For consumer insurance, the modern question is usually not whether you volunteered every fact the insurer might have wanted. Under CIDRA, the consumer must take reasonable care not to make a misrepresentation in response to the insurer's questions.
Insurance disputes are rarely decided by one sentence in the policy. The wording, what the insurer asked, what happened, the evidence and the reason given for the decision all matter. Keep those questions separate so the complaint stays testable.
Key points
- For consumer policies entered into or renewed from 6 April 2013, CIDRA is central to most misrepresentation disputes.
- The clarity and specificity of the insurer's question matters when deciding whether the consumer took reasonable care.
- If the consumer took reasonable care, the insurer generally cannot use an innocent misrepresentation as a remedy.
- Where there is a qualifying misrepresentation, the remedy can depend on whether it was careless or deliberate/reckless and what the insurer would have done with the correct information.
Diagnosis
First: what exactly has happened?
Start by identifying the actual dispute. Similar-looking insurance complaints can turn on very different rules.
| What happened? | What to check first |
|---|---|
| The insurer says you failed to disclose a previous claim | Find the exact question, timeframe and answer given at sale or renewal. |
| The insurer says a medical condition was not declared | Check the actual health question, symptoms/diagnosis dates and whether the question was clear. |
| The insurer voids the policy from the start | Ask whether it alleges deliberate/reckless or careless misrepresentation and what underwriting evidence supports avoidance. |
| The insurer reduces the claim | Ask what premium/terms it says would have applied and how the proportionate remedy was calculated. |
| The insurer says you should have volunteered information | For consumer insurance, focus on what was asked and whether your answer was reasonably careful. |
Get the question and answer, not a paraphrase
Ask for the proposal, online journey, call recording or statement of fact showing the actual question and answer. A complaint cannot be tested properly against "you failed to disclose X" without knowing whether X was actually asked about and how.
Reasonable care depends partly on the question
CIDRA requires reasonable care not to make a misrepresentation. The clarity and specificity of the insurer's questions are relevant. Ambiguous or broad questions can make it harder to show that a consumer acted carelessly.
Qualifying misrepresentation requires more than an incorrect answer
The insurer must show the misrepresentation mattered to its decision to insure the risk or the terms offered. Ask for underwriting evidence explaining what would have happened had the correct information been provided.
Careless versus deliberate or reckless
The classification matters because the available remedies differ. Do not accept a serious label merely because the answer was wrong. Look at what the consumer knew, what the question asked and why the answer was given.
What would the insurer actually have done?
If the insurer says it would not have insured the risk at all, ask for underwriting criteria from the relevant date. If it says it would have charged more or imposed a term, ask for the calculation and policy wording that would have applied. This is often the most important evidential step.
Renewal can create a fresh issue
Insurance renewal is normally a new contract. Check the questions and statement of fact for the relevant renewal year rather than assuming the original application remains the only evidence.
Cancellation, avoidance and claim reduction are not interchangeable
Ask the insurer to state exactly what it has done to the policy and under what CIDRA remedy. "Policy cancelled" can be used loosely in correspondence even where the legal effect being asserted is avoidance from inception.
What to say next
Ask the firm to provide: the exact question and answer; why it says reasonable care was not taken; the classification of the misrepresentation; underwriting evidence showing what it would have done; and the calculation of the remedy applied. Challenge each step separately.
Who is responsible for the information recorded?
Responsibility can depend on how the policy was sold. If you answered questions directly online, preserve the journey and statement of fact. If an adviser, broker or call-centre agent completed the answers, obtain the call recording or sales notes and check whether your information was entered accurately.
An insurer should not simply treat an intermediary's inaccurate data entry as proof that the consumer deliberately supplied false information. Identify who asked the question, what was said and who recorded the answer.
What remedy is realistic?
The right remedy depends on the CIDRA analysis. If you took reasonable care, ask the insurer to restore the policy/claim position and remove any adverse consequence based on the alleged misrepresentation. If there was a careless qualifying misrepresentation, the insurer may be entitled to a proportionate statutory remedy, but that remedy should mirror what it would actually have done with the correct information.
Where avoidance or cancellation has also produced database or fraud-marker consequences, ask the firm to correct records that no longer reflect the properly determined outcome.
Important exceptions and edge cases
Business insurance and some non-consumer arrangements are governed by a different disclosure regime, including the Insurance Act 2015. This ConsumerWise guide is focused on consumer insurance and CIDRA.
A deliberate or reckless misrepresentation is much more serious than a careless mistake. If the insurer uses that classification, insist on the evidence and reasoning rather than accepting the label as a consequence of the wrong answer alone.
Common insurer responses - and what they do not necessarily prove
| The insurer says | What to test |
|---|---|
| "You should have told us." | For consumer insurance, ask what clear question required that information and when. |
| "Our underwriting rules say we would not have covered you." | Ask for evidence of the underwriting rule in force at the relevant sale or renewal date. |
| "The answer was wrong, so the policy is void." | An incorrect answer is not automatically deliberate/reckless and does not automatically justify avoidance. |
| "You signed the statement of fact." | That is relevant evidence, but the clarity of the questions and the circumstances of the answer still matter. |
Evidence worth keeping
Build the file around the issue the insurer actually has to decide. Preserve documents from the time of the claim rather than relying on memory later.
What to do
A practical next-step plan
- Obtain the exact question and answer.
- Ask the insurer to identify the CIDRA classification and remedy.
- Demand underwriting evidence for what it says it would have done.
- Correct any factual chronology errors.
- Escalate an unresolved regulated complaint to FOS within the applicable time limit.
What happens after you make a formal complaint?
The insurer or other regulated firm should acknowledge and investigate the complaint under the FCA complaint rules. For most ordinary insurance complaints it should send the required written response within eight weeks. Keep the complaint separate from day-to-day claim chasing: the claim can continue progressing while the complaint tests the decision or handling.
If you receive a final response and remain dissatisfied, check Financial Ombudsman eligibility immediately. FOS normally requires referral within six months of the date on a valid final response. Continuing to argue with the insurer does not safely stop that external clock, so diary it even if the firm says it is willing to look again.
Official sources
Check the current source material.
- Consumer Insurance (Disclosure and Representations) Act 2012
- FOS: misrepresentation and non-disclosure
- FCA Handbook: ICOBS 8 claims handling
Insurance rules, policy wording and Financial Ombudsman approaches can change. Check the live source and the policy wording for the relevant policy year before relying on a formal deadline, exclusion or remedy.