Yes, a life insurance company can refuse to pay a claim, but only on grounds that the law or the policy sets out, and most claims are paid. The main grounds are wrong answers on the application, a death by suicide inside a first-year exclusion, a policy that ended because premiums stopped, and exclusions written into the policy.

If you are choosing cover and want to see how an insurer would treat your own health answers, fill in the form for a free call: the broker who rings is authorised by the FCA. If a claim has already been declined, the last section sets out where to complain.

When can a life insurer decline a claim?

Legal & General's Life Insurance terms (QGI12849 2026/10) have a section headed "When we won't pay a claim". It says a claim "may be refused or impacted" in four situations: the claim does not meet the policy's definition for the type of claim made; the offer was conditional on cancelling another policy and that was not done; the application questions were not answered correctly, so the wrong terms were applied; or the policy had lapsed through missed payments before the event. Exclusions, it adds, appear on the Policy Schedule sent when cover starts.

An insurer is not free to decline on any ground it likes. The FCA's rules (ICOBS 8.1.1R) require an insurer to "handle claims promptly and fairly" and to "not unreasonably reject a claim", including by terminating or avoiding a policy.

What if the answers on the application were wrong?

A wrong answer on the application is the leading cause of the life claims Aviva declined in 2025 (figures below). The law on it, the Consumer Insurance (Disclosure and Representations) Act 2012, is covered in full in life insurance disclosure requirements; three points decide what happens at claim time. The mistake counts only if the insurer shows that the right answer would have led it to refuse cover or set different terms. An answer is treated as careless unless the insurer proves it was deliberate or reckless. And the outcome follows what the insurer would have done: refuse claims but repay the premiums, apply the terms it would have set, or pay a reduced share where it would have charged more. Only a deliberate or reckless answer lets it refuse all claims and also keep the premiums, unless keeping them would be unfair.

The same insurer's Life Insurance+ summary (AL50001 02/2026, from Aviva's adviser library) puts the rule in one line: it "may amend or cancel your policy, or we may not pay a claim at all" if the application questions were not answered "completely, truthfully and accurately". Pages on life insurance with a heart condition and life insurance for pilots show how these rules meet particular questions.

In a dispute, the Financial Ombudsman Service looks at whether the questions were clear and specific, whether the person took reasonable care to answer correctly, and whether the insurer would have acted differently with the right answer. It accepts that "it might not be reasonable to expect you to know the answer to a question at all", but if you are unsure, "it's reasonable to expect you to find out the answer". A broker can go through the questions with you before an application is sent, and the form here starts that. Medical questions for life insurance explains what is usually asked.

Does a suicide exclusion apply?

On the underwritten policies from Legal & General and Aviva, it applies at the start of cover. Legal & General's terms say "The policy will be cancelled if within the first year of the policy, the life insured dies as a result of" suicide, "Intentional and serious self-injury" or "An event where, in our reasonable opinion, the life insured took their own life". Where there is no suicide verdict, it will weigh "The method and timing of death", the evidence from the time and place, documents left by the person or available from others, and medical history it is reasonably entitled to obtain.

Aviva's Life Insurance Plan conditions (DA03011 05/2023, still the version linked from its life insurance page) say: "We won’t pay if the life covered dies because of suicide or intentional self-inflicted injury within 12 months of the policy start date. If this happens, the policy will end." The same conditions apply the exclusion, without the 12-month limit, to the free cover between exchange of contracts and completion on a house purchase. Wording differs between insurers, so your own policy decides.

If you would like to talk to someone, Samaritans can be called free from any phone, any time, on 116 123.

What if the premiums stopped being paid?

A policy that has ended cannot pay a claim. Legal & General's terms treat a policy as cancelled once a missed payment is 60 days overdue, and say that where it lapsed through missed payments before the event, the claim will not be paid. Aviva's Life Insurance+ summary lists a policy ended through unpaid premiums among the cases where it cannot pay anything. SunLife's Guaranteed Over 50 Plan terms (S-G050T12.25.V3) say that if premiums stop for any reason the plan is cancelled and nothing comes back.

Grace periods and restart options differ: see what a lapsed life insurance policy means and what happens if you cancel. Whether an insurer can end a policy that is up to date is a separate question, in can a life insurance company cancel your policy.

Which other exclusions and conditions can stop a payment?

No single list is shared by every policy. These examples come from named documents:

  • Aviva's Life Insurance+ summary (adviser library), under "Before you make a claim", also lists a terminal illness diagnosis where the person is expected to live longer than 12 months, being "not covered for the benefit you claim for", a death outside the policy term, and a second-event joint policy where only one event has happened.
  • Legal & General's terms reserve a right to "cancel your policy, deny a claim or take reasonable action" to comply with laws and sanctions relating to financial crime.
  • SunLife's plan pays the full sum in the first year only for an accidental death, and its accidental death benefit would not be payable where death was caused directly or indirectly through a criminal act, flying (except as a fare-paying passenger), hazardous pursuits, self-inflicted injury, war or hostilities, alcohol or drug abuse, or natural causes, an illness or disease.

The SunLife plan is a guaranteed-acceptance over-50s plan, which works differently from underwritten cover; is there a waiting period for life insurance covers those qualifying periods. On underwritten cover, a job or hobby that raises the risk is something the application asks about, as the pilots page shows. Cover that pays on illness has its own list: see why critical illness claims are refused and terminal illness benefit.

How many life insurance claims are paid?

Most are. Each of these figures has its own scope and year, so they are not a league table:

  • The ABI's release of 29 June 2026 says 97.9% of individual protection claims were paid in 2025. That covers individual life, income protection and critical illness together, not life cover alone.
  • Aviva's release of 25 March 2026 gives "an acceptance rate of 98.7%" in 2025 for individual life insurance claims, including over-50s plans and advance payments for terminal illness, across 40,000 claims. Of the small proportion declined, "the leading cause remained misrepresentation of relevant information, in particular health and lifestyle information".
  • Royal London's release of 15 June 2026 says it paid 98.4% of all its protection claims in 2025, a figure across every protection product rather than life cover alone, with a 99.9% payout rate on whole of life claims.

A payout rate is a past average, not a promise about any one claim. More is on life insurance claims statistics in the UK.

What can you do if a claim is declined?

A declined claim after a death is a lot to deal with. If you would like to talk to someone, Cruse Bereavement Support has a helpline on 0808 808 1677.

The first step is a formal complaint to the insurer. Aviva's summary promises "a written response within eight weeks of receiving your complaint" and notes that the Ombudsman's decisions bind the firm but not you; Legal & General's terms say a complaint "will not affect your legal rights".

The second step is the Financial Ombudsman Service, which is free; you can ask "a family member, friend or someone else" to help. Its time limits cover both steps. You usually need to complain to the business within 6 years of the problem happening, or 3 years of becoming aware (or when you could reasonably have realised) that you had cause to complain. You can then refer the complaint once you have a final response, or after eight weeks without one: "You have 6 months from the date on the final response you receive from the financial business to bring your complaint to us." After that it usually cannot help, unless exceptional circumstances prevented the referral; its examples include "a bereavement at the time in question".

If an application, rather than a claim, was declined, see what to do if you are declined life insurance; for income protection, income protection claim rejected. If you are looking at cover for the future, a few minutes on the form will set up a free call-back with a broker. The wider picture is in how life insurance works.

Frequently asked questions

Does life insurance always pay out?

No. A valid claim under a policy in force is generally paid, and the published rates above are high, but a claim can be declined for the reasons on this page. Whether yours is valid depends on your policy's wording.

What deaths are not covered by life insurance?

There is no standard list. The insurers above name suicide or intentional self-injury within the first 12 months, a death after the policy has ended, and, on one over-50s plan, particular causes for the accidental death benefit. Your Policy Schedule shows any exclusion applied to you.

Do insurers check medical records after a death?

Their documents say they may ask. Aviva's conditions list written consent to access "the medical information or reports of the life covered" and reports from coroners and attending consultants, and Legal & General asks for the doctor's details when a claim is made. Neither says how often records are checked.

Sources

  • legislation.gov.uk, Consumer Insurance (Disclosure and Representations) Act 2012, sections 2 to 5 and Schedule 1, read 20 October 2026. legislation.gov.uk
  • FCA Handbook, ICOBS 8.1 Insurers: general (last updated 1 August 2017), read 20 October 2026. handbook.fca.org.uk
  • Legal & General, Life Insurance Policy Terms and Conditions (QGI12849 2026/10, direct version), read 20 October 2026. legalandgeneral.com
  • Aviva, Life Insurance Plan Policy Conditions (DA03011 05/2023, adviser library), read 20 October 2026. static.aviva.io
  • Aviva, Policy Summary of Life Insurance+ (AL50001 02/2026, adviser library), read 20 October 2026. static.aviva.io
  • SunLife (Phoenix Life Limited), Guaranteed Over 50 Plan Terms and Conditions including the Policy Summary (S-G050T12.25.V3, no printed date), read 20 October 2026. sunlife.co.uk
  • ABI, Protection insurers pay out £7.84 billion to help customers safeguard their finances (29 June 2026), read 20 October 2026. abi.org.uk
  • Aviva, Aviva paid nearly £2 billion in protection claims in 2025 (25 March 2026), read 20 October 2026. aviva.com
  • Royal London, Royal London pays record £821m in protection claims with 98.4% payout rate (15 June 2026), read 20 October 2026. royallondon.com
  • Financial Ombudsman Service, Misrepresentation and non-disclosure, How to complain and Time limits (last updated 17 August 2022), read 20 October 2026. financial-ombudsman.org.uk
  • Samaritans, Contact a Samaritan, read 20 October 2026. samaritans.org
  • Cruse Bereavement Support, Get support, read 20 October 2026. cruse.org.uk