What to do if your insurance claim is
rejected
If your claim has been rejected and you think
it’s unfair, there are things you can do to address the problem.
- Why might your claim be rejected?
- What to do if you feel your claim
shouldn’t have been rejected
- Do you need an ‘expert’ to help with your
complaint?
Why might your claim be rejected?
Did You Use A Broker?
If you bought your policy through an insurance broker, they
might make your complaint for you – it’s worth asking, to save yourself the
hassle.
There are a number of reasons why a claim
could be rejected.
- Incorrect information –
if you gave wrong information at any stage (for example, about how
something got damaged), it could affect your claim
- Lack of due care –
for example, leaving valuables on display in your car or your mobile phone
on the bus may mean you’re not covered under the terms of the policy
- You didn’t take reasonable care to answer all the
questions on the application truthfully and accurately – for example you might not have told the company
about a pre-existing medical condition or a criminal conviction
If you are not happy with the reasons the
insurance company give for rejecting your claim, you have a right to complain.
What to do if you feel your claim shouldn’t have been rejected
Check your policy documents
Check the details of your policy to see if the
facts fit the reason for the rejection.
- Check you gave all the correct details in the
beginning.
- Note down or highlight the exact wording in your policy
that says you’re covered – you’ll need it later.
- If the wording is ambiguous or poorly explained, note
that down too. Your insurance company is duty-bound to give you clear
information.
- New rules state that an insurance company can’t reject
your claim if you took reasonable care to answer all their questions
honestly and to the best of your knowledge. If your insurer didn’t ask for
information they now say you should have voluntarily disclosed, note that
down too.
Then find any other documentation that relates
to your policy. For example, if you sent your insurance company a letter
advising them of a change in your circumstances (this is your responsibility),
try to find a copy of the letter.
Contact the insurance company
Once you’ve taken a look at your policy, it’s
time to get in touch with the insurance company. You can phone the company and
speak to their complaints handlers or write a formal letter of complaint and
send it to the contact given in the company’s complaints procedure.
How to write a formal complaint letter
- Mark the letter ‘complaint’ clearly at the top
- Put the date on the letter
- Give your name and policy number
- Explain your complaint clearly, stating why you think
your claim should not have been rejected
- Include any evidence you have to support your complaint
- Say what you would like the company to do to put things
right
- State that if you are unhappy with the company’s
response you will take the matter to the Financial Ombudsman Service (see
below)
Get an independent assessment
If the problem is technical or specialist –
for example, if your insurer is arguing that damage to your property was as a
result of wear and tear and you’re arguing that it was accidental damage – it
may help to get an independent assessment. Get a loss assessor (sometimes
called a loss adjuster) in to look at the damage and send their report to the
insurance company as evidence. They will charge a fee for representing you.
Even if it doesn’t change the insurance
company’s mind, it may be useful information to have later on.
Go to the Ombudsman Service
If, after going through the insurance
company’s complaints process, you are still unhappy with the outcome, you have
a right to take your complaint to the Financial Ombudsman Service. You can only
do this once you have received what’s called a ‘final response’ from your
insurance company, or eight weeks have passed and you haven’t received a
response from them.
The Financial Ombudsman Service is an
independent, free service that investigates complaints from individuals about
financial companies. If you take your complaint to them they’ll consider both
sides of the story, look at the documentation and attempt to find a fair
outcome based on the facts and common sense.
If they decide your claim was wrongly
rejected, the Ombudsman Service has the power to make the insurance company:
- Explain their actions
- Apologise, and
- Pay compensation or take appropriate steps to change
the outcome
Download and complete a complaint form from
the Financial Ombudsman Service website. Send it off with a copy of the final
response letter from your insurance company plus any other documents you have
that support your case.
Your case will first of all be looked at by an
‘adjudicator’ but if either you or your insurance company is unhappy with the
outcome, it can be referred up the chain to an ‘Ombudsman’. The Ombudsman’s
decision is final and binding on the insurance company. If you’re unhappy with
the outcome, you will still have the right to take your case to court.
Do you need an ‘expert’ to help with your complaint?
No. You shouldn’t need any special help or
support if you complain. Also, the Ombudsman Service is a free and informal
service and they prefer to hear from you in your own words.
Everyone has the right to have someone else to
act on their behalf. Some people might like to have someone from their local
Citizens Advice Bureau or a relative or friend to help them with their
complaint.
However, if you decide to employ someone to
present your case for you – for example, a claims management company – you will
almost certainly have to pay their costs yourself. This could mean you paying
them part of any compensation you are awarded.
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