Medical evidence defeats insurer’s non-disclosure defence
The Appeal Tribunal found that the skin cancer had been completely treated, while evidence showed that the insured did not have lung disease.
#casestudy
False incident date costs policyholder his claim and cover
The NFO upheld the claim rejection and policy cancellation after the policyholder admitted combining damage from two incidents and falsifying the date.
Insurer cannot diagnose non-disclosure with hindsight
The doctor’s medical knowledge did not allow Discovery Life to rely on developments he could not reasonably have known about when applying for cover.
Why ‘ever’ matters when answering insurance questions
A fraud-related cancellation almost 15 years earlier cost the policyholder his tornado claim because he failed to disclose it when applying for cover.
Insurer cannot rely on policy terms after adviser’s misrepresentation
A policyholder’s godfather was recorded as her father despite the adviser knowing the true relationship, leading to a ruling that the insurer must pay the claim.
Claim delay exposes importance of keeping policyholders informed
An NFO case highlights the requirements of Rule 17.8.6 and the consequences when an insurer fails to communicate during a prolonged claims process.
Not every medical non-disclosure justifies claim rejection
The Appeal Tribunal found that an undisclosed diagnostic test was not material to the insurer’s assessment of the risk and ordered the claim to be paid.
Landlord’s fire claim fails after tenant-created hazard goes undisclosed
The NFO found that a property owner could not avoid responsibility for an increased risk where poor construction, electrical defects, and tenant conduct contributed to the loss.
Income protection dispute turns on 10% increase versus CPI cap
The Appeal Tribunal found that voluntary pre-claim benefit increases were distinct from post-claim escalation and could not be used to support a fixed 10% increase.
Misclassified vehicle use – a reminder to provide adequate advice
An FSP failed to ensure that a client was made aware of the implications of modifying his policy, resulting in an insurance claim denial.
