Making claims & why disclosure matters

Protection insurance is designed to pay claims

Whether it's life insurance, critical illness cover, income protection or family income benefit, protection policies are designed to provide financial support when it's needed most.

Every year, UK insurers pay millions of pounds in claims to help individuals and families cope with bereavement, serious illness and loss of earnings.

Whilst the vast majority of valid claims are paid, there are occasions where claims may be delayed, reduced or declined. One of the most common reasons is inaccurate information being provided when the policy was originally taken out.

Why disclosure matters

Your application forms the basis of your cover

When you apply for life insurance or protection insurance, insurers calculate their risk based on the information you provide.

The questions asked during the application process are not designed to catch people out. They allow the insurer to assess your circumstances and offer appropriate cover.

It is essential that all information provided is truthful, accurate and complete. This includes:

• Medical history
• Current and previous health conditions
• Medication and treatment
• Smoking or vaping habits
• Alcohol consumption
• Recreational drug use
• Occupation
• Hazardous activities and hobbies
• Family medical history (where requested)

Even information that may seem minor could be relevant to an insurer's assessment.

What is non-disclosure?

Non-disclosure occurs when information is omitted from an insurance application. Examples may include:

• Not declaring a previous medical condition
• Failing to mention ongoing investigations or tests
• Not disclosing smoking or nicotine use
• Omitting information about alcohol consumption
• Not declaring a hazardous occupation or pastime

Sometimes this can be intentional, but often it happens simply because people forget information or believe it is not relevant.

If in doubt, it is always better to disclose the information and allow the insurer to decide whether it is relevant.

What is misrepresentation?

Misrepresentation occurs when information provided to an insurer is incorrect or misleading. Examples might include:

• Stating you are a non-smoker when you use nicotine products
• Understating alcohol consumption
• Giving inaccurate information about your medical history
• Failing to disclose previous diagnoses or treatment
• Providing incorrect occupational details

If information provided at application differs from medical records or other evidence obtained during a claim assessment, additional investigations may be required.

Common reasons protection claims may be declined

Although each case is assessed individually, claims are most commonly declined because:

Material information was not disclosed

The insurer later discovers information that should have been declared during the application process.

Information provided was incorrect

Details provided differ significantly from medical records, prescription history or other evidence.

Policy terms were not met

For example:

• A critical illness did not meet the insurer's policy definition.
• An exclusion applied.
• A waiting or deferred period had not been satisfied.

The policy had lapsed

Premium payments were not maintained and the policy was no longer in force when the claim occurred.

How to protect yourself when applying

Take your time

Insurance applications should never be rushed. Read questions carefully and answer them fully.

Be honest

Providing accurate information is far more important than trying to obtain cheaper premiums.

A slightly higher premium is almost always better than discovering years later that a claim cannot be paid because information was omitted.

Check your medical history

If you are unsure about dates, diagnoses or medication, take time to check before submitting your application.

Tell your adviser everything

Your adviser is there to help. Even if information feels embarrassing or irrelevant, it is usually better to discuss it than leave it out.

What happens when you make a claim?

The claims process will vary slightly between insurers, but generally follows these steps:

Step 1 – Notify the insurer

You, your family or your adviser contacts the insurer to inform them of the claim.

Step 2 – Evidence is gathered

The insurer may request:

• Claim forms
• Medical reports
• GP records
• Hospital information
• Proof of identity
• Death certificate (for life insurance claims)

Step 3 – Assessment

The insurer reviews the claim and checks it against:

• The policy terms
• Medical evidence
• Original application information

Step 4 – Claim decision

If the claim meets the policy conditions, payment is made to the policyholder or beneficiaries.

Reviewing existing policies

Many clients assume that once a policy is in place there is nothing more to think about. However, it can be worthwhile to:

• Keep copies of your policy documents.
• Ensure beneficiaries know the policy exists.
• Review whether policies are written in trust.
• Understand any additional benefits included.
• Review your cover regularly as your circumstances change.

Many modern protection policies also include valuable support services such as:

• Virtual GP access
• Mental health support
• Physiotherapy services
• Second medical opinions
• Bereavement support

These benefits are often available without making a formal claim.

Frequently asked questions

If I forget something on my application, will my claim automatically be declined?

Not necessarily. Insurers will assess the circumstances and determine whether the information would have affected the original underwriting decision. However, it can create delays and complications, which is why full disclosure is so important.

Do insurers check medical records when I claim?

In many cases, insurers may obtain medical evidence from your GP, consultant or hospital to assess a claim.

If I stop smoking after taking out a policy, can my premium reduce?

Potentially. Some insurers allow policies to be reviewed in these circumstances. Speak to your adviser for guidance.

Should I tell my insurer if my health changes after my policy starts?

Most protection policies are based on your health at the time of application and do not require ongoing disclosure after acceptance. However, always check your policy conditions and contact your adviser if you are unsure.

The most important thing to remember

Protection insurance is there to provide financial support when life takes an unexpected turn. The single best way to ensure your policy works as intended is to answer every application question honestly, accurately and completely.

Full disclosure gives both you and your family the confidence that, should a claim ever be needed, there is the best possible chance of a smooth claims experience.