Failure to disclose medical history results in loss of cover...

An insured took out life and trauma insurance through her bank in 2012.  In 2016 she made a claim on the cover because she had breast cancer.

On examination of the insured’s medical history it was discovered that she had failed to disclose information about high blood pressure for which she had been prescribed medications and also failed to advise about investigations for a breast lump which had resulted in a diagnosis of multiple breast cysts.

The Insurance Ombudsman’s Case Manager considered that the insured had failed to provide answers to questions asked by the insurer when she did not disclose her prior history of high blood pressure and breast cysts.  To determine whether this information was material to the claim the Insurance Ombudsman’s Office asked two senior independent underwriters how this would have affected their decisions to insure the customer.  Both underwriters would not have issued policies on the same terms that the insured obtained because of the previous high blood pressure and breast cysts. 

The Insurance Ombudsman’s Office therefore found that the insurer was entitled to not pay out under the policy because of material non-disclosures of her medical history.

Alan Knowsley

Insurance Lawyer
Wellington