When might a life and critical illness claim not be paid?

When might a claim not be paid?

Answer

We wish we could pay all claims but there are some claims we can’t pay. The ABI (opens in a new window) have two definitions for declined claims; misrepresentation and not meeting the policy definition.

Misrepresentation is when important information is missed off the application form when the policy started. Information which could have meant you would not have been able to take out insurance with us, or been able to get insurance cover with us but with an exclusion. Common reasons are customers not telling us how much they smoke or drink when completing their application form, and then claiming for lung or liver cancer.

Not meeting the policy definition is when the terms and conditions of the policy are not met. An example of this might be a customer with a terminal illness and making a claim, but their doctor has said they have longer to live than 12 months (we won't pay if you don't meet our terminal illness conditions).

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