Insurance World

Insurers treat the non-disclosure of information on an application form very seriously indeed, and it is the most common cause for the rejection of a life or critical illness insurance claim. This true story explains that the situation isn’t always black and white, and demonstrates the severity of the penalty. We have changed some details to protect the anonymity of the policyholder.

Ms W had to have an operation to eradicate cancerous lymph nodes from her groin, and immediately fell ill after surgery with an infection she picked up in hospital. Critically ill, she had already made a claim on her critical illness insurance, however she received some unexpected bad news. Her claim was rejected and she was not going to receive the Ј200,000 she was insured for. How did this happen? Read on so we can explain.

June 2001 – Ms W went to see her doctor about an area of flaky skin on her back, she assumed it was something like eczema. Her GP wanted a specialist to have a look, and made a referral to a dermatologist. Before the appointment arrived, the patch of flaky skin cleared up, so Ms W cancelled the appointment, thinking no more about it. She did not imagine that it was anything serious, and the GP had not given her the impression that there was anything to worry about.

August 2001 – a sales representative from Ms W’s life insurer, Standard Life, called for a routine sales visit. Ms W’s circumstances had changed and she now had a young family depending on her. The sales rep suggested taking out a critical illness insurance policy, and she readily agreed. Ms W took out Ј200,000 worth of critical illness insurance.

The sales representative talked Ms W through the application form, filling in the answers on her behalf. When they came to the section about any incidences of referral from a GP, Ms W was unsure what the question meant, and asked the sales representative for clarification. According to Ms W, the sales rep told her that she only needed to mention a referral if it related to a serious matter. Ms W didn’t think it was worth mentioning the GP referral for the flaky skin, since she thought it was probably just eczema. She didn’t mention it so it didn’t go on the form. Ms W signed the form after completion and she applied for the Standard Life policy believing that she had provided all the required information.

Ms W soon received notification that she was insured for Ј200,000 in case she developed a critical illness.

Two years later – Ms W learnt that she had skin cancer, and major surgery quickly followed to try and remove the cancer. Ms W naturally made a claim on her critical illness policy, for which she fully expected to receive a Ј200,000 payout.

Soon after, Ms W received the rejection letter from Standard Life – the claim was rejected on the grounds of “reckless non-disclosure”. As far as the insurer was concerned, Ms W had withheld information on the application form, and this had invalidated her claim.

As you no doubt have realised, Ms W should have mentioned the GP referral to a dermatologist – and her failure to mention it resulted in a severe penalty. How could she have made such a mistake?

Two major errors were made:

1. When Ms W was asked to give details of any referrals she asked the sales rep what kind of referrals they meant. She was advised that she only needed to mention referrals relating to serious conditions. This advice was incorrect. The question asked for details of “all occasions her GP had referred her for tests or treatments”. ALL OCCASIONS means ALL – whether they were thought to be serious or not. The insurance company needs to know absolutely everything they ask for on the application form, and Ms W unfortunately did not provide that, thanks to the sales rep’s advice.

2. The GP did not give Ms W any indication that the flaky skin could be something serious, a fact that the GP stood by later. Ms W did not realise that the skin condition could be anything other than eczema, and so when told that she only needed to give details of referrals relating to serious conditions, she truly believed that her dermatologist referral was not worth putting on the form. She made this decision based on advice given by the sales rep, and it was a genuine mistake on her part.

Taking the above story into account, we think that Standard Life should realise that Ms W made an honest mistake, and did not deliberately withhold any information. The sales rep did not give the right advice, and Ms W followed that bad advice in good faith. It wasn’t her fault, and Standard Life should relax the penalty in this particular case.

Make sure it doesn’t happen to you

Filling out a life or critical illness insurance application form has to be taken very seriously indeed. You must read every single question and answer each one providing all the necessary information and detail. Withholding information is not an option, don’t be tempted by the thought of cheaper premiums because on making a claim, you will be found out and the claim will be invalid. Don’t take that risk!

Hopefully, Standard Life will see that Ms W did not deliberately mislead them, and they will give her the payout she deserves.

People that do deliberately mislead the insurers do deserve what they will eventually get – nothing.

NB: Standard Life rejects 5%, Friends Provident rejects 15% and Legal & General rejects 16% of all critical illness claims because of policyholders withholding information (whether deliberately or not). The insurance industry realise that they need to do something to address the situation, and are currently developing new ways to get information from applicants, and to publicise the severe penalties for not providing full and accurate information.

When it comes to life insurance we have two primary types of policy to choose from – term life insurance or whole of life insurance. Many people find it hard to come to a decision about which type of policy to take out but the decision you have to make really isn’t that complex and both will offer good levels of cover for the majority of people. Let’s take a closer look at your options.

The most popular type of life insurance is, without a doubt, term life insurance. This kind of policy will be set out to last for a specified ‘term’ – i.e. it will last for a set time period. So, you can take out a life insurance term policy for 25 years, as an example. During this 25 year period you will make your policy payments and you’ll have the protection of the policy if you die. So, your next of kin can claim against the policy in the event of your death. But, at the end of the 25 years your policy will be finished and you’ll get no further protection from it.

Many people opt to take out a term life insurance policy because they know that they will no longer have a great need for insurance at the end of the specific term. For many people this kind of policy will end at around the time that they retire so their mortgage will probably be repaid, their families will be grown and they won’t need to make provision for their family to have such a large lump sum or income if they die. So, a term policy can suit them very well indeed, giving them cover during the years when they really need it and finishing when they don’t.

A whole of life policy, on the other hand, will suit those of us who want protection for the rest of our days. This kind of life insurance is designed to last until you die – so you’ll be covered in the short, medium and long term. A lot of people who opt for this kind of life insurance do so because it can be set up to help with issues such as inheritance planning, although many people simply prefer to get cover that is guaranteed to make a payment at some point so that they feel that they are getting some return on their policy payments. There is a guarantee of payment with a whole of life policy that isn’t there with a term policy. Once your term policy is finished that really is it – you are only guaranteed a payment if you do die while the policy is in force.

Many people make their choice here based on their budget. The fact that a term life insurance policy may not ever make a payment (i.e. the fact that you will probably survive your policy) means that insurers can offer lower costs. A whole of life policy – with its guaranteed payment at some point – is consequently more expensive. The choice you make here will be a personal one and may well depend on your financial circumstances. The vital thing to remember is that some form of life insurance cover is vital for most of us – especially if we have a family to consider and we can consequently get great protection from either kind of policy at the end of the day.