Life Life insurance - genuine mistake, what next?

ConnieD

New Member
Messages
6
I have taken up life and mortgage insurances earlier this year with the same insurer.

I have a breast check scheduled soon and my GP suspects I have cysts. So recently I have re-read the policy documents and got worried that they may refuse to pay if I die of breast cancer – I have realized that I had inadvertently omitted from the health check questionnaire information of an all-clear breast check I had done two years ago. We flew over this questionnaire over the phone and at the time I didn’t think to mention it as it was one of many checks (dental, cervical, eyes, hearing, bloods etc.) I did at that time. I made a genuine mistake.

Should I go back to my insurer and inform them about this omission? Like – right now, before I have the breast checks done and find out if there is a problem?

Or should I leave the existing insurances in place and once I have the results and I don’t have cancer – take up a new insurance with a different provider for the balance I need based on the current health records?

I don’t know which one to worry more about – from the insurance point of view – the all-clear results of two years ago or the potential diagnosis coming up.

Any thoughts, feedback or suggestions would be greatly appreciated.
 

Ordinary User

Registered User
Messages
27
In my understanding you are making declaration based on facts not speculations. So if I get this right, at the time of signing your medical declaration your statement was true.
Your GP might be right but might be wrong - mine was treating me for muscle strain when I had a pulled disk. Furthermore, not all cysts are cancer related.

When you establish facts then make a call what to do about it. Not sure if this is correct, but that would be my approach.
 

ConnieD

New Member
Messages
6
Thank you @Ordinary User - I agree, will get the facts first.
There was a question if I've been referred to have tests, scans etc. in the last 3 years and I said 'no' which was incorrect. I should have said 'yes' and explained that the results have shown no issues.
 

Steven Barrett

Registered User
Messages
3,899
In my understanding you are making declaration based on facts not speculations. So if I get this right, at the time of signing your medical declaration your statement was true.
Your GP might be right but might be wrong - mine was treating me for muscle strain when I had a pulled disk. Furthermore, not all cysts are cancer related.

When you establish facts then make a call what to do about it. Not sure if this is correct, but that would be my approach.
This is incorrect advice. All medical questionnaires state "have you ever suffered from or received treatment, advice or had investigations for any of the following"... and then gives a long list.

The form also says that you have to disclose all material facts and whether in doubt that a fact is material or not, you should disclose it.

Your best course of action is to contact the insurer and explain what happened and get them to reunderwrite your application. If you got the all clear, it won't make any difference to your policy anyway. But you do not want to take the risk that if something happened to you they void the policy because you didn't disclose all material facts at the proposal stage.


Steven
www.bluewaterfp.ie
 

Ordinary User

Registered User
Messages
27
looks like I got the timeline wrong, I though the GP consultation took place after you got the insurance. Steven's advice is correct one. I Actually looked at the form I've filled out few years back and it's states that if you unsure whether an information is material or not it's better to disclose it which would support your genuine intention. thanks @Steven Barrett
 

ConnieD

New Member
Messages
6
I'm just thinking out loud. It is obvious that a claim would be refused if a person have concealed that they had a condition which required treatment. But why would a claim be refused if there is no connection between the cause of death and the breast check? Especially with medical evidence which clearly indicates that there was no issue at all, no treatment required and none received?

And if the dreaded breast cancer causes death - wouldn't it be unreasonable to refuse the whole claim? Doesn't it actually work to the advantage to have a medical proof that there clearly wasn't a pre-existing condition?
 

Leo

Moderator
Messages
12,621
But why would a claim be refused if there is no connection between the cause of death and the breast check?
Because insurance companies often try all the can to get out of paying up. the more successful they are in that, the more money they make.
 

Steven Barrett

Registered User
Messages
3,899
Because insurance companies often try all the can to get out of paying up. the more successful they are in that, the more money they make.
Life cover isn't quite the same as general insurance where there may be a thousand different reasons for claims and pages and pages of exceptions and exemptions.

The simple fact is that the insurer entered into a contract with the policyholder and the policyholder had to disclose all material facts to do with their application. They didn't, they remembered that they didn't and didn't correct it. The life company are not in the wrong in this instance. If there is a death and a claim, voiding the contract is not the only means of recourse to the life company. They may reduce the payment or if they concluded that the premium would have been increased if the correct information was provided at outset, they may just collect the premiums owed.

Either way, the OP is aware that she hasn't disclosed all material facts to the insurance company. She is also aware what she needs to do to rectify it. If there is a claim and they refuse to pay out, you can't blame the life company.


Steven
www.bluewaterfp.ie
 
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Mona G

Registered User
Messages
42
For the argument sake - is my case/ reasoning strong enough to challenge a potential refusal?

I'm reading some decisions of the Financial Services and Pensions Ombudsman on non-disclosure and it seems that the main indisputable reasoning for rejecting claims is when people have records of medical issues and treatment they didn't disclose. My records on the other hand provide medical evidence of all-clear and no treatment required.
 

Mona G

Registered User
Messages
42
Thank you @Steven Barrett - do you think it likely that the insurance provider would have treated my application differently if they were aware of the all-clear results of the check-up?
 

Monbretia

Registered User
Messages
2,032
For the argument sake - is my case/ reasoning strong enough to challenge a potential refusal?

I'm reading some decisions of the Financial Services and Pensions Ombudsman on non-disclosure and it seems that the main indisputable reasoning for rejecting claims is when people have records of medical issues and treatment they didn't disclose. My records on the other hand provide medical evidence of all-clear and no treatment required.
I dunno, I dealt with a case where a man had investigations but all clear and no treatment/medication required, roll on a few months and life cover issued, he hadn't mentioned it as thought it was a thing of nothing obviously with the all clear, however maybe 12 months later (can't remember exactly) the same issue arose and this time cancer was found on investigation, he subsequently died and insurer did not pay out. It was not a massive amount as it was small enough mortgage.

I advised his wife to go to Ombudsman on the basis that even if he had mentioned it when applying all the docs reports would have said nothing that should have caused it to be underwritten differently but Ombudsman upheld decision. No point taking any chances with life insurance!
 

Mona G

Registered User
Messages
42
Thank you @Monbretia - would you have a reference number for this Ombudsman's decision by any chance? When was it? Ombudsman's decisions are publicly available but so many - having a ref. no. would help to find it and learn more of the circumstances.
 

Monbretia

Registered User
Messages
2,032
Thank you @Monbretia - would you have a reference number for this Ombudsman's decision by any chance? When was it? Ombudsman's decisions are publicly available but so many - having a ref. no. would help to find it and learn more of the circumstances.

No I haven't a clue, it was back when I was working, couldn't even guess at the year although I see the man's anniversary in the local paper every year!
 

SPC100

Registered User
Messages
896
Their models probably assume somewhat higher risk for anyone who had any life longevity risk related thing investigated, even if they were given the all clear.
 

Steven Barrett

Registered User
Messages
3,899
Thank you @Steven Barrett - do you think it likely that the insurance provider would have treated my application differently if they were aware of the all-clear results of the check-up?
It is impossible to know as we don't know what the investigations were for and I am not an underwriter.

Even if you think something isn't that important from an underwriting point of view, an insurer will see things differently. Take arthritis for example. I have a few clients who have arthritis from a young age. It is perfectly manageable with medication and despite being riddled with it, they are able to play sports and be active. Arthritis won't kill you so why are their premiums increased for life cover? Because of the side effects of the medication that they take. Some of them can lead of liver failure and that is the extra risk the insurer is taking.

You need to disclose all material facts. It is written on the form before you answer the medical questionnaire and it is also stated in the consumer declaration before you sign your name.


Steven
www.bluewaterfp.ie
 

ConnieD

New Member
Messages
6
I'm looking at this questionaire again - I have talked to the insurer this morning and was writing to tell them. And only now I see that it says: 'You don't need to tell us about: (...) routine smear test or mammograms not requiring further investigation'.

Am I right in saying that in this case I am fine and don't need to do anything?
 

ReesesPieces

Registered User
Messages
34
Was it a mammogram you were called for as part of a national screening based on your age, or something you were referred to because of some symptoms?

If the former you're fine, if the latter it would still count as something that should have been disclosed.

I went to the GP about some issues I had breastfeeding, she examined me and found a lump I hadn't noticed, I was referred and had a mammogram and all clear. I completely understand how its something you would forget about, but I think its something I would need to declare.

Similarly I had a standard cervical check smear, it showed some irregularities, I had follow up tests and monitoring then the all-clear. Again, if the first smear was clear its not something to mention, but the follow-ups are, and if I had the smear because I'd noticed, say, bleeding, that would be as well.

I actually do wish there was a more straightforward process to help with these: when we did our mortgage insurance questionnaire the woman in the bank talked us through the form and inputted it into her computer, It then broke down half way through and we had to re-do it. When we did it a second time, we both remembered things we'd forgotten the first time. I wish there was a standard printout your GPs records could do to capture all the referrals you've had: we're both relatively young and very healthy but between us I've had an irregular smear, he's had blurry vision which was investigated in case it was a TIA (it wasn't) etc etc. When things turn out to be nothing they don't stick in your mind.

Good luck with your investigations: the vast majority of cysts are benign but I think you're right to ensure coverage is in place, the last thing anyone needs at a difficult time is worries about insurance.
 
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