Our third case study explores deliberate misrepresentation, where a client knowingly provided false information on their application in order to obtain cover. This type of misrepresentation is considered serious and can result in a declined claim. Read the timeline of events below.
1
Policy start date
20th September 20232
Date first absent
2nd February 20243
Cause of absence
Injury to hand while chopping logs4
Medical History or other misrepresented facts
No relevant medical history as the misrepresentation related to the client’s occupation. At point of claim the client told the claims assessor he was a scaffolder and had been for a number of years. On the application his occupation was given as a decorating contractor.5
Application questions answered incorrectly
What is your job?6
Retro Underwriting decision
If the occupation had been correctly listed as scaffolder when the application was completed, the insurer would have declined the application as they don’t offer cover to scaffolders.7
Client explanation
The client explained that he had told his adviser he was a scaffolder when applying for cover.On investigation, it was noted the adviser had made a number of alterations when applying for cover online. First, he’d put in scaffolder, then construction worker, and painter and decorator, before settling on decorating contractor which is the only one of these occupations this insurer offers cover for.
8
Decision
Deliberate misrepresentation9
Reason
The client’s only fault was to fail to check his application answers and spot his occupation was shown incorrectly. It was therefore felt he’d acted carelessly. However, it was clear the adviser had deliberately changed the occupation until it was one covered by the insurer. The ABI Code that insurers follow states that where the intermediary is acting on behalf of the customer, as in this instance, they should be accountable for any misrepresentation resulting from their action or omission.10
