DRN-6161511

The complaint Mr N and Mrs N (‘the complainants’) are unhappy with the position they consider Aviva Life & Pensions UK Limited (‘Aviva’) put them in last year, and to date, in its investigation of an alleged non-disclosure pertaining to the Aviva Life Policy they purchased in 2018. Aviva says information came to light last year, in relation to the complainants’ application to top-up the policy, which suggests the same information ought to have been disclosed by them in their initial application for the policy in 2018 – hence the investigation. The complainants say – the entire matter (including their complaint about it) has been mishandled by Aviva; as a matter of fact, there was/is no non-disclosure; the relevant issue has been completely misunderstood and, but for Aviva’s mishandling of the matter, it could and would have been promptly resolved without the need for an investigation. Mr N has led the representations on their behalf. What happened To further define the complaint, at the time of its referral to our service the complainants described the impact they face as follows – “We are uncertain to what cover we currently have during this investigation by Aviva. We have to pay money each month as if we do not Aviva will not refund any monies due. We are unable to get any answers from Aviva as to the decision making process. We are currently unsure if we are financially secure in the event of needing to claim. Aviva are also unsure We have been presumed guilty before a trial and without being able to have our evidence listed to. All of this doubt, concern and pressure placed on us by Aviva has made my wife and I very stressed with worry … We have been treated as criminals and accused of maliciously not disclosing information, dictated to how this "investigation" will be resolved and not considered or treated with understanding or compassion.” The case relates to a specific question answered by the complainants in the 2018 application. The question was about any hospital or clinic referral, treatment or investigations that had happened in the two years before the application – so, between 2016 and 2018. The answer given was “No”. A 2023 General Practice Report (‘GPR’) was reviewed by Aviva last year. Within it, Aviva identified information that referenced a medical/surgical procedure Mrs N underwent. A note in the GPR described the procedure as having happened seven years previously. Aviva considered this an indication that it happened between 2016 and 2017. As such, it also considered that the “No” answer to the 2018 question conflicted with this. Hence its decision to investigate a potential non-disclosure in the 2018 application. Mr N recently set out how he believes Aviva misdirected itself. In the main, he says – • Mrs N underwent the relevant procedure in 2012, six years before the 2018 application. The 2018 question asked for information about events within two years of the application, starting from 2016. Therefore, the question did not require disclosure

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of the 2012 procedure, and, with full justification, they did not mention it in response to the question. • Her GP has explained, in writing, to them that – the GPR contained a 111 report from January 2023 written by a 111 call handler; the call handler made a note about the relevant procedure; the note says the procedure had happened seven years before; the GP has since corrected this and explained that the procedure happened 11 years before the time of the note/the GPR (so 2012); the GP says an explanation has also been given to Aviva about the 111 call handler being a non-clinical official. • Despite the GP’s clarification Aviva still appears to be preferring the erroneous record of a non-medically qualified administrator over the accurate correction and information from the GP, and over the honest confirmation from Mrs N that the procedure happened in 2012. Furthermore, Aviva has also caused delays in its engagements with the GP to clarify this matter. • These facts also reinforce justification in the manner in which the 2018 question was answered. It was answered correctly and truthfully, because it asked about events within the preceding two years, no relevant events happened in that period, the procedure happened outside of that period. In referring their complaint to our service, the complainants mainly highlighted the following – • Aviva’s investigation has alleged, or at least insinuated, fraudulent behaviour on their part, without grounds to do so. They have also been treated in a fashion defined by that unjust allegation/insinuation. • Aviva were reluctant to listen to them, as they complained about the matter, and reluctant to properly understand the nature of their complaint, resulting in its misunderstanding of the complaint and its failure to properly address it. • Aviva also mishandled the complaint related telephone conversation it had with Mr N on 2 December 2025, in which its official failed to address key aspects of the matter and during which its official conducted himself unprofessionally towards Mr N. • Aviva has created circumstances in which they are essentially being forced to continue the payments for the policy – because they risk having the policy lapse if they stop the payments (thereby forfeiting a refund of all previous payments) – but, based on its failure to affirm ongoing coverage (especially during the 2 December 2025 call) and because of the ongoing investigation, they appear to be paying for a policy that does not provide them with cover. One of our investigators looked into the complaint and concluded that it should not be upheld. She found that Aviva had a fundamental entitlement to assess its own appetite for risk in the policies it issued, so it is also entitled to conduct a reassessment where prompted by new information. She considered that the 2018 policy had been underwritten on the basis of the answers given by the complainants at the time, but the information from the 2023 GPR suggested that there might have been a material non-disclosure in those answers, so it had grounds to investigate further. She also noted that Aviva had explained that cover in the policy remained active and that it would still consider a claim under it, if one was made, but it cannot guarantee any outcome, and that upon the conclusion of its investigation the potential outcome were no change to the policy, an increase in premiums or withdrawal of cover and a refund of premiums. Mr N was dissatisfied with this outcome. He considered that the situation remains the same and unimproved despite our investigation, that Aviva should have to manage and conclude the investigations in line with a time limit, that the matter of its official’s unprofessional conduct had not been addressed, and that the entire case needs to be reviewed. The

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complaint was then referred to an Ombudsman. On 17 February 2026 Aviva updated us to say the GP’s correction of the 111 call handler’s note had been received and passed to its underwriter to review in the investigation. What I’ve decided – and why I’ve considered all the available evidence and arguments to decide what’s fair and reasonable in the circumstances of this complaint. The complainants have wider complaint issues concerning Aviva. My understanding, based on some of the information I have seen from Aviva, is that there are around four other complaint issues that have been dealt with separately to the present complaint. My remit is limited only to the issue in the present complaint that has been referred to me. That issue is about the alleged non-disclosure investigation and the matters associated with it, which are the only matters I address in this decision. I acknowledge the complainants’ strong objection to the accusation, or at least insinuation, of fraud related wrongdoing on their part, which they perceive from Aviva’s investigation (including the investigation’s subject matter and the manner in which they consider it has been presented to them). It is clear they are very offended by what they see as an allegation or suggested that they intentionally concealed information that was material to their 2018 application, a notion that they vehemently reject. I fully understand their position. I also believe that I have seen enough, including from Aviva, to deal with this aspect quite straightforwardly. What Aviva noted in 2025 as a potential indication of non-disclosure in 2018 appears to have rested on an error in 2023 that was remote to both parties. It seems there would have been no obligation upon the complainants to disclose, in response to the relevant 2018 question, the procedure in question (concerning Mrs N) because that procedure appears to have happened in 2012 and the question asked for information only relevant to the two years before 2018. This finding might not be as definitive an expression as the complainants might like. With reason, I have used language in it designed to avoid precision, but I consider that what I have said is enough to convey my view that nothing in the evidence currently available to me suggests they mishandled the relevant 2018 application question. Despite this view, I must also respect Aviva’s ongoing investigation into the matter. Aviva is the policy provider with an exclusive remit to conduct and determine, definitively, its own investigation. I cannot reasonably breach that remit, and I do not wish to do so. This is why I have made the above finding in the manner it is presented, and I do so only in the context of the complaint that I am dealing with. Nevertheless, I hope the finding offers some value to the complainants, in terms of addressing the upset in their feeling that they were/are being accused of committing a wrongdoing that they have not committed. I also hope they can find some additional value in the fact that Aviva has confirmed to our service that it does not in any way say or suggest that they completed the 2018 application fraudulently. It says it only seeks to clarify the information discovered last year in relation to that application. Therefore, contrary to their perception, it does not appear that the complainants have been accused of any fraud related wrongdoing. I understand Mr N’s points about the error in the GPR note. As I said above, that error was remote to both parties. It appears to have been committed by a third party, the 111 call

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handler. However, the GPR note and its contents have an unavoidable presence in the case, from which Aviva obtained information that stood in conflict with the answer given to the relevant question in the 2018 application. The 2023 note said the procedure happened seven years previously, so the implication was that it happened in 2016, and 2016 was/is a year captured by the relevant question in the 2018 application. Before turning to how the issue was handled, I find that notice about this potential conflict justified Aviva’s investigation. I have not seen evidence that any error in the GPR note would have been apparent to anyone other than the complainants and those involved in the medical care of Mrs N. In other words, without and prior to any corrections from the complainants and Mrs N’s GP, I do not consider it unreasonable for Aviva to have viewed the information in the note as being enough to prompt an investigation into the potential conflict. A correction from the complainants, on its own, would not have been enough. Aviva would reasonably have sought to satisfy itself with information from all concerned with the relevant procedure on the question of when it happened. Mr N has helpfully explained this, but Aviva still needed/needs to obtain input from Mrs N’s GP. As I said in the previous section, its update to us in February confirmed that the GP’s correction of the call handler’s note has been received and passed to the underwriter reviewing the alleged non-disclosure. The matter has been subject to due process in the investigation since around early September 2025, and to date. Both the investigation and its due process are legitimate, for the reasons given above. I have found nothing in the evidence or in Mr N’s submissions that could justify a finding that says Aviva should not have investigated information that suggested a potential material non-disclosure in the 2018 application. With regards to Aviva’s handling (or alleged mishandling) of the investigation process, the sub-issues appear to be threefold – • Could the issue have been resolved quicker if, as Mr N has argued, there was better engagement between Aviva and the complainants? • Have the complainants been treated unfairly with regards to the efficacy of their policy’s coverage and/or the premiums they have paid (and continue to pay) whilst the investigation is ongoing? • Was their complaint (including the complaint related call of 2 December 2025), which they consider arguably connected to the resolution of the investigation, mishandled? For the reasons I have already addressed, engagement with the complainants could only have been a part of the investigation process. It could not have been its entirety. Input from the GP and clarification, at source, of the GPR note was needed and the complainants could not provide that. They have described how the first three sets of correspondence they received from Aviva on the matter, beginning 9 September 2025, did not even reference the matter. They say the connection between the correspondence and the alleged non-disclosure/investigation was not confirmed until when, in response to the third letter they received, they called Aviva and were informed about it. I understand their criticism in this respect and I agree that the issue and the investigation process to follow should have been made clear to them at the outset. They were entitled to know this information. I can see that Aviva addressed this entitlement in its letter to them of 18 November 2025, which explained the issue it was looking into and asked for Mrs N’s consent to obtain information from her GP, but I consider that this should have been explained earlier. Having said the above, I consider that the same process would probably have been followed

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even if there was an earlier explanation of the issue and investigation. In this respect, the complainants could argue that less time would have been consumed in the investigation if the explanation and request for consent were issued earlier. This brings me to the second sub-issue summarised above, with regards to the impacts, if any and if adverse, on the policy, on the premium payments and on the complainants arising from the investigation. It stands to reason that any such impacts could be what might have been mitigated if less time was consumed in the investigation. Aviva has repeatedly confirmed that, pending completion of the investigation, there is no immediate adverse effect on the policy, the premiums or coverage for the complainants. In the 18 November 2025 letter, it said – “In the meantime, we’ll keep your policy in force and continue to collect payments. Please note that any claims received during this reassessment process may be reduced to reflect the information provided in the medical report.” This quite clearly confirms that the policy continued as normal during the investigation. In the second sentence Aviva created some allowance for any adjustment in any claim that might be needed after consideration of the medical information it was seeking, but that was not unreasonable given that the investigation was still ongoing and neither the medical information nor the investigation’s outcome could not be predicted. I have listened to the recording for the 2 December 2025 telephone conversation between Aviva and Mr N. In the recording, Aviva repeated the fact that the policy remained active and that if a claim was to be made during the investigation it would be considered but, again, the official could not be drawn, and refused to be drawn, on predicting the outcome of such a claim. For the reason given in the paragraph above, I do not consider this to have been unreasonable. In Aviva’s complaint response of the same date, it repeated the same things and went further. It said – “I also understand you want to know why you're paying for cover when there is no guarantee a claim will be paid. The cover you have is active and we would consider paying a claim if one was made today. However, paying out a claim is never guaranteed, especially where important medical evidence and medical history has not been disclosed. What we're doing right now is ensuring that we complete an underwriting assessment inline with our risk appetite, which we hope will prevent any potential upset if a claim were to be made. I understand this means there are a few potential outcomes such as: • Cover being withdrawn and premiums being refunded. • Cover remaining in place, with premiums increased with additional risk in mind. • Cover remaining the same, with no changes. Please note if you decide to cancel your policy and the policy fully lapses, we would not be in a position where we can reinstate the policy or refund premiums. It's important that we complete our investigation to ensure you receive the best outcome in these circumstances.” On balance, I am satisfied that the above made matters sufficiently clear to the complainants. They were being told, again, that their policy remained active and that if a claim was to be

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made under it the claim would be considered. They were given summary reason for the investigation. They were informed about the three potential outcomes of the investigation. In this respect, cover remained in two of the potential outcomes. In the third potential outcome cover could be withdrawn – which, based on the terms of the policy, Aviva was entitled to do in relevant circumstances – but the complainants would receive a full refund of their premiums (so the loss of their premiums was not a risk they faced in this potential outcome). I can understand why the concluding warning against cancelling the policy and allowing it to lapse could have been perceived negatively by the complainants, but my reading of it is that it was a warning aimed at serving their best interests. The message was essentially that they would be better off allowing the investigation to conclude before considering any such step, to avoid the loss of the policy and premiums. This was a fair message, especially as the policy remained broadly unaffected during and despite the investigation. Subsequent to all the above communications to the complainants, Aviva has also conveyed the same points to us, in terms of the policy remaining active, cover continuing, its readiness to consider a claim if one arises, the reason for and the three potential outcomes of the investigation, and merit in avoiding the effect of a premature cancellation of the policy. For all the above reasons, I do not consider that there are any meaningful adverse effects from the ongoing investigation on the policy, the premiums or the complainants. I can understand their eagerness for the investigation to conclude. I expect Aviva shares the same. It should. Its update to us two months ago suggests the investigation should now be nearer to its conclusion. The last sub-issue relates to Aviva’s complaint handling and to Mr N’s allegation that its official behaved unprofessionally towards him in the 2 December 2025 call. With regards to the former, complaints about a firm’s complaint handling, in isolation, is not a regulated activity so it is not a matter we have jurisdiction to determine. However, with regards to the latter, Mr N’s experience in the telephone call was part of Aviva’s service delivery to him for the policy, so it was/is ancillary to its provision of the life policy (which is a regulated activity). We have jurisdiction to address complaints about activities ancillary to a firm’s regulated activity. Having listened to the call, I consider that the official was ill-prepared for it in terms of dealing with specific details sought by Mr N. This should have been avoided given that he acknowledged awareness of the communication from Mr N that set out his specific enquiries. The official ought reasonably to have been properly prepared to discuss those specific enquiries, but that was not quite the case. For example, and most notable, the official was unaware of the specific 2018 application question that was being investigated by the underwriter. This should have been one of the fundamental pieces of information he identified prior to the call, especially as no previous correspondence to the complainants had referred to the specific 2018 application question. However, I am not persuaded that the official behaved unprofessionally in terms of his engagement with Mr N during the conversation. I also consider that the official gave him meaningful high-level insight into the investigation process and, as I noted above, the absence of an adverse impact on the policy. Mr N has made some allegations of wrongdoings committed by the official during the conversation. For the reason given above, I agree with him on the official being poorly prepared to address details of the investigation, but with regards to the other allegations, and upon listening to the recording, I disagree and I have not found wrongdoings. The call lasted 33 minutes.

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The official confirmed at the outset that he had completed his complaint investigation and that he wanted to give Mr N an overview of it. The conversation became heated from around the 15th minute onwards. Mr N felt frustrated that the official could not confirm the specific 2018 application question being investigated. The official acknowledged this omission and promised to return to the investigation in that respect to obtain that information. This did not land well with Mr N, who considered that the official should have obtained the information before the call. He was also frustrated by the official’s responses to his enquiries about the policy, coverage and the likely treatment of a claim (if one was to be made at the time). Despite the official conveying the same information as I set out above, Mr N appears to have perceived a different message, whereby he considered that he and Mrs N were essentially in limbo, without any cover under the policy, but with an unfair requirement to continue paying premiums for a policy that did not cover them. This mismatched what the official had told him. Mr N began to wind down the conversation in around the 28th minute, because he considered that the official was not listening to him. He was also offended that his offer to go through his and Mrs N’s complaint was declined by the official (who considered that he already understood the complaint). In around the 31st minute the official also attempted to wind down the conversation, because he considered that Mr N was being unduly argumentative, which Mr N rejected, and that the conversation was not progressing. The official began to conclude the conversation by assuring Mr N that his complaint issues would be addressed in the complaint response following the call, but Mr N responded to cast doubt over this, given his view that the official did not understand the complaint. Mr N has told us that the official then terminated the call abruptly by saying the call was not of value to his (the official’s) time. The official did terminate the call by hanging up at his end, but his concluding remarks referred to time value for both Mr N and himself. The sequence was – the official said “… I will take the time with a customer where I need to however I don’t feel that this call as it is going on at the moment, is going to be of any value to you or myself”; Mr N then interrupted him; then the official said “I am ending the call, you have a good day [Mr N]” and hung up. Overall, it is clear that the call was difficult for both parties, and that it certainly could have ended in a better fashion. However, I did not identify any behaviour or language from the official that amounted to unprofessionalism on his part. Both parties could have handled the substance of the call better. The official could have been better prepared, in relation to the pre-call enquiries Mr N set out. However, I note that this shortcoming was partly mitigated by the fact that his written complaint response was issued after the call on the same date, and additional information was available to the complainants in that response (as I quoted above). Mr N could have been more open to listening to the important points the official was making and trying to establish, which addressed, somewhat positively, his (Mr N’s) concerns about the policy and coverage under it during the investigation. My final decision For all the above reasons, I do not uphold the complaint from Mr N and Mrs N.

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Under the rules of the Financial Ombudsman Service, I’m required to ask Mr N and Mrs N to accept or reject my decision before 12 May 2026. Roy Kuku Ombudsman

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