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Servicing
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.
In June 2021, we were notified by Kelly’s* family that she had sadly passed away due to endometrial cancer that month. We contacted her doctor for a report and this showed that she had seen her GP the day before applying for cover with us, with concerns of symptoms that had been present for around a year. Her GP referred her and this led to a cancer diagnosis. Sadly, if she had disclosed her symptoms and referral within her application then we wouldn’t have been able to offer her cover. We had to make the difficult decision to decline her claim due to misrepresentation.
*This is a real claim example from 2021. 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 96% of Personal Protection claims in 2021
We’re committed to paying your client’s claims. In 2021 we paid 96% of all claims – 98% Life Insurance***, 93% Critical Illness Cover* and 93% Income Protection**.
* Critical Illness cover claims are based on our Life and Enhanced Critical Illness cover only.
** Includes new claims admitted in 2021 and those already being paid before 1 January 2021 that continued to be paid in 2021, we paid 82% of new Income Protection claims admitted in 2021.
*** 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.
* Critical Illness cover claims are based on our Life and Enhanced Critical Illness cover only.
** Includes new claims admitted in 2021 and those already being paid before 1 January 2021 that continued to be paid in 2021, we paid 82% of new Income Protection claims admitted in 2021.
*** 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.
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