Rejecting a claim

lionish

A few years ago we had difficulty with a travel insurance claim. My wife suffrede a brain bleed but the insurer queried it because we had not (inadvertently) declared a pre existing condition from a long time past which bore no relation to the brain bleed. At the time my daughter found an article by - I believe - the British Insurance Association stating that insurers must not reject a claim for a condition on the basis of a non declared pre condition unless it was relevant. We cannot find the article. Does anyone know anything helpful?

Annemos

There are 40 cases in here on the FOS website. I did the search on "travel claim denied pre-existing conditions". 

If you can take a look through some of these, it will give you an idea of how The Ombudsman views such cases. 


https://www.financial-ombudsman.org.uk/decisions-case-studies/ombudsman-decisions/search?Keyword=travel+claim+denied+pre-existing+conditions&IndustrySectorID%5B3%5D=3&Sort=relevance

DullGreyGuy

lionish said:

A few years ago we had difficulty with a travel insurance claim. My wife suffrede a brain bleed but the insurer queried it because we had not (inadvertently) declared a pre existing condition from a long time past which bore no relation to the brain bleed. At the time my daughter found an article by - I believe - the British Insurance Association stating that insurers must not reject a claim for a condition on the basis of a non declared pre condition unless it was relevant. We cannot find the article. Does anyone know anything helpful?

The law changed in 2012 unfortunately. The ABI isn't a regulatory body and can only provide rules for its members and not all insurers selling insurance in the UK are members. If members dont follow its rules the worst it can do is apply modest fines and revoke their membership. 

Parliament introduced the legislation  Consumer Insurance (Disclosure and Representations) Act 2012 which materially changed matters. Its rules are:

• Customer intentionally or recklessly didnt disclose something (accurately) - void the policy, avoid the claim, keep premiums

• Customer carelessly didnt disclose something and you wouldn't have insured them had it been disclosed - cancel the policy, avoid the claim, refund premiums

• Customer carelessly didnt disclose something and you would have insured them had it been disclosed - pay the claim but reduce settlement to reflect the proportion of under paid premium

Ultimately it comes down to two things... do they think it was careless or worse? Would they have provided cover had it been declared? Whether the non-disclosure is related to the claim or not is no longer of any consequence under the CIDRA legislation.

What was the condition? How long ago before you bought the policy was it? What is your explanation for why it wasnt reported?