Legal & General Insurance Claim Denied: How to Appeal in the UK

Legal & General Insurance Claim Denied: How to Appeal in the UK

Legal & General (L&G) is one of the UK's largest and most established financial services groups, with a history dating back to 1836. L&G is a major provider of life insurance, critical illness cover (CIC), income protection insurance, and mortgage protection insurance for millions of UK individuals and families.

When L&G denies a life insurance, critical illness, or income protection claim, the financial consequences for policyholders and their families can be severe. However, L&G's decisions are not final — and the Financial Ombudsman Service (FOS) provides an independent, free route to challenge wrongful denials.

About Legal & General

L&G's insurance products include:

• Life insurance (term life, whole of life, over 50s plans)
• Critical illness cover — pays a lump sum on diagnosis of specified conditions
• Income protection insurance — replaces income if you cannot work due to illness or injury
• Mortgage protection — life or critical illness cover tied to a mortgage
• Business protection (key person and partner protection)

L&G also operates as a major group insurance provider through employers.

Common Legal & General Denial Reasons

Life insurance non-disclosure denials: This is L&G's most common denial type. L&G argues that the policyholder failed to disclose relevant medical information when applying for the policy (non-disclosure or misrepresentation). L&G uses this to:

• Void the policy entirely (as if it never existed) and refuse to pay
• Avoid the policy on the ground that the concealed information would have led to a different premium or exclusion

Under the Insurance Act 2015, the law now distinguishes between deliberate or reckless misrepresentation (which can void the policy) and innocent or careless non-disclosure (which allows L&G to remedy proportionately — e.g., pay a reduced claim rather than deny entirely). If L&G is treating innocent non-disclosure the same as deliberate fraud, this may be challengeable.

Critical illness claim disputes:

• L&G defines each covered condition precisely in the policy. Disputes arise when your condition does not exactly meet L&G's definition (e.g., a cancer diagnosis that doesn't meet the specific staging criteria in the policy; a heart attack that doesn't match the troponin thresholds specified).
• What to do: Obtain your full medical records, the specific policy definition, and a letter from your treating specialist explaining why your condition does or does not meet the definition. Expert medical opinion is critical.

Income protection claim disputes:

• L&G may argue you are not sufficiently unable to work, based on their own or an independent medical examiner's assessment.
• Disputes frequently arise about the definition of disability (unable to perform "own occupation" vs. "any occupation").
• L&G may terminate ongoing income protection payments based on surveillance or independent medical examination.

Pre-existing condition disputes:

• If L&G claims the condition that triggered the claim existed before the policy started (and was not disclosed), the claim may be denied based on the pre-existing condition exclusion.

Suicide clause:

• Most L&G life policies exclude suicide within the first 12 months of the policy. After 12 months, suicide is typically covered. Disputes arise about the classification of a death as suicide vs. accident.

Accidental death disputes:

• L&G may dispute whether a death or injury was accidental (particularly for policies with accidental death benefits), arguing the cause was not covered.

Your UK Rights When L&G Denies a Claim

FCA regulation: L&G is regulated by the Financial Conduct Authority (FCA) and the Prudential Regulation Authority (PRA). This means they must follow FCA rules on complaint handling and treating customers fairly.

Insurance Act 2015: The Insurance Act 2015 reformed the law on consumer insurance to provide fairer treatment of non-disclosure. If L&G is applying pre-2015 law standards, this may be worth raising.

Consumer Insurance (Disclosure and Representations) Act 2012 (CIDRA): For policies taken out after April 2013, CIDRA governs the duty of disclosure. Innocent misrepresentation allows proportionate remedies, not automatic voiding.

Financial Ombudsman Service (FOS): After exhausting L&G's internal complaints process, you can refer to the FOS. The FOS is free for consumers and can direct L&G to pay valid claims.

Step-by-Step: How to Appeal a Legal & General Denial

Step 1: Request the Reason for Denial in Writing

Ask L&G to provide a full written explanation of the denial, citing:

• The specific policy clause relied on
• The factual basis for the denial
• The legal or regulatory basis if applicable

If L&G says you failed to disclose something, ask exactly what they say was not disclosed and how they believe it is material to your claim.

Step 2: Obtain Your Full Medical Records

For non-disclosure or pre-existing condition disputes:

• Request your complete GP records and hospital records covering the period before the policy was taken out
• Review whether L&G's characterisation of your medical history is accurate
• Obtain a letter from your GP clarifying the medical history

For critical illness definition disputes:

• Obtain a detailed letter from your treating specialist explaining the clinical details of your diagnosis and whether they meet the policy definition

Step 3: Review the Insurance Act 2015 / CIDRA

If L&G is alleging non-disclosure:

• Under CIDRA (for policies from April 2013), the question is whether you made a "reasonable presentation" of the risk. You are not required to volunteer information — you must answer questions honestly and with reasonable care.
• If the non-disclosure was innocent (not deliberate or reckless), L&G's remedy is proportionate — not automatic voiding.
• If L&G never asked about the relevant condition in the application, you typically had no duty to volunteer it.

Step 4: File a Formal Complaint with L&G

Contact Legal & General:

• Phone: 0370 010 4080 (life insurance claims)
• Online: legalandgeneral.com (member portal)
• Post: Legal & General, City Park, The Droveway, Hove, BN3 7PY

In your complaint:

• State you are making a formal complaint
• Reference your policy and claim numbers
• Explain clearly why you believe the denial is incorrect
• Attach all supporting medical evidence and documentation
• Request the specific remedy (pay the claim, reverse the denial)

L&G must acknowledge your complaint within 5 business days and issue a Final Response within 8 weeks.

Step 5: Escalate to the Financial Ombudsman Service (FOS)

If L&G's Final Response does not resolve your complaint (or if 8 weeks pass without a resolution):

FOS Complaint:

• Online: financial-ombudsman.org.uk
• Phone: 0800 023 4567 (free)
• Deadline: Within 6 months of L&G's Final Response

The FOS is particularly effective for:

• Non-disclosure disputes where the misrepresentation was innocent or careless
• Critical illness definition disputes (FOS applies a fairness standard and considers whether L&G's interpretation of the definition is reasonable)
• Income protection disputes about the definition of disability

Step 6: Consider Legal Action

For very large claims or clear policy breaches, a solicitor specialising in insurance disputes can advise on litigation. Many work on conditional fee (no win, no fee) arrangements for insurance disputes.

L&G-Specific Tips

Non-disclosure: the burden of proof is on L&G: L&G must prove that you failed to make a fair presentation of the risk. If their questionnaire didn't ask about a specific condition, you generally had no duty to disclose it.

Critical illness policy definitions evolve: L&G's policy definitions for critical illness conditions (particularly cancer, heart attack, and stroke) have been updated over time. Obtain the exact definition from your specific policy document — not a general description.

Income protection: functional capacity evidence: If L&G argues you are capable of working, commission an independent functional capacity evaluation or neuropsychological assessment. Objective functional assessments are much more persuasive than L&G's own or an IME's subjective opinion.

Beneficiary claims: If you are making a claim as a beneficiary on a deceased person's life insurance policy and L&G is disputing, ensure you understand what the policyholder disclosed at application. L&G must prove the non-disclosure — the burden is not on you.

Conclusion

Legal & General is one of the UK's most established insurers, but that doesn't make their denials correct. Whether it's a critical illness definition dispute, a non-disclosure allegation, or an income protection termination, you have the right to challenge L&G's decision through their formal complaints process and, if necessary, the Financial Ombudsman Service. Use ClaimBack at claimback.app to generate a professional complaint and appeal letter for your L&G insurance dispute.

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Related Reading:

• Aviva Health Insurance Claim Denied: How to Appeal in the UK
• LV= Insurance Claim Denied: How to Appeal in the UK
• Critical Illness Insurance Claim Denied: Your Rights
• How to Negotiate with Your Insurance Company