Case Study

Life Insurance Claim

Judy’s husband was diagnosed with lung cancer in 2017 and sadly passed away in 2019. They had a joint Life Insurance policy that was to help with funeral expenses and pay-out a lump sum should one of them pass away. Judy said, “I was so distraught my daughter had to do all the paperwork for the insurance.”

Judy’s insurance provider told her that they were unable to pay the claim and declined the Life Insurance claim. They stated that her husband had not disclosed a pre-existing medical condition. Three years before the policy was taken out Judy’s husband had gone for an X-Ray which had found he had a cyst in his lower abdomen. They advised that if this had been disclosed, they would not have provided cover for her husband. They had subsequently cancelled the policy and refunded all the premiums paid.

Judy and her daughter tried to appeal the decision with the insurance provider but were unsuccessful. “I just didn’t think we had a chance, the way the insurance company put it made it seem like there was not even a reason to appeal. I honestly felt quite embarrassed.”

They then contacted Resolute Claims and we investigated how the claim was handled. We requested medical evidence that the insurance company had seen along with details about Judy’s policy. We were able to identify certain regulatory issues that the insurance company did not adhere to, especially when assessing and requesting the medical information. We invited the insurance company to comment on our concerns and asked for a full explanation on the points we had raised.

The insurance company changed its mind and offered to reduce the amount of cover it would have provided (known as rating the premium). Although we managed to successfully appeal the insurance decision, we did not accept the insurance decision that they would have reduced the level of cover and referred the case to the Ombudsman. After reviewing the case the Ombudsman awarded the full original sum covered.

The Ombudsman ordered the insurance provider to pay the full insured amount plus 8% interest.

Judy’s story is not unique. Around £80,000,000 pounds worth of declined Life Insurance claims are reported yearly and the overwhelming majority of these go unchallenged. If you feel, like Judy, that your Life Insurance claim has been rejected unfairly please get in touch. We offer a free and impartial guidance service, so why not speak with one of our experts today 0333 050 8792.

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If you have been declined while trying to claim on a life insurance, critical illness, or income protection policy then we can help. We also help with all other financial service complaints, for example, mis-sold pensions and insurance cover.

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