Income Protection:

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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.
docuemnt with ? sign , behind stack of coins

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.
Tina* applied for a Personal Sick Pay policy. The only pre-existing medical condition she declared was asthma – so she was offered a policy at standard rates.

A month later she contacted us, advising she was having a hysterectomy. Her medical evidence showed a long history of gynaecological issues, and that she was on the waiting list for surgery when she applied for her policy. 

Tina would’ve known about this when she applied for her policy, but answered ‘no’ to any questions relating to gynaecological issues and awaiting further treatment. This was classed as a case of misrepresentation.

*This is a real claim example from 2019. The name has been changed to protect the identity of our customers.
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.
  • 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 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.
Book School Documents

We paid 94% of Personal Protection claims in 2019

We’re committed to paying your client’s claims. In 2019 we paid 94% of all new claims – 99% Life Insurance*, 88% Life and Critical Illness Cover and 93% Income Protection**.

*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.

**Includes new claims admitted in 2019 and those already being paid before 1 January 2019 that continued to be paid in 2019, we paid 81% of new Income Protection claims admitted in 2019.
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