Innocent Misrepresentation

Policy start date

11th March 2024

Date first absent

5th November 2024

Cause of absence

Granulomatosis with polyangiitis – a rare condition where blood vessels become inflamed mainly around the nose, ears, kidneys, and lungs.

Medical History or other misrepresented facts

The client saw his GP in December 2023 with a suspected ear infection and was noted to be suffering from a cold. In February 2024 he was seen again for ear pain and reduced hearing, together with repeated nosebleeds. He was given antibiotics and told to return if the nosebleeds continue.

Application questions answered incorrectly

In the last 5 years have you had, or do you currently have, any of the following:
- Any condition affecting your ears or hearing, or your eyes or vision that is not wholly corrected by spectacles or lenses?
- In the last 3 years, have you been prescribed medication or treatment regularly for a period of 4 consecutive weeks or more, or have you been under review from your doctor or medical professional?
- In addition, apart from anything you have already told us about, do you have any symptoms for which you haven’t yet sort medical advice?

Retro Underwriting decision

If the client had answered ‘Yes’ to the above questions the underwriters would have postponed cover until symptoms resolved. The eventual diagnosis of granulomatosis with polyangiitis would have meant the application for Income Protection would have been declined.

Client explanation

The client explained he’d been told by his GP he had an ear infection, and he didn’t believe this counted an ear ‘condition’ and was instead a common winter illness that didn’t need to be disclosed. He wasn’t aware it was anything more serious until after cover had started. He was prescribed antibiotics but in no way was this regular or consecutive treatment, and nor was he under review by a doctor.

Decision

Innocent misrepresentation

Reason

The insurer felt that the client had acted honestly and reasonably when answering these questions and therefore the misrepresentation should be considered innocent.

Outcome

The misrepresentation was set aside and the claim paid in full while the client couldn’t work.