Ten Working Days: Challenging a Genetics Decision

If you want to complain about an insurer using a genetic test result, there is a defined route and there are real deadlines on it. The short version: put the complaint to the insurer in writing, say clearly that you believe a predictive genetic result shaped the decision, and ask for it to be reviewed under the Code on Genetic Testing and Insurance. If the answer does not satisfy you, or eight weeks pass without a proper reply, you can take it to the Financial Ombudsman Service for free.

Before you start, one honest check saves a lot of wasted effort. Insurers are, in almost all cases, not even allowed to ask for a predictive genetic result — so a decision that genuinely turned on one is unusual. Far more often the thing that moved the decision was your family history, which is a legitimate question, or a piece of ordinary medical evidence, not a protected gene result. Establishing which of those actually happened is the first step, because it decides whether you have a Code complaint at all.

This page sets out how to tell the difference, how to ask for the insurer's reasons, and then the two-stage route — the insurer first, the Ombudsman second — with the deadlines that apply to each.

First, work out whether it really was a genetic result

The Code on Genetic Testing and Insurance draws a firm line between three things people lump together. A predictive genetic test result — a gene test taken while you are well, to gauge future risk — cannot be asked for or used for life cover, with one listed exception: Huntington's disease, and only above £500,000 of cover. That is the protected category.

Source: HM Government and the Association of British Insurers, Code on Genetic Testing and Insurance.

Sitting outside that protection are two things an insurer is entitled to weigh. Your family history — whether a parent or sibling had a condition, and at what age — is a fair question, and it is not a genetic test result. And ordinary medical evidence — your own diagnoses, symptoms, investigations, a diagnostic test taken because you already had symptoms — is disclosable and usable. A decision built on either of those is not a breach of the Code, however much it may feel connected to genetics. Our piece on whether a claim can be refused over family history unpacks that boundary, and it is worth reading before you frame a complaint, so the complaint lands on the right target.

Ask for the reasons in writing

You cannot challenge a decision you do not understand, so ask the insurer to set out, in writing, exactly what its decision was based on. Was it a predictive genetic test result? Family history? A specific piece of medical evidence from your GP records or a report? A clear answer often resolves the matter on its own — either because it shows the decision rested on something the insurer was entitled to use, or because it exposes a reliance on something it was not.

Put the request plainly and keep a copy of everything. If the decision followed a direct-to-consumer test you had taken — an ancestry or health kit — be aware that those results are covered by the Code in the same way as clinical ones, a point we cover in whether you must declare a shop-bought DNA result to a life insurer. Knowing that helps you say precisely what you think the insurer got wrong.

Step one: complain to the insurer and invoke the Code

If, having seen the reasons, you still believe a predictive genetic result influenced the outcome, make a formal complaint to the insurer. Do three things in it. State clearly that you are making a complaint. Say that you believe a predictive genetic test result was asked for or used, contrary to the Code on Genetic Testing and Insurance. And ask specifically that the case be reviewed by the insurer's nominated genetics underwriter — participating insurers commit to having a senior individual responsible for genetics matters, and asking for that route by name keeps your complaint out of the general queue and in front of someone who knows the Code.

Set out the facts in order, attach the correspondence, and be specific about what you want — the decision reconsidered without the protected result, and confirmation of what it was based on. The genetics community and the ABI, which administers the Code, expect these complaints to be handled properly, so framing it as a Code matter rather than a vague grievance carries weight. If your test itself came about through a research study or a relative's research finding, the status of your result has its own subtlety, set out in how cascade testing after a research finding is treated.

The deadline that matters: eight weeks to a final response

Once you have complained, the clock the Financial Conduct Authority sets begins. Under the FCA's complaint-handling rules, a firm has up to eight weeks from the date of your complaint to send a final response — its definitive answer, and the point from which your right to escalate is measured. Many complaints are resolved faster, but eight weeks is the outer limit before you gain the right to go over the insurer's head.

Two practical things follow. Diarise the date you complained, so you know when the eight weeks are up. And keep the final response letter safe when it arrives, because it starts the next deadline. If the insurer offers to put things right — reassessing the application without the protected result — that may be the end of it. If it does not, you move to stage two.

Step two: the Financial Ombudsman Service

The Financial Ombudsman Service is an independent, government-established scheme that settles disputes between consumers and financial firms, and it is free to use. If you are unhappy with the insurer's final response, or if eight weeks pass without one, you can refer the complaint to the Ombudsman. You normally have six months from the date of the final response letter to do so, so do not let that window lapse — it is one of the most common ways a good complaint is lost.

The Ombudsman will look at what happened and decide what is fair and reasonable, taking the Code and the law into account. You can read how the process works, and start a complaint, at the Financial Ombudsman Service. Its decisions, where you accept them, are binding on the firm. You do not need a solicitor or a claims company to use it, and you should never pay a percentage of any outcome to a third party to do something the Ombudsman lets you do yourself for nothing.

Raising whether the Code was followed

Running alongside your individual complaint is a separate question: whether the insurer followed the Code at all. The Code on Genetic Testing and Insurance is administered by the Association of British Insurers on behalf of the industry, and concerns about whether a subscribing insurer is complying with it can be raised with the ABI. That is not a substitute for the Ombudsman route — the Ombudsman decides your case, while the ABI oversees the framework — but it is a useful pressure point where you believe a firm has treated a protected result as fair game.

It also helps to understand where the current rules came from, because insurers sometimes act on outdated assumptions. The open-ended Code replaced an earlier time-limited arrangement, a change we explain in what replaced the genetic testing moratorium. Citing the correct, current framework in your complaint is more persuasive than referring to the old moratorium by name.

What a good outcome looks like, and the evidence to keep

A successful challenge usually ends in one of two ways: the insurer reassesses your application without the protected result and offers terms accordingly, or the Ombudsman directs a fair reconsideration. Neither guarantees cover on the terms you wanted, because the insurer is still entitled to weigh your family history and your genuine medical evidence — what the challenge removes is the improper reliance on a protected gene result, not the underwriting itself.

Give yourself the best chance by keeping a tidy file from the start: the application, the questions exactly as they were put, the decision, the reasons, and every letter and email. Note in particular whether you ever volunteered a result, because a favourable predictive result you chose to share is treated differently from one an insurer improperly demanded. If, having been through all this, you simply want to apply cleanly elsewhere, you can get life insurance quotes and let an FCA-authorised broker approach it correctly from the outset, so the medical questions are answered accurately and no protected result reaches the form. Whether to secure cover before any further testing is a related decision, covered in whether to buy cover before genetic testing.

Throughout, it helps to keep the underlying risk in proportion rather than letting one decision loom over everything. The plain figures in your real chance of dying before 65 are a steadier reference point, and the wider family history, inherited risk and the odds hub puts the whole subject in context.

Scotland and Northern Ireland

The route is the same across the United Kingdom. The Code on Genetic Testing and Insurance is an industry-wide agreement, the FCA's complaint rules apply UK-wide, and the Financial Ombudsman Service covers the whole of the UK, so a reader in Scotland or Northern Ireland follows exactly the same two stages — the insurer first, the Ombudsman second — with the same eight-week and six-month deadlines.

The Consumer Insurance (Disclosure and Representations) Act 2012, which governs what you had to disclose in the first place, also applies throughout the UK. So while court procedure and some estate matters differ between the nations, none of that changes how you challenge an insurance decision you believe leaned on a protected genetic result.

Frequently asked questions

What do I do if I think an insurer used a genetic test result?

Complain to the insurer in writing, saying clearly that you believe a predictive genetic result influenced the decision and asking for it to be reviewed under the Code on Genetic Testing and Insurance. Ask for the insurer's nominated genetics underwriter to handle it, and keep copies of everything. First check, though, that the decision was not simply based on your family history or ordinary medical evidence, which insurers are entitled to use.

How long does the insurer have to respond?

Under the FCA's complaint-handling rules a firm has up to eight weeks to provide a final response. Many complaints are answered sooner, but eight weeks is the outer limit before you gain the right to escalate. Ask for the case to go to the nominated genetics underwriter by name, rather than joining a general complaints queue, so it is handled by someone who knows the Code.

Can I take it to the Financial Ombudsman Service?

Yes. If you are unhappy with the final response, or eight weeks pass without one, you can refer the complaint to the Financial Ombudsman Service free of charge. You normally have six months from the date of the final response letter, so do not let that deadline lapse. You do not need a solicitor or a paid claims company to use the service.