Financial services giant Friends Provident has been criticised for a mailshot sent to 10,000 people which looked like medical test results.
The Advertising Standards Authority (ASA) said recipients were likely to infer the brown envelope contained test results or hospital medical records.
The X-ray photo inside was used to advertise income protection if people suffered from an accident or illness.
Friends Provident sent written apologies to those who complained.
Brown envelope
The advert was in a rigid brown envelope with "X-Ray film, please do not bend" written on the outside in bold red print.
Inside there was an X-ray photograph of a pinned joint and a promotion for income protection.
The advertising watchdog said it received three complaints about the mailshot suggesting it was likely to cause distress by "masquerading as official medical records".
In its response to the ASA, Friends Provident said the advert was a test run and admitted they had not fully appreciated the impact it would have on people awaiting medical results.
Advert withdrawn
The insurance company accepted that the envelope should have made it clear that it contained marketing material.
The company told the ASA it had withdrawn the mailing, had no plans to reuse it and had issued written apologies to those customers who had complained to them directly.
Upholding the complaints, the ASA said the small print on the reverse of the envelope was insufficient to stop people inferring it contained medical records.
"We were concerned that the approach had caused alarm to some recipients and had misled them to believe the envelope contained official medical records belonging to them or their loved ones," the ruling said.
"We concluded that the envelope should have stated clearly that it contained marketing material to avoid giving a misleading impression of its contents and causing distress to recipients."
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