Your Claim Has Been Rejected: Now What?
There are a few reasons why an insurer may reject your claim. You could have given the wrong information, either intentionally or by mistake – like forgetting to update your car insurance with a new address, for example.
Another reason could be if you’ve not taken enough care to protect the item which has been damaged or stolen.
Or maybe you’ve withheld information, like a pre-existing medical condition, when purchasing insurance.
If the rejection is made on reasonable grounds, you’re highly unlikely to get the decision reversed. But if you do feel it shouldn’t have been rejected, here is what you should do:
1. Check your policy documents
Specifically, check them to see if they marry with the reasons behind your rejection. Your insurance provider should have provided clear information in your policy documents, so be sure to note down any areas which are confusing.The revised Insurance Act which came into force in August 2016 states that providers can’t reject a claim on the basis of an immaterial fact – that is one which has no relevance or bearing on the claims loss.
2. Check your own information
There may have been some missed communication or administration error which meant crucial details were not updated. Check for any emails or copies of letters you sent to confirm whether or not your advised the insurer of your chance in circumstance.The amended Insurance Act means that insurers can’t reject your claim if you took reasonable care to answer all questions honestly and to the best of your knowledge.
3. Speak to your insurer
Once you have the information you need, speak to your insurance provider. They will have a complaints procedure for you to follow, which may involve speaking to the relevant department over the phone or sending a letter. Refer to supporting evidence and state what resolution you would like.If the issue relates to a loss adjuster who is appointed by the insurer, you can have an independent assessment to see whether or not they agree with the decision.
4. Contact the Ombudsman Service
If you don’t agree with the insurance provider’s “final response”, or it’s been eight weeks and you’ve not received a response, then you can take your complaint to the Financial Ombudsman Service.This independent, free service will look at both sides and try and reach a fair outcome based on the facts.
If they agree your claim shouldn’t have been rejected, the Ombudsman Service can make your insurance provider explain their actions, or apologise and either pay compensation or change the outcome.
In the event that you’re unhappy with the outcome, you can take the matter to court, probably at cost to yourself.
How an insurance broker can help
An independent insurance broker is there to help you understand your policy from the offset, so there’s little room for confusion.
Many insurance brokers make life easier by only dealing with reputable insurance providers who would only reject a claim on reasonable grounds.
However, if a claim is rejected, an insurance broker will make the complaint and the case for the rejection to be overturned on your behalf.