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Most people worry that if they or a loved one pass away or a diagnosed with a Critical Illness due to an alcohol related disorder that their insurance company won’t pay-out.
Often people worry about a “Aviva Rejected Critical Illness Insurance Claim” or “Legal and General Rejected Critical Illness Insurance Claim” because a loved one has passed away from an alcohol related disease such as liver cirrhosis or Liver disease.
Normally when insurance companies are assessing claims they will check to see if the information you gave at the start of the application was correct, this is called checking for a non-disclosure. Normally they can only do this if they have reasonable doubt that the information someone provided wasn’t correct at the time the application was done.
For example, if someone took out an insurance policy a year previously to them passing away or being diagnosed with an alcohol related disease it may raise an insurance companies suspicion that they’re history of alcohol intake wasn’t disclosed (as these types of illnesses take many years to progress).
Most cases of non-disclosure we identify are picked up innocently though. Someone may have stated on their application they consumed around 20 units per week but have said to their GP that they were consuming 30/35 units per week.
As always when appealing a decision, the rub is in the details. What type of question was asked? Most insurance companies ask specifically what the average you consumed was, and the GP might ask what you have been drinking recently. The insurance company may ask what you’ve consumed on average over the last six months rather than anything more historical than that.
Insurance companies tend to have a narrative around lifestyle they set to make things look as bad as possible. We have seen a customer that has went through a marital breakup 10 years before the application was completed and advised by his GP to reduce his alcohol consumption. Two years after taking out the insurance he was advised he had cancer. The insurance company denied life insurance claim advising they asked, “have you ever been advised to reduce your alcohol intake”.
We challenged this decision on two points:
- It would not be reasonable for someone to remember a one-off event due to severe stress.
- That this was not a qualifying misrepresentation as if he disclosed this cover would still have been offered.
We were able to successfully overturn this decision as we proved that the misrepresentation was not deliberate or reckless and that it was reasonable that this was left from the application. Have a “life insurance denied claim” or “declined life insurance claim” doesn’t always mean that the insurance company won’t pay-out.
You can speak with Resolute Claims experts, completely free for an independent assessment of you claim.
