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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 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.

Naomi* took out a Life and Critical Illness policy in September 2022. She didn't make any disclosures on her application. She called us at the end of 2022 and advised she'd been diagnosed with breast cancer at the end of September. The medical showed she first saw her GP in August 2022 as he'd found a lump and she was referred for investigations. 3 days before she applied for the policy, she was told the likely diagnosis was breast cancer and biopsies were taken.

When we asked her why she didn't tell us of her medical investigations she said she thought she didn't need to until she had a formal diagnosis and said she wanted to get insurance sorted. Unfortunately, we couldn’t pay this claim because this wasn’t disclosed at application, and it likely would have impacted the cover we offered.

*This is a real claim example from 2023. The name has been changed to protect the identity of our customer.

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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 94% of Personal Protection claims in 2023

We’re committed to paying your client’s claims. In 2022 we paid 95% of all claims – 97% Life Insurance* 85% 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 2023 and those already being paid before 1 January 2023 that continued to be paid in 2023, we paid 81% of new Income Protection claims admitted in 2023.

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