Frequently Asked Questions

Normally the insurance company will apply an “appropriate remedy”. This might involve paying the claim in full, paying a proportion of the claim, cancelling the policy and refunding the premiums or cancelling the policy and not refunding the premiums (unlikely).

Insurance companies normally identify non-disclosure in two ways. Firstly, the insurance company will ask questions regarding your claim when you contact them, and this can result in you inadvertently highlighting a non-disclosure. Secondly, the insurance company may ask your GP some questions when assessing the claim. Where the information provided differs from that on the application, the insurance company may state there has been a non-disclosure.

If you have an insurance claim rejected due to non-disclosure, it is important to understand exactly what information the insurance company can request. Some insurance companies may go “fishing” in a bid to find a non-disclosure which is not allowed. For more information on how to identify these practices, you can call Resolute Claims.

When making a claim of Life, Critical Illness or Income Protection insurance your provider will often write to your GP asking them some questions. These questions will be around your condition but may often ask questions like “has the patient ever smoked?”, “has there ever been any records of drug abuse?” or “what is the last recorded alcohol intake?”. This is how most alcohol consumption non-disclosures are identified. If an insurance company have rejected your claim, it can often be challenged in different ways. Resolute Claims are experts at identifying potential avenues to appeal rejected insurance claims. For free information and guidance, you can speak with one of our experts.

Have you had a Critical Illness claim denied or a Life Insurance claim denied because the insurance company have identified a non-disclosure? An estimated 1 in 4 people will experience mental health conditions every year so it would be considered normal for a person to experience some mental illness at some point in their lives. Insurance companies normally ask some questions when you are applying for the insurance, like “have you been diagnosed with suffering depression or have you taken medication for depression in the last five years” OR “have you seen your GP or specialist about a mental health condition in the last five years”. It is completely normal for someone to experience mental health issues during their lives. Often insurance companies will place undue significance on these issues and make assumptions to reject an insurance claim.

We have seen instances of people’s insurance claims being rejected after going to see grief counsellors following the death of a loved one. Grief following bereavement is not mental health condition and is a normal, recognised process. Insurance companies should be looking for patterns that would make you an increased risk. For example, someone who has had a couple of periods of anxiety during particularly stressful periods of their life may not have their claim rejected. Another person with a well-managed General Anxiety Disorder might receive a rated premium.

More serious mental health conditions such as psychosis or suicide attempts may result in a rejected insurance claim, but this can depend on individual circumstances. For instance, how long ago was the last episode, the reasons behind the episode (bereavement/unusual stress such an abusive relationship/major adverse life event) and if there has been any reoccurrence.

Resolute Claims are experts in fighting denied insurance claims. Some insurance companies have been rejecting claims for the following reasons:

Insurance companies assuming that symptoms must have been apparent and known about before the application for insurance was made
Where the symptoms were present before the application, but the customers medical professionals provided an unrelated diagnosis that would not have impacted the application
Insurance companies requesting full medical records in order to “find” a non-disclosure
Exaggerating previous medical conditions such as mental health issues to make them seem more severe than they are
Failing to get clarification around any potential non-disclosure

They are a few different ways a rejected insurance claim may be challenged when it comes to non-disclosure. The first is, was the question clear enough? Any ambiguity should go in the customer’s favour. The second is, should you have reasonably known about it? For insurance, if an event happened 4 years 10 months ago and the question asks about the last five years, it could be seen as reasonable you inadvertently omitted to disclose information. Thirdly, have the insurance company been “mining” your medical data? There are very strict rules around what medical information insurance companies can request. We have seen instances of insurance companies requesting people full medical records when making a claim solely to identify a non-disclosure. Resolute Claims are successful at challenging these types of rejected insurance claims when making an insurance complaint.

When making an insurance complaint it is important that you carefully consider the specific point about which you are complaining. It is best to research the regulation and guidelines and how these apply to your case. It is often best to submit a factual, reasoned complaint rather than relying on emotional or narrative driven points. At Resolute Claims, we are experts at making objective, evidence-based challenges following claim rejections on the grounds of non-disclosure.