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A Critical Illness claim rejected always has a significant impact on the policy holders loved ones and wider family. The main reason this could happen is due to non-disclosure. Some non-disclosures can be due to incorrect “lifestyle” information submitted when someone applied for the insurance.
Someone’s Critical Illness claim denied because of an insurance company claiming someone has misrepresented their smoking status is a common occurrence and results in a large amount of claims being rejected.
When assessing someone Claiming on Critical Illness insurance an insurance companies may well check that the answers provided on the application were correct. They may write to your GP asking if you have ever smoked and when you gave up. They may also ask the same about your alcohol intake and if someone has ever used recreational drugs.
If the insurance company identify that someone has not been truthful when disclosing their smoking status, they may choose to apply a “remedial action and proportionate remedy.” The ABI state that:
“A proportionate remedy means that, as far as possible, the insurer will seek to put the customer
back to the same position as an identical customer who had accurately disclosed the omitted
information and who paid the same premium for the same type of policy”
This means that insurance companies need to say what they would have done if someone did disclose their smoking status. Normally this would result in a rating of your premium (for example +20/50% depending on your age).
However, we are seeing an increase in cases where insurance companies are classifying this non-disclosure as “reckless/deliberate” which means the insurance company can void the policy and cancel it from inception (resulting in no pay-out).
Resolute Claims are experts is appealing Critical Illness claims and helping people with Insurance Complaints. We have helped hundreds of customers challenge these decisions and get the pay-out they deserve. We can help If you are concerned about an insurance claim decision you can obtain free information and guidance around your options.
