Life/Critical illness insurance

CStar75

Hi, my husband took out a policy with a well-known insurer. About the same time he had blood tests as he was suffering from fatigue and rib pain. The GP was not concerned about the rib pain, saying it was probably an injury and the results eventually diagnosed as a vitamin d deficiency and was treated accordingly. He did not advise the insurer about the tests when taking out the policy as he felt it was insignificant as billions of people suffer with this treatable condition, nor did he advise he went for a cholesterol test in 2019 following an over 50s health check, later treated and no longer suffering. He then went to the GP for muscle fasciculations 2 months after the policy was taken out and he was diagnosed with MND, 2 months after that. He submitted a claim on the policies and has been told by the insurers they will not be settling the claim due to the non disclosure of the tests which are totally unrelated to the MND diagnosis, our GP has since confirmed that he wasn't presenting MND symptoms at that time. We have appealed and they are not budging despite the threat of going to the FCA and social media platforms. Any suggestions would be welcome please? Thanks.

DullGreyGuy

If you've already been to the Financial Ombudsman and they agreed with the insurer then the only option that remains is court but the FOS tend to be much more consumer leaning than the courts and exceptionally few cases are overturned by the courts. 

The relevant law is  Consumer Insurance (Disclosure and Representations) Act 2012 which states that if you intentionally or recklessly make false declarations when taking out a policy the insurer can void the policy and avoid all claims. You will have been asked when taking out the insurance to declare all conditions you've had in the last X years including undiagnosed symptoms, tests, things you've spoken to a medical professional about etc. By your own admission he decided not to declare some things thinking they wouldn't be interested but that wasn't his call to make. CIDRA doesn't require the declaration to be related to the claim in question. 

CStar75

Thanks for responding and for the information. We will try the FOS as the next step as we're currently in discussion with the insurer. 

DullGreyGuy

CStar75 said:

Thanks for responding and for the information. We will try the FOS as the next step as we're currently in discussion with the insurer. 

Sorry, you said the FCA who dont deal with individual customer complaints and so assumed you meant the FOS as most others do when they say the FCA. 

You must have received a Final Response from the insurer, or 8 weeks have passed since the complaint was logged, before you can take the matter to the FOS

Seasalt3

  When you take out life/critical illness policy you have to declare everything health wise however minor and once you've been accepted for the policy if there have been any changes to your health, including visits to doctors for minor ailments , between completing the application and the policy being put into force, you have to let the insurer know. The insurer usually sends an acceptance letter stating this.  I have experience of this as I used to work for a independent financial adviser company and we advised our clients and sold these policies.  We did have a case similar to your situation where we challenged this and fortunately the insurer did pay the claim but its not always the case.  
Taking out any type of Insurance can be very challenging in terms of what you need to declare.   I'm sorry this has happened to you and hope you can get this resolved