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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.
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Why might a claim be declined?

We’ll only decline a claim for misrepresentation after we’ve looked into the claim in detail, and it’s clear misrepresentation affects the claim being made. 

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.

Jane* applied for Personal Sick Policy with a 4 week deferred period. On her application she told us she had hearing difficulties in one ear and so we applied an exclusion to her cover relating to this.
We were contacted in April 2020 as she’d been unable to work since February due to an issue she was having with her knee. 

After obtaining the medical records, the evidence found showed that the issue with her knee predated her policy and she'd been having treatment when she applied for the policy. This was classed as a case of misrepresentation and had we known of these issues this would have affected the terms of the policy.  

*This is a real claim example from 2020. The name has been changed to protect the identity of our customers.

 

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.
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We paid 95% of Personal Protection claims in 2020

We’re committed to paying your client’s claims. In 2020 we paid 95% of all new claims – 99% Life Insurance**, 92% Life and Critical Illness Cover and 93% Income Protection*.

*Includes new claims admitted in 2020 and those already being paid before 1 January 2020 that continued to be paid in 2020, we paid 80% of new Income Protection claims admitted in 2020.

**Our Life Insurance figures include claims paid for our Life Insurance, Terminal illness, and whole of life products. Our whole of life products are no longer available.
 
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