The Royal London Mutual Insurance Society Limited · DRN-6311100

The complaint Ms A as a trustee of the G Trust complains that The Royal London Mutual Insurance Society Limited declined a claim she made on a life insurance policy. What happened Ms A claimed on a life insurance policy on behalf of the G Trust following the death of Mr G. Royal London declined the claim as they said Mr G hadn’t accurately declared his medical history. They said, had he done so, they wouldn’t have offered the policy. Ms A complained to Royal London, but they maintained their decision was fair and in line with the policy terms and relevant legislation. Unhappy, Ms A complained to the Financial Ombudsman Service. Our investigator looked into what happened and didn’t uphold the complaint. In summary, he thought Royal London had fairly concluded that relevant medical information hadn’t been disclosed and the policy wouldn’t have been offered if it had. Ms A didn’t agree and asked an ombudsman to review the complaint. In summary, she said that the evidence didn’t support that Mr G was aware he’d been referred to a specialist. She also questioned the medical information which the investigator had relied upon. The investigator provided further information about the medical information he relied on. The complaint was referred to me to decide. What I’ve decided – and why I’ve considered all the available evidence and arguments to decide what’s fair and reasonable in the circumstances of this complaint. The relevant law in this case is The Consumer Insurance (Disclosure and Representations) Act 2012 (CIDRA). This requires consumers to take reasonable care not to make a misrepresentation when taking out a consumer insurance contract (a policy). The standard of care is that of a reasonable consumer. And if a consumer fails to do this, the insurer has certain remedies provided the misrepresentation is - what CIDRA describes as - a qualifying misrepresentation. For it to be a qualifying misrepresentation the insurer has to show it would have offered the policy on different terms or not at all if the consumer hadn’t made the misrepresentation. CIDRA sets out a number of considerations for deciding whether the consumer failed to take reasonable care. And the remedy available to the insurer under CIDRA depends on whether the qualifying misrepresentation was deliberate or reckless, or careless. Royal London says Mr G failed to take reasonable care during the application process when he answered questions about his medical history. Mr G submitted his application in mid November 2016 and the policy commenced in early February 2017.

-- 1 of 3 --

Mr G was asked during the application process: Apart from anything you have already told us about, in the last 3 years have you: Been referred to a specialist or had, or been advised to have, any investigations? And: Do you have any symptoms for which you haven’t yet sought medical advice, or are you awaiting referral, investigation, results or treatment for anything else? Mr G answered ‘no’ to those questions. Following the application Mr G was also sent a document called a ‘confirmation form’. The form prompted him to check the application details were accurate and said ‘if any information we have been given has changed since this form was completed, you should tell us on this form by completing the box below’. Mr G amended his height and signed the form in January 2017. Royal London say Mr G failed to let them know that he’d been referred for a neurological assessment after he attended a GP appointment in December 2016. The notes from the appointment show that the GP noticed a lack of facial expression and slowed down movement. The GP asked Mr G some questions about this and referred him to the Parkinson’s clinic. I think Royal London reasonably concluded that this was a development which Mr G ought to have let them know about. The referral took place prior to the confirmation form being returned by Mr H. So, as he was prompted to let Royal London know about any changes, I think he ought reasonably to have disclosed the referral on the form. I’ve thought about Ms A’s representations that Mr G was unaware of the referral but I’m not persuaded that’s most likely to be the case. The GP referral says: I have explained that he may possibly have early Parkinson’s disease and we have agreed that it would be very helpful to have your opinion regarding whether this could be the case or not. The notes from the consultation also indicate that Mr G was examined and there was a discussion about Mr G’s presentation and other symptoms. The plan recorded is ‘refer for opinion re parkinsons’. Therefore, I’m satisfied, on the balance of probabilities that Mr G was most likely aware of the referral. So, even though Mr G saw the GP after he completed the application form, I still think he was aware of the position prior to sending the confirmation form back to Royal London. Ms A has also referred to correspondence from Royal London which mentioned another person which wasn’t Mr G. This was a letter sent in May 2024. It seems most likely to me that this was an error on Royal London’s part. I’ve seen no compelling evidence which supports that there was some wider issue with Mr G’s claim. I’m satisfied, based on the available evidence, that Royal London considered the documentation relevant to Mr G including his medical records and application documents. So, this point hasn’t changed my thoughts about the overall outcome of the complaint. Royal London has provided evidence from an underwriter which shows that Royal London wouldn’t have offered Mr G a policy had they known about the referral and the subsequent

-- 2 of 3 --

results. This means I’m satisfied Mr G’s misrepresentation was a qualifying one. I appreciate that Parkinson’s wasn’t the primary cause of death. However, that’s not central to the outcome of the complaint. The issue is whether a policy would have been offered had Royal London been aware of the relevant information. And, as I’ve explained, I’m satisfied they wouldn’t have offered the policy if they had been aware of it. Royal London have said Mr G’s misrepresentation was deliberate or reckless. They also highlighted the nature of Mr G’s profession. I think that was reasonable and in line with the relevant guidance in the Association of British Insurer’s (ABI) guidelines. I’ve also considered the proximity between Mr G’s appointments, and the referral, to the application process and the completion of the confirmation form. Given that they were very close in time, I think it’s unlikely that Mr G would have failed to understand the significance of the referral to Royal London. As I’m satisfied Mr G’s misrepresentation should be treated as deliberate or reckless I’ve looked at the actions Royal London can take in accordance with CIDRA. In such circumstances they are entitled to decline the claim, cancel the policy and retain the premiums. So, I’m satisfied they’ve acted in line with CIDRA when they declined the claim and cancelled the policy. I also note they’ve offered to refund the premiums which goes beyond what they are required to do by CIDRA in such circumstances. In view of all of the above I don’t think it’s fair and reasonable to uphold this complaint. My final decision For the reasons set out above I’m not upholding this complaint. Under the rules of the Financial Ombudsman Service, I’m required to ask Ms A as a trustee of the G Trust to accept or reject my decision before 26 May 2026. Anna Wilshaw Ombudsman

-- 3 of 3 --