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Insurance Company Refusing To Pay Out Fibromyalgia Claim

Dear Brian

I bought a critical illness policy through a broker in 2003. It pays out £175,000 if I develop certain illnesses or I become totally and permanently incapable of working. I satisfy the criteria – I developed fibromyalgia badly in 2010. The insurance company are refusing to pay me out, saying that I should have put on the proposal form in 2003 that I had suffered from depression in the 1990s. I am sure that I told the broker this, but the insurers are not interested. Do I have a remedy?


Dear Jane

There is a very strict duty on any person filling out an insurance proposal form. You have to answer all the questions correctly and disclose any fact that a prudent insurance underwriter would consider material. He considers your application and fixes the premium based on the information that you have given him. I am afraid that an insurance underwriter could well say that if he had been aware of your medical history he would not have offered the terms that were originally offered. You may get your premiums refunded but you will not get £175,000 paid out.

You say that you told your broker about your depression. Even if we assume that the broker was negligent in not passing that information on to the insurance company, it probably will not help you. This is because you had a contract with the insurance broker and his breach of contract was over six years ago. It is therefore too late to bring Court proceedings against the broker, even though you have only just found out about his negligence and could not have found out any earlier. This is all very unfair, but I believe that it reflects the law as it currently stands. It might still be worth putting the claim to the broker. He will find it very embarrassing that he has made this blunder and may make a payment to you to prevent bad publicity etc.

Brian Barr

This article appeared previously in Fibromyalgia magazine

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