What actually happens if you lie on a moratorium PMI application (and the FOS cases that prove it)

Non-disclosure — deliberate or otherwise — is the fastest way to lose a PMI claim. The Financial Ombudsman Service has ruled on hundreds of cases. Here are the patterns that decide who wins.

The short answer

• The Consumer Insurance (Disclosure and Representations) Act 2012 governs UK PMI non-disclosure
• Deliberate or reckless non-disclosure lets the insurer void the policy and refuse all claims
• Careless non-disclosure allows a proportionate remedy — often a reduced payout, not zero
• The Financial Ombudsman upheld 38% of member complaints on non-disclosure 2020–2025

The legal framework

UK PMI non-disclosure is governed by the Consumer Insurance (Disclosure and Representations) Act 2012 (CIDRA). The Act removed the pre-2013 doctrine of 'utmost good faith' and replaced it with a duty to take reasonable care not to make a misrepresentation. Crucially, CIDRA classifies non-disclosure into three tiers with different consequences.

CIDRA classification and insurer remedy, 2026

• Non-disclosure complaints upheld against insurer at FOS 2020–25: 38%
• Average awarded when upheld: £11,400
• Most common reason members win: Ambiguous question wording

Ten cases in one paragraph

FOS decisions from 2020–2025 reveal recurring patterns. Members won when the application question was ambiguous ('any GP visits in the last five years' — does that include a check-up?), when the omitted information was clinically irrelevant to the claim (an unrelated dermatology consultation before a cardiac claim), or when the insurer failed to ask a specific-enough question. Members lost when they positively answered 'no' to a specific question that they had documented history of ('have you ever been diagnosed with diabetes?'), when they omitted named medications, or when the omitted information was directly relevant to the claim. The single biggest predictor of outcome was whether the application asked a specific question the member answered wrong, or asked a vague question the member interpreted reasonably.

"The one thing every FOS-winning member has in common is a clear reasonable interpretation of the question. Members who lose usually did know the answer, thought it wouldn't matter, and gambled. The gamble almost never pays." — Tumaris Rahimova, Head of Operations, PremierPMI

The four practical rules

• If in doubt, disclose. It costs nothing at application; it can void the policy at claim.
• Do the application with your GP records open in front of you. Insurers can — and do — request a full GP subject access request at claim.
• Use FMU (full medical underwriting) for anything material. It converts uncertain moratorium exposure into a clear written insurer decision.
• Keep a copy of your application answers. If FOS is ever needed, the exact wording of the question matters more than anything else.

PremierPMI is a UK private medical insurance broker specialising in whole-of-market placement across 10+ leading UK health insurers including Bupa, AXA Health, Aviva, Vitality, WPA, Freedom Health, The Exeter, General & Medical and National Friendly. FCA regulated (Tesha Family Ltd, FRN 1029667). Speak to a broker on 020 4525 0884, WhatsApp 020 8064 2273, or email contact@premierpmi.co.uk.