Most people who take out life or critical illness insurance do so for practical reasons, without ever expecting to have to make a claim. At the time of taking out the policy they answer questions in good faith, not imagining they’ll be scrutinised later. When the worst happens, those making a claim, are incredibly vulnerable. They’ve either been given a devastating diagnosis, or experienced the loss of a loved one, and must now consider their financial future. Insurance is meant to act as a safety net so when a claim is denied, due to misrepresentation or non-disclosure, it can be a huge blow.
What is misrepresentation and non-disclosure in life or critical illness insurance claims?
A health insurer might refuse a claim if it believes the policyholder misrepresented their circumstances, such as their current health, medical history, or lifestyle choices, at the time of taking out the policy. They may also reject a claim if they believe the insured person failed to disclose something important that would have impacted their decision to provide cover. In cases, where the person is very unwell, or worse still not able to speak for themselves, this can feel especially cruel, and as though the insurer is trying to get out of paying.
Appealing a life or critical illness insurance claim that was denied for misrepresentation or non-disclosure
If you’ve been told that you or your loved one gave incomplete or misleading information at the time of taking out an insurance policy, then your claim will likely be rejected for misrepresentation or non-disclosure. The insurer may suggest you, or the policyholder, was careless or even worse, deliberately dishonest when answering questions as part of the insurance application process. If you don’t agree with this, and feel your insurer is treating you unfairly, or trying to get out of paying your insurance claim, then you can appeal it.
Different ways an insurer might try to get out of paying a life or critical illness claim
If you’re accused of misrepresentation or non-disclosure the insurer will likely argue that if you, or the policyholder, had given more accurate information, at the time of taking out the policy, they would have acted differently. This will normally result in them trying to do one of four things:
- They might try to charge you more money for your health insurance policy on the basis that they would have charged more at the time.
- They might apply a restriction to your insurance cover – meaning the ongoing claim, or any future claim, is denied.
- They might settle a claim proportionately – paying only part of the claim as opposed to the full amount you were insured for.
- They might avoid the policy – treating it as though it never existed and therefore not paying you anything.
Why use CEL Solicitors if your life or critical illness claim is rejected?
If your life or critical illness claim is rejected, you can absolutely complain directly to your insurer. You can also take your case to the Financial Ombudsman if you’re not happy with their response. However, if you’re not sure how best to navigate this area or would prefer someone else to do this for you, then our friendly and professional team are experienced in bringing successful financial complaints.
If we don’t believe your insurer acted fairly, we will prepare a robust case setting out exactly why we think your insurance claim should be paid in full. Your insurer has obligations, under The Consumer Insurance Disclosure and Representations Act 2012 (CIDRE). We will consider:
- The questions that you were asked: these should be specific questions that were clear and capable of being understood. This is important because if the questions were unclear, this could have led you to not answer or give an incorrect answer.
- The reasonable care you took when applying for insurance: bear in mind, that it’s acceptable not to disclose something that you didn’t know or couldn’t have reasonably known, at the time.
- The information you gave, was supposedly incorrect or incomplete. The insurer should provide evidence of this. This could be call recordings or a copy of your original insurance application.
- Evidence that the insurer would have done anything differently had it been given the correct or complete information. If the misrepresentation was unlikely to make a difference, and you would have likely still been insured, then your insurance should be paid out.
- The insurer has been fair in the way they handled the misrepresentation.
It’s important to note, that you’re only expected to take reasonable care not to make a misrepresentation. It might not be reasonable to expect you to remember every detail of your or a joint policyholder’s medical history. In some cases, it might not be reasonable to expect you to know the answer to a question at all.
Overturning a life or critical illness insurance claim
If we can demonstrate that you haven’t made a misrepresentation, or that the insurer treated you unfairly, we can help you:
- Get the terminated insurance policy reinstated
- Get any newly added terms removed, reverting to the original policy
- Reclaim any increased premiums that were added, plus interest
- Settle the claim in full (as opposed to no or a partial payment)
- Claim compensation for the distress and inconvenience you’ve suffered
Appealing an insurance claim rejected for misrepresentation or non-disclosure
Insurers sometimes get it wrong so if your life or critical illness insurance claim has been denied then you can appeal this decision. At CEL Solicitors we specialise in insurance claim appeals. We offer free initial, no-obligation advice if you would like a second opinion. We also work on a no-win, no-fee basis so there is nothing to pay upfront and nothing to lose by speaking to one of our friendly advisors today. Call 0808 273 0900 or complete an online form and a member of our team will be in touch.