Insurers treat the non-disclosure of information on an application form very seriously. It is the most common cause for the rejection of life or critical illness insurance claim. This true story explains that the situation isn’t always black and white and demonstrates the penalty's severity. 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 the hospital. Critically ill, she had already claimed on her critical illness insurance. However, she received some unexpected bad news. Her claim was rejected, and she would not receive the $200,000 she was insured for. How did this happen? Read on so we can explain.
June 2019 – 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 canceled the appointment, thinking no more about it. She did not imagine anything serious, and the GP had not given her the impression that there was anything to worry about.
August 2019 – a sales representative from Ms. W’s life insurer, 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 $200,000 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 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 insurance company policy believing that she had provided all the required information.
Ms. W soon received notification that she was insured for $200,000 if she developed a critical illness.
Two years later, – Ms. W learned that she had skin cancer, and major surgery quickly followed to remove cancer. Ms. W naturally made a claim on her critical illness policy, for which she fully expected to receive a $200,000 payout.
Soon after, Ms. W received the rejection letter from her Life insurance company – 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, which invalidated her claim.
As you no doubt have realized, 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 realize that the skin condition could be anything other than eczema. 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 the sales rep's advice, and it was a genuine mistake on her part.
Taking the above story into account, we think that her insurance company should realize 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 her insurance company should relax the penalty in this particular case.
Make sure it doesn’t happen to you
Filling out 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, her insurance company 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.
Life insurance companies reject from 5% to 16% of all critical illness claims because of policyholders withholding information (whether deliberately or not). The insurance industry realizes that they need to do something to address the situation and are currently developing new ways to get information from applicants and publicize the severe penalties for not providing full and accurate information.