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What to do if an insurer rejects my claim?

Insurance Questions Answered: 

I believe insurer has refused my claim unfairly, what can I do next?

No insurer wants to reject a claim. While 94%* of insurance claims are paid out to customers, there are some circumstances in which a claim may be rejected. If your claim is turned down you can challenge the decision, but first it’s helpful to make sure there’s not a valid reason for the refusal.

First, is there a valid reason why your insurer may have rejected your claim?

Providing your insurer with incorrect information could lead to a claim being refused. It could be that you didn’t answer the questions on your initial insurance application accurately, for example not disclosing a pre-existing medical condition, or it could be that you provided your insurer with the wrong information when making the claim, such as how an item got damaged.

It could also be that your claim has been refused due to lack of reasonable care. This could be not maintaining your property which leads to a major leak, or leaving valuables unattended on display in your car.

It could also be that your policy simply doesn’t cover you for what you are claiming for. For example, many annual travel insurance policies don’t cover winter sports as a standard feature, so you may not be covered for any emergency medical treatment costs for an injury sustained while skiing. Extra coverage would need to be purchased for this, so make sure you always check your policy to make sure you have the right cover for your needs.  

Find out more about choosing your insurance policy here.

If you feel your claim shouldn’t have been rejected

The first thing you should do is check your policy document. This should be clearly worded and unambiguous, and it might be helpful to highlight the exact policy wording that states that you are covered. It’s also worth making a note of any wording that seems confusing and needlessly complex.

Make a note if your insurer didn’t ask for information in the policy documents that they have now said that you should have voluntarily disclosed.

You should also find any correspondence you have informing your insurers of any change of circumstances that may have affected your policy, e.g. if you have moved to a new house.

Once you have the information you need, you’ll need to go through your insurer’s internal review process. This process varies from insurer to insurer, but does generally mean your case being reviewed by someone at a more senior level.

Find out more about making a complaint here.

If you are still unhappy with your insurer’s response?

If, after going through your company’s internal review process you are still unhappy, then you can take your complaint to the Financial Ombudsman Service. This is a free, independent service. You can do this after you have received a ‘final response’ from your insurer, or if they have not responded to you after eight weeks.

They will look at the facts of the claim as an independent party and provide a ruling. If they decide that your claim was wrongly rejected, they can make the insurance company explain their actions to you, as well as providing the payment.

The decision made by the FOS is final, though if you are still unhappy with the outcome you can take your claim to court, however this will be at your own cost.

 

*Domestic general insurance claims acceptance rate figure from ABI motor, property and travel data.

Last updated 15/02/2019