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Underwriting misrepresentation
We’d like to pay all claims, but we must run a responsible policy. It means that we’re fair to our members and customers.
Why might we be unable to pay a claim?
We assess all claims in detail and will only make a decision not to pay a claim where there is clear evidence of misrepresentation which affects the terms offered on the policy.
We understand that in many cases misrepresentation can be accidental. But sometimes people can deliberately choose not to disclose information, whether that's to secure cover or reduce their premium. If we had this information from the outset we may not have been able to offer cover, or it might have impacted the terms we offered.
We may request medical evidence to validate a claim.
Rosie* took out a Life Protection policy in October 2021. We were contacted by her family in February 2022 as she had passed away due to Breast Cancer. The medical evidence showed that she had found a lump in September 2021 and was given a cancer diagnosis in October 2021. She applied for her policy 4 days after she was told her diagnosis. We would not have been able to offer her cover had we known she'd been diagnosed with cancer.
*This is a real claim example from 2022. The name has been changed to protect the identity of our customer.
Supporting your client's application
To ensure the information provided is correct, and to avoid misrepresentation, there are things you can do to support your client’s application:- Make sure you and your client read the application questions. Your client should then answer them fully and honestly.
- We might have questions about the disclosures your client has made. Please advise your clients to be available to respond to us – this may help avoid the need for medical evidence.
- If we ask follow up questions, ensure your client provides as much information as possible. Provide us with copies of any hospital or doctors letters where possible.
We paid 95% of Personal Protection claims in 2022
We’re committed to paying your client’s claims. In 2022 we paid 95% of all claims – 97% Life Insurance*, 88% Critical Illness Cover and 92% Income Protection**.
* Our Life Insurance figures include claims paid for Life Insurance, Terminal illness and Whole of Life products (including some non-underwritten guaranteed whole of life products). Our whole of life products are no longer available.
** Includes new claims admitted in 2022 and those already being paid before 1 January 2022 that continued to be paid in 2022, we paid 80% of new Income Protection claims admitted in 2022.
* Our Life Insurance figures include claims paid for Life Insurance, Terminal illness and Whole of Life products (including some non-underwritten guaranteed whole of life products). Our whole of life products are no longer available.
** Includes new claims admitted in 2022 and those already being paid before 1 January 2022 that continued to be paid in 2022, we paid 80% of new Income Protection claims admitted in 2022.
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