Potential non disclosure issue with Critical Illness claim - consequences?

voodoojimi

We remortgaged with extra borrowing at the start of this year and were given 3 days notice from our lenders solicitor of the completion date of 1st February, so I quickly rushed through a new joint Life and CI policy with L & G through Cavendish to start 1st Feb and cancelled our existing policy which was also with L & G.

I took care of all of the documentation and ticked no for all of the medical questionnaires about existing illness for both me and my wife, although at the time she had had a slight pain in her breast on and off for about a month. She went to see her GP on 30th January but we didn't think there was any potential issue or anything serious. She had no other worrying symptoms or lumps and the GP initially suspected she just had a cyst. So none of this was logged on our application.

After a referral to the local breast unit in mid February, she was actually diagnosed with breast cancer, had an operation at the start of April and has been having chemotherapy since the end of May but is clear of the disease. As her sick pay is reducing over time, she is worried about money and one of her friends said we should claim on our critical illness policy but I didn't think that this was covered as she is clear of cancer so I never checked and had absolutely no intention of raising it with L & G.

My wife eventually pressured me to check our documents last night and I found that L & G will make a small pay out for invasive breast cancer separate to our standard policy. I rang the claims department this morning to see what options we had. I was told that as I had not disclosed her intermittent breast pain on the initial application that we would probably have any claim rejected, which is fair enough - I made a mistake with the application, but we didn't think there was a serious issue with my wife at the time.

I was then told that due to my dishonesty it was likely that my policy would be cancelled, which has now got me really worried. I haven't deliberately tried to make a false claim - I did not know that this type of cancer was covered, I had not intended to even contact L & G about it and I had the same cover with my old policy so could have just claimed with that one if necessary. I only changed the policy as the amount of mortgage cover and term were different.

So am I going to end up on some type of insurance blacklist? Is the non-disclosure my issue as it was done by me, my wife's issue as it relates to her or both of us as it is a joint policy? How can I get life cover if this policy gets cancelled as I know it will be looked at badly by other insurers?

Weighty1

I'm really sorry that you've found yourself in this situation. Legal & General are completely right in being able to cancel the policy, in fact, at the start of the online application journey L&G have a declaration which states the questions must only be answered by the person being insured so your wife should have absolutely answered the questions herself AND disclosed this breast pain.

Unfortunately, I don't see where you have to go with this. If your wife had chemotherapy, there's a good chance that this would mean she'll be uninsurable for at least a couple of year and even once she can get cover it'll be life insurance only (no critical illness cover) for a good number of years and the likelihood is there'll be a massive premium increase.

You won't be looked at badly by other insurers, it's not like the process with arranging car insurance if you have a policy cancelled, however, any application would want to know about yours and your wife's medical history and that is when the problems will start, maybe not for yourself, but almost certainly for your wife.

Boggles190

By the ‘letter of the law’ then L&G are correct and will have legitimate grounds to cancel your cover.

I would suggest your best option is to write to them with a full explanation of what has happened, how and a full timeline of your wife’s illness and make it clear your non-disclosure is an innocent mistake, not a deliberate attempt to obtain cover by deception. They should treat you differently if it’s clear an innocent mistake has been made. Depending on their approach as insurer they will look back and see what effect the disclosure would have had on the policy when you took it out and whether it would have meant a compete decline or just terms on the cover.

Manxman_in_exile

Boggles190 wrote: »

By the ‘letter of the law’ then L&G are correct and will have legitimate grounds to cancel your cover.

I would suggest your best option is to write to them with a full explanation of what has happened, how and a full timeline of your wife’s illness and make it clear your non-disclosure is an innocent mistake, not a deliberate attempt to obtain cover by deception. They should treat you differently if it’s clear an innocent mistake has been made. Depending on their approach as insurer they will look back and see what effect the disclosure would have had on the policy when you took it out and whether it would have meant a compete decline or just terms on the cover.

That's what I'd do too. But an issue might be whether, when you completed the declaration, you were aware that your wife was being referred to a breast clinic for investigation. It's not clear from your OP whether your wife had already seen her GP and been told she was being referred before you made the declaration, or after you made it. I can understand you overlooking a "pain" before seeing a GP, but it gets a bit more difficult if you already knew of the referral when making the declaration.

csgohan4

For future readers, if you are having any investigations or seen a GP within the last 12 months, declare it, anything less and you will risk claim rejection.


Most insurers will usually ask the above

kingstreet

voodoojimi wrote: »

We remortgaged with extra borrowing at the start of this year and were given 3 days notice from our lenders solicitor of the completion date of 1st February, so I quickly rushed through a new joint Life and CI policy with L & G through Cavendish to start 1st Feb and cancelled our existing policy which was also with L & G

Is that a non-advised service or did Cavendish look at your existing cover? Presumably, unadvised.

If you had sought advice, the advisor would have compared your existing cover with new cover and checked for any guaranteed increase options. These can be exercised at milestones such as marriage, moving house, increasing mortgage and so on, without evidence of health or medical questions.

Increased cover with no further declaration would have resulted and this situation avoided. Intended for future readers, really.

Weighty1

Boggles190 wrote: »

By the ‘letter of the law’ then L&G are correct and will have legitimate grounds to cancel your cover.

I would suggest your best option is to write to them with a full explanation of what has happened, how and a full timeline of your wife’s illness and make it clear your non-disclosure is an innocent mistake, not a deliberate attempt to obtain cover by deception. They should treat you differently if it’s clear an innocent mistake has been made. Depending on their approach as insurer they will look back and see what effect the disclosure would have had on the policy when you took it out and whether it would have meant a compete decline or just terms on the cover.

The difference is that no insurer on the market would offer cover whilst someone is awaiting a referral/investigation. No terms, no cover, same end result as them declining a payout due to non-disclosure ultimately.

sheramber

It doesn't need to be a serious issue to need to disclose it.

I had to have a medical before taking out cover as I had lost more weight than a figure they quoted.

I had lost weight because I had had baby but that didn't matter. My GP was amused when I visited but no doubt he claimed a fee for doing it.

The rejection is because you didn't report that she had visited her GP with breast pain the day before you completed the form.

Manxman_in_exile

sheramber wrote: »

The rejection is because you didn't report that she had visited her GP with breast pain the day before you completed the form.

I don't think the OP explained when the form was completed in relation to the GP visit - only that she visited the GP the day before the insurance became effective.


EDIT: Of course the T&Cs probably require that the insurer be informed of any subsequent change in health?

csgohan4

Manxman_in_exile wrote: »

I don't think the OP explained when the form was completed in relation to the GP visit - only that she visited the GP the day before the insurance became effective.


EDIT: Of course the T&Cs probably require that the insurer be informed of any subsequent change in health?

Usually to inform BEFORE insurance kicks in, anything after that is irrelevant

Manxman_in_exile

csgohan4 wrote: »

Usually to inform BEFORE insurance kicks in, anything after that is irrelevant

The OP hasn't replied to #4 about timing.