Reassured Ltd · DRN-5976777

The complaint Mr L’s complained that Reassured Ltd failed to pass on health information he provided when he bought a life and critical illness policy. This led to his claim being declined and his policy cancelled. What happened In summer 2023, Mr L approached Reassured for assistance in buying life and critical illness cover. As part of the application, he provided Reassured with answers to a number of health and lifestyle questions and, amongst other matters disclosed that he’d had an echocardiogram (ECG). An application was submitted to an insurer I’ll call A, which was accepted and cover started. At the end of 2024, Mr L suffered a stroke. So he contacted A to claim on the critical illness part of his policy. A assessed the claim and declined it. They said that the ECG – which was done in 2019 - hadn’t been disclosed on his application. If it had been, they would have requested a report from his GP, which would have revealed an issue with Mr L‘s heart – although Mr L wasn’t aware of the issue. This, together with the other issues Mr L disclosed, meant they would never have offered him critical illness cover. A said that this entitled them not only to decline the claim, but also to cancel the policy. Mr L complained to Reassured that he’d told them about the ECG and they’d not passed that information onto A. So he hadn’t had the benefit of critical illness cover when he needed it. In their response, Reassured acknowledged Mr L had made them aware of the ECG. But they said he’d not disclosed it when asked if he’d had any medical investigation, scans or blood tests in the previous five years – only when he was telling them about stomach pains which were investigated in 2021. And they said A would have sent Mr L the answers he’d given, so he could check for errors and make any amendments needed. Mr L didn’t think Reassured’s response resolved his complaint and brought it to the Financial Ombudsman Service. Our investigator reviewed the information provided by both parties and concluded Reassured needed to do more to resolve it. He was satisfied Mr L had told them he’d had an ECG and that hadn’t been recorded on his application. The investigator said he couldn’t say Reassured should pay the claim, because they’d provided evidence that, had full disclosure been made, Mr L wouldn’t have been offered critical illness cover by any insurer on their panel. But he did think only finding this out when he made a claim caused Mr L distress, for which Reassured should pay him £400 compensation. Reassured didn’t agree with the investigator’s view. So the complaint’s been passed to me to make a final decision. What I’ve decided – and why I’ve considered all the available evidence and arguments to decide what’s fair and reasonable

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in the circumstances of this complaint. Having done that, I’m upholding Mr L’s complaint and requiring Reassured to pay him the £400 compensation our investigator recommended. I’ll explain why. Reassured’s position remains that they answered all the questions appropriately, because Mr L told them about the ECG in relation to stomach pain – which was disclosed. I’ve thought about this but I don’t agree. I don’t think it requires specialist medical knowledge to know that an ECG assesses the heart – not the stomach. Even if that was the context in which Mr L disclosed it, I agree with our investigator that it’s reasonable to say this should have prompted the Reassured adviser to revisit the information and review it as it was likely to have been wrong. And that they should have disclosed the ECG on the application. So I’ve thought about what Reassured need to do to put things right. I understand why Mr L would say they should pay the claim that A refused. But, when we decide what a business needs to do to resolve a complaint, we assess that by looking at what would have happened if nothing had gone wrong. In this case, if nothing had gone wrong, Reassured would have disclosed the ECG to A. That would have led to A getting a GP report, finding out about Mr L’s heart issue, and declining his application for critical illness cover. Reassured have provided evidence that other insurers they work with would have made the same underwriting decision. Mr L disputes he wouldn’t have been offered cover and tells us he made a successful application, even after disclosing all the medical information. At my request, our investigator asked Mr L if he could provide evidence to support what he told us. Mr L has sent us a screenshot of a text he received from a broker confirming the new cover and a letter from the insurer confirming a policy had been set up. I’ve considered these. The first thing to note is that A transferred its policy to another insurer after Mr L bought it. It was this second insurer from whom he bought the policy. While I understand his logic, each insurer asks its own questions to decide whether to offer cover and one may offer cover where another wouldn’t. Mr L hasn’t been able to provide a copy of the questions he was asked. So I’ve not been able to verify that they required the same disclosure as A did. Secondly, it’s not clear what cover the new policy provides. The text he sent us says: “I am so glad we have sorted your Life Insurance to help cover you for Critical Illness.” I accept this mentions critical illness. But it’s not clear to me that’s the cover Mr L has been sold because it refers only to sorting out life insurance. And the letter from the insurer refers only to life cover – there’s no indication that includes any critical illness cover. So, on balance, I’m not persuaded that Mr L would have been able to buy critical illness cover had an insurer been made aware of all his medical issues. That means I can’t say it’s reasonable that Reassured pay him what he believes he should have been able to claim under the policy. I’m limited to making an award for the distress Mr L was caused by finding out he didn’t have cover when he tried to claim. I agree with our investigator £400 is a reasonable amount to compensate him for that. So that’s what Reassured need to pay Mr L to resolve his complaint.

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My final decision For the reasons I’ve explained, I’m upholding Mr L’s complaint about Reassured Ltd and directing Reassured to pay him £400 compensation. Under the rules of the Financial Ombudsman Service, I’m required to ask Mr L to accept or reject my decision before 16 January 2026. Helen Stacey Ombudsman

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