want nothing more to do with them.

However my main concern was that they are looking into my previous claim as a fraudulent one as they say the policy should not have been incepted. At a time when I’m already unwell the prospect of a Fraud accusation has terrified me, which I suppose is what they wanted. Could they take this forward? And what could happen?

BooJewels

I don't think anyone can possibly answer you without knowing much more detail. But I think to actually call it fraud and take further action, they'd have to have good evidence that you deliberately set out to mislead them when you either took the policy, or made the first claim.

As I said, get out your copy of the application form and see exactly what was asked and how you answered. I think on the forms we filled in for our critical illness policy, there wasn't any questions about childhood illnesses where your situation could have been answered. Questions took the form of "have you ever been diagnosed with . . ." "are you currently being investigated for any of the following:" "Are you having any ongoing treatment for any of the following . . . " etc. Vague questions like, 'have you ever consulted a doctor about any of the following' just didn't appear.

So your situation will be determined by the specifics of your own application, the terms of the policy and the nature of your earlier claim.

Perhaps ask yourself; had you answered the questions differently (i.e mentioned the childhood back issues, was there actually an opportunity to do so), might it have prevented either the policy being offered, it being offered at a higher premium or would it have invalidated your earlier claim?

stator

MissWorried wrote: »

Thank you all for replying. To be honest I have been so unwell I do not feel I have the strength to fight them. And considering their behaviour, I frankly want nothing more to do with them.

However my main concern was that they are looking into my previous claim as a fraudulent one as they say the policy should not have been incepted. At a time when I’m already unwell the prospect of a Fraud accusation has terrified me, which I suppose is what they wanted. Could they take this forward? And what could happen?

Your best defense is attack.
If the ombudsman rules in your favour on the claim they have rejected, it would be an excellent defense if they tried to make a fraud complaint against you regarding the previous claim.