The Insurance Council of British Columbia (the Council) has imposed conditions on former life and accident and sickness insurance agent Svetlana Rock after determining that she failed to properly advise a client on exclusions within a critical illness insurance policy.
The decision follows an investigation under the Financial Institutions Act that found the client was not made aware that a pre-existing condition would prevent a successful claim, despite disclosing extensive medical history during the sales call.
The complaint was filed in August 2023 and related to a critical illness policy sold in January 2021. The client had requested both life and critical illness coverage but only received the latter.
According to council records, the client’s claim was later denied by the insurer because his prior heart condition fell under a pre-existing exclusion.
The policy had been sold over the phone, and although disclosures were read, council determined the former agent failed to explain how the exclusion would materially limit the insurance benefit.
A recording of the sales interaction confirmed the client shared details of prior heart surgery, dialysis, a stent procedure and bypass surgery.
The former agent assured the client that he could make a claim immediately in the event of another serious medical event, but did not provide clarification on how the pre-existing condition clause applied. The Council found that a competent licensee should have recognized that the client’s medical history would trigger exclusions and should have ensured the client understood the limitations before proceeding.
The Council also found that the former agent did not document fact-finding or evidence that coverage was placed as instructed. While it accepted that the agent did not act with intent to mislead, it determined that the level of advice and product understanding fell below expected professional standards. As a result, the decision cites breaches of the Code of Conduct relating to good faith, competence, client dealings, and accurate representation of insurance products.
Rock must complete a series of compliance courses before being eligible to apply for a licence again, including training on client fact-finding, product suitability and documentation standards.
If she seeks to return to the industry, she will be required to work under supervision for two years. The Council also assessed $2,437.50 in investigation costs, which must be paid in full before any future licence application will be considered.
