Life insurance Case study 4

05 December 2016
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life and critical illness insurance – smoking – monitoring of blood pressure – no non-disclosure

When Mr L applied for life assurance in July 2005 he stated that he had not smoked within the previous 12 months. Asked about any medical consultations, he said he had sought advice about a hernia that had subsequently required surgery. He also disclosed that there was a history of hypertension in his family.

Five months later he submitted a claim for oesophageal cancer. The insurer rejected the claim, on the grounds of reckless non-disclosure, and it avoided the policy. It said that when looking into his claim it discovered that he had previously been a heavy smoker. It accepted that he had now stopped smoking. However, there was a record of his regularly having smoked one cigar a day at the start of the 12-month period in question. The insurer said Mr L should also have disclosed that his blood pressure had been monitored in the period between 8 June and 18 July 2005.

Mr L said he had only smoked cigars very occasionally since giving up heavy smoking in 1994. And he insisted that he had accurately stated on the application form that he had not smoked at all in the previous 12 months. He did not deny that his blood pressure had been monitored for a few weeks. But he said this had only been done in advance of – and in connection with – the hernia operation.

complaint upheld

On his application form, Mr L had provided clear details of his impending hernia surgery and also the family history of hypertension. He had obviously given some attention to the application form and taken it seriously in this respect. The insurer had not sought any additional information about these matters, either on the form or subsequently.

The blood pressure monitoring had clearly been simply a preparatory step before the surgery for his hernia. It had been considered a necessary precaution because of the family history of hypertension. Mr L had disclosed both the surgery and the history of hypertension, so we did not consider that he had also been obliged to disclose the blood pressure monitoring. There was no separate question that would have required specific disclosure of it, and in any event the results of the monitoring had not merited any medical follow-up.

Mr L submitted evidence from his GP, who said he could not recall his conversation with Mr L and accepted that he might have misunderstood Mr L's history. The GP also said that the computer system on which he entered details of patients' tobacco consumption was unable to record a minimum consumption of less than one cigar or cigarette per day. We were satisfied, on a balance of probabilities, that Mr L had told the truth when he stated that he had not smoked in the 12 months before July 2005. So we concluded there had not been any non-disclosure in relation to his smoking. We required the insurer to meet Mr L's claim in full.