Are there only certain misrepresentations insurance can deny claims for?

Or can any misrepresentation no matter significance result in denial of a claim. I suppose this is a case of what does ‘significance’ mean. I almost want to say this is decided by ‘common sense’ but I doubt that would hold up legally.

For example I can see why not disclosing serious heart abnormalities would result in denial, but there are other ‘abnormalities’ in fact a plethora of them which aren’t so obviously serious to the common man and going to lead to your death. Some of them could even be called technicalities I suppose.

In my case I’ve been asked if I were treated in a hospital, day clinic, sanatorium etc for mental health issues and depending on the way you interpret it, I either have or haven’t. One of the follow up questions was were you treated as an inpatient at a hospital, day clinic etc and again this just confused things for me.

In an effort to be as specific as possible I detailed what exactly it was I attended. ‘I received NHS talking therapies, where I’d go weekly for about an hours/40mins chat with a therapist’. 1: this doesn’t fall under the definition of ‘inpatient’ because that would be to stay overnight which I didn’t 2: but in contradiction it was at a hospital, but a specific part of the hospital/annex that I’m not even sure would be considered ‘hospital’ (classical typical mental health hospital ward for example). Also the examples given were probably not an extensive list meaning if I were to put NO, something could come along and suddenly YES I have been treated at a such and such.

Of course I do want to be fully truthful but it’s hard to be if I and the insurer could potentially interpret details differently.

4 Likes

I think you’re in the UK and that is very important to the answer. Please confirm.

3 Likes

I am in U.K. yes but I’m actually taking out life insurance where the company is based abroad

3 Likes

Sounds like the specific type of facility would fall under the “etc” portion of the list.

3 Likes

If you really want to get specific there should be an area where you can indicate the information further. Your advisor can also indicate everything in the advisor disclosure form.

2 Likes

Ah that was just my addition so etc wasn’t actually on the list

1 Like

I see the distinction like this:

Were you treated by the hospital staff because you needed urgent or significant care? If yes, then you were treated by the hospital.

Were you treated by a doctor who just had an office in the hospital? If yes, then that doesn’t count as hospital treatment.

I always advise my clients to be honest, but remember that insurance companies don’t like gray areas. It’s better to give a clear yes or no when answering.

Is it possible to ask insurance companies to clarify or is it left completely to how it’s worded initially and so I have to ultimately interpret it myself

1 Like

You can ask, or rather your agent can, but it’s not always as helpful as you would hope.