Refused Critical Illness Payout

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I am hoping someone out there can help my wife and I. We are very stressed about a refusal by an insurance company to payout on a critical illness claim. It's a long story but I will try to summarise:

2020 my wife and I took out separate critical illness policies with Aviva under the guidance and support from a financial advisor - the advisor completed the online application
2022 I was diagnosed with kidney cancer - had surgery and am ok now thankfully - aviva paid out on the policy and cancelled my policy - this is ok
October 2023 my wife goes for a cardiac appointment after putting pressure on the GP because she had chest pains. GP thought it was most likely musculoskeletal. Cardiac consultant, after appointment and scans, said most likely athletic heart remodelling (my wife ran half marathons) or untreated hypertension or small chance of hypertrophic cardiomyopathy.. ordered surveillance scan for 18 months or so later
Feb 2025 same financial advisor contacted my wife to offer to put in place a new, better critical illness policy with aviva. She went through phone call with him with my support and she declared her hypertension and the cardiac appointments and scans. Financial advisor says no need to declare the cardiac details because it is directly linked to hypertension that you have already declared. He submitted the application online for my wife. She got an email then from aviva saying here's the details and if there is anything incorrect let us know. She didnt contact them because she took the advice of the advisor as being correct.
October 2025 - she had the surveillance scan - consultant and 2nd opinion consultant agree that the heart thickening had reduced and the underlying issue was most likely her untreated hypertension that is now being treated and was declared in her application by the financial advisor
March 2026 she is diagnosed with stage 3, grade 3 breast cancer with spread to lymph nodes and surrounding node tissue. Has had surgery, chemo, due to get radiotherapy and 1 year phesgo and 5 years hormone treatment. A very tough journey for her
Claim submitted to Aviva but they refused payment due to non declaration of cardiac appointments and scans - they say if they had known she was going through tests or had had appointments in past 2 years they would not have put the policy in place until scans were all finished and there was a full diagnosis re cardiac issues -
We have submitted a complaint and are waiting on a response from aviva - if they do not uphold the complaint we will submit a case to the financial ombudsman.

Just wondering if anyone else has had a similar experience and might have any advice or any detail on what the outcome was for them

Thanks you all in advance for any advice or support

Kindess always x

SarahH21 9 hours ago

Hi Kindness

I’ve seen your post appear in some other groups in the community, and I’m so sorry to see the position you’ve found yourself in.

I have no experience of critical illness policies myself, but I noticed you had a financial advisor under the Openworks “umbrella”. So did I, unfortunately, and my experience was dreadful. I actually was very badly advised by someone who I trusted to be doing the best for me and regret now that I didn’t complain, but at the time I was very unwell with my cancer and couldn’t face it. I should have, and I hope you do.

My financial adviser actually died, but Openworks never told me. They only admitted this 5 months later when my emails to him were going unanswered and I contacted Openworks to try and get answers. I discovered they had appointed a new financial adviser without telling me, who was equally incompetent. As a result I have lost a huge amount of money and had a huge amount of stress.

One question I had for you was that, if the financial adviser submitted everything on your wife’s behalf, did she actually sign anything or did she give authority for the advisor to do everything on her behalf without her signature? There should be records of everything, including the advice given by the advisor, and the reason for that advice.

My original advisor literally hounded me for my signature on documents-one time coming to my home just after I’d had surgery and was in bed. He actually wanted to come up to my bedroom to get me to sign something, but luckily my partner was at home and refused.

I can’t turn the clock back on my situation, especially since my first advisor has died-ironically from cancer-but I’d encourage you to pursue this. I lost out on so much because of 2 incompetent advisers and it’s hard not to feel bitter, but I need to move forward from this dreadful experience.

I’d definitely pursue a complaint about the advisor-we trust them while we are in vulnerable situations and deserve better. I hope that you can get the decision reversed by Aviva, and that you can both move on.

Sarah xx

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Kindness 40 minutes ago in reply to SarahH21

Thanks for your kind reply Sarah. Firstly I hope you are well. Your experience with Openworks is very concerning and I am sure it was challenging for you. That's the last thing you need when you are going through treatment for cancer. I do plan to persue this to the end. The advisor filled in the forms online. My wife didnt sign anything. It was all done online and she was given access to the documents in the aviva portal to check and to come back to them if anything was inaccurate. We believed the details to be correct based on the advice from the advisor.

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