Life insurance claim declined: why it happens and what you can do

Most life and protection claims are paid: the ABI reports that 97.9% of individual protection claims were paid in 2025. When a claim is refused, the usual reason is the original application. The insurer says an answer was wrong or incomplete, and that it would have refused cover, charged more or added an exclusion had it known.

The law limits what an insurer can do. Under the Consumer Insurance (Disclosure and Representations) Act 2012 (often called CIDRA), the insurer only has a remedy if you failed to take reasonable care and it can show the wrong answer made a difference. If you disagree with a decision, you can complain to the insurer and then, for free, to the Financial Ombudsman Service.

Why life and protection claims get refused

A wrong or incomplete answer on the application

MoneyHelper gives failure to disclose a pre-existing medical condition as a common example. When a claim comes in, insurers check medical records, and differences between those records and the application answers are where most disputes start.

An exclusion in the policy

Some causes of death or illness may be excluded, either in the standard terms or in a specific exclusion added when you applied. Over-50s plans also have a waiting period: MoneyHelper says buyers should check how long it is before the plan will pay out.

The policy wasn't in force

If premiums stopped and the policy lapsed, or a term policy had already reached its end date, there is no cover to claim on.

The claim falls outside the definition

This matters most for critical illness cover and income protection, where a condition has to meet the policy's wording. See also declined income protection claims. For life cover, the event is usually clear.

The 2012 Act: what "non-disclosure" means now

CIDRA came into force on 6 April 2013 and, under section 2(4), replaced the older duty of disclosure for consumers. Section 2 says your duty is to take reasonable care not to make a misrepresentation to the insurer. Not answering when asked to confirm or update details can count as a misrepresentation.

Whether you took reasonable care is judged on all the circumstances. The standard is that of a reasonable consumer, adjusted for anything the insurer knew or should have known about you. A dishonest answer always counts as a lack of reasonable care.

The Financial Ombudsman Service says it looks at:

• how clear and specific the questions were
• what documents the insurer gave you
• whether a broker or other agent was involved
• your circumstances when you answered

The ombudsman also says it may not be reasonable to expect someone to remember exactly when events happened. But if you were unsure, you were expected to find out.

Qualifying misrepresentation

Section 4 of the Act says an insurer has a remedy only for a qualifying misrepresentation. That means both:

1. you made it in breach of the duty to take reasonable care, and
2. the insurer shows that without it, it wouldn't have offered the policy at all, or only on different terms.

The FOS says that if you did take reasonable care, the insurer can't take any action against you, even if an answer turned out to be wrong.

A qualifying misrepresentation is either deliberate or reckless, or careless. Section 5 puts the burden on the insurer to show it was deliberate or reckless.

What the insurer can do

Schedule 1 of the Act sets out the only remedies:

The proportion works like this. The FOS gives the example of a customer who paid 100 when the premium should have been 150. Two-thirds of the correct premium was paid, so two-thirds of the claim is paid.

One further protection for life cover: if a careless misrepresentation comes to light before any claim, the Act doesn't allow the insurer to end a policy that is wholly or mainly life insurance by giving notice.

Policies taken out before April 2013

Life policies often last decades, so older rules can still matter. The FCA's claims rules say that for contracts entered into or varied on or before 5 April 2013, it is unreasonable to reject a consumer's claim for non-disclosure of a fact they couldn't reasonably have been expected to disclose, or for a non-negligent misrepresentation, except where there is evidence of fraud.

More broadly, FCA rules require every insurer to handle claims promptly and fairly and not to unreasonably reject a claim, including by cancelling or avoiding a policy.

How to challenge a refusal

1. Get the reasons in writing

Ask the insurer to explain exactly which answer it says was wrong, and what it would have done with the correct answer.

2. Gather the evidence

• The application. Ask for a copy of the questions and answers, or screenshots of the online journey. The FOS lists these as evidence it may ask insurers for.
• The insurer's evidence of difference. The FOS may ask for underwriting guidelines or an underwriter's statement showing the answer really would have changed the outcome.
• Medical records, to check whether the condition was known and diagnosed when the application was made.
• The policy wording, including any exclusions. MoneyHelper suggests noting the exact wording that says you're covered, and any wording that is unclear.

3. Complain to the insurer

MoneyHelper suggests writing a letter marked "complaint", with the date, policy number, why you think the decision is wrong, supporting evidence and what you want the insurer to do. The insurer usually has eight weeks to send a final response.

4. Go to the Financial Ombudsman Service

If you are unhappy with the final response, or eight weeks pass without one, you can refer the complaint to the FOS. It is free, and the FOS says you don't need to pay a lawyer or claims management company. You normally have six months from the date on the final response to do this.

If the FOS decides you were treated unfairly, its general approach is to put you back where you would have been, which can include reinstating a cancelled policy. There is a cap on what it can tell a business to pay: £455,000 for complaints referred on or after 1 April 2026 about events on or after 1 April 2019, and £205,000 where the events were earlier. It can recommend more, but the business doesn't have to pay it.

Time limits

• Complaining to the insurer: generally within six years of the problem, or three years from when you knew, or reasonably should have known, you had cause to complain.
• Going to the FOS: normally within six months of the final response.
• Going to court: a separate route with its own time limits. In England and Wales, an action on a simple contract generally can't be brought more than six years after the cause of action arose. In Scotland, many contractual obligations are extinguished after a five-year prescriptive period. A solicitor can confirm which applies.

When a solicitor can help

The ombudsman route is designed to work without a lawyer. A solicitor may still be worth considering where the sum is beyond the FOS limits, you want to take court action, or the dispute involves an estate or a trust, for example where trustees or executors disagree about who should claim. Scottish estates and trusts follow different rules, so a Scottish solicitor is the right person there.

What to check in your policy

• Application record: a copy of every question and answer, including any phone application
• Policy start date: and whether it began before or after 6 April 2013
• Exclusions: both standard and personal ones added at application
• Waiting period: especially on over-50s plans
• Changes since: any later increase in cover or change of terms, which may have had its own questions
• Premium history: whether any payments were missed and how the lapse rules work
• Who can claim: trustees, nominated beneficiaries or executors
• Complaints procedure: the insurer's complaints contact, as set out in your documents

When to talk to a regulated adviser

The FOS takes into account whether a broker or other agent was involved in the application, so if a broker or adviser arranged the policy, tell the insurer and the ombudsman how the questions were asked and answered. A regulated adviser can also help with replacement cover if a policy has been cancelled.

This guide is general information about how insurance works in the UK. It isn't advice and doesn't take your circumstances into account. Policies differ: your own policy documents are what count.