If you file an insurance claim under your policy, your insurance company could inform you that they will not pay you or only pay a portion or all of what you’ve declared. There are a variety of reasons for this to be the case and there are a number of things you can do to deal with the issue.
What could cause your insurance claim to be denied?
There are a variety of reasons claims could be denied either in fairness or not. A few of them are listed below.
It is possible that you have provided insufficient or incorrect information in your claim, either intentionally or by error. In this case, for example, how something took place or what happened to it.
The insurance company believes that you didn’t exercise’reasonable care’
The majority of policies have a’reasonable care or ‘duty to care’ clause which will require you to take the necessary steps to stop a claim being made. For instance, if you have left your valuables out in your car or left your phone in the car in the car, your insurance company might consider this to be an excuse to deny your claim.
Inaccuracies, omissions or mistakes on your insurance application
The insurer may deny an application if the insurer has grounds to believe that you did not take reasonable care to answer all questions on your application truthfully and in a timely manner. An example of this is the failure to reveal an existing medical condition.
Technical “sticking points”
Insurers may discover small print issues to contest your claim. For instance, they could argue that an item stolen or lost was used for business or personal purpose. If the latter is the case the item may not be covered under the policy.
The proper claim process was not followed.
Insurance companies often require clients to follow the law and could make use of evidence that you are not following their claim process precisely enough to justify declining the offer.
The insurance company insists that it will only pay only a portion of the claim.
It could occur, for example when your insurance policy doesn’t provide enough insurance to fully cover your losses. You’ll be required to pay an additional amount in the event that your insurer thinks you’ve exaggerated the amount of your claim.
If you’re unhappy with the reason given by the insurance provider for refusing to pay your claim, you’re entitled to lodge a grievance.
What do you do if believe your claim shouldn’t been denied
Review the policy documents of your company.
Examine the specifics that you have included in the policy determine whether the information you have provided is in line with the reason behind the rejection.
It’s worth challenging the decision If you feel that it was wrongly rejected in a way that was unfairly. This is because such decisions are sometimes overturned (often when you take them to Financial Ombudsman Service – find out more about this in the following):
Make sure you have provided all necessary information in the beginning.
Highlight or write down the exact words in your policy which states you’re covered . You’ll need it later on.
If the words are unclear or poorly explained, take note of it down. The insurance company has a responsibility to provide you with clear and concise details and must provide an adequate explanation as to why they are refusing to settle your claim.
The new rules stipulate that insurance companies aren’t able to refuse to accept your claim if they were able to answer all of their questions in a timely manner in your ability. If your insurer did not require information, and they’ve now said you must have disclosed the information in a timely manner the information, so note that down as well.
Did the insurer request to provide the information it claims you should have divulged? If not, take the note of this.
Visit this website for insurance claim rejected help.
Find any other documentation related with your policies.
For instance, if you wrote the insurance provider a note informing the company of changes in your situation (this is your obligation) You should try to find the original letter.
Get in touch with the insurer
After you’ve had a look through your policies, you’re now ready to reach out to your insurance provider.
You can call the company to speak with their complaint handlers, or compose an official letter of complaint and mail it to the address listed in the company’s complaint procedure.
Your complaint will then go through the internal review procedure. You can request specifics on this process if you would like to.
If you purchased your policy with an agent they could handle your claim for you. It’s definitely worthwhile to ask, in order to save yourself the trouble.
How to draft an official complaint letter
Here are some guidelines for writing your letter of complaint:
Include an inscription on your letter.
Please provide your name and the your policy number.
Write the word ‘complaint’ prominently on the top.
Include any evidence you can to back up your claim.
Write what you want for the business to take action to fix things right.
Make your complaint clear by stating the reasons why your claim shouldn’t be denied.
If you’re dissatisfied with the response of the company. You’ll submit the issue up with the Financial Ombudsman Service.
Find an independent evaluation
If the issue is one that is technical or specific or specialized, you may want to seek an independent opinion. For instance, if your insurance company claims that the damages to your property occurred caused by wear and tear but you’re saying it was an accident that caused the damage.
It’s worth contacting an assessor (not not to be confused with loss adjusters who is employed by an insurance firm) to evaluate the damage and provide a assessment to insurance companies for evidence.
You should be aware of the fact that these companies will charge you a cost for representing you.
If it doesn’t change the mind of the insurance company the insurance company, it can be valuable data to keep for later.
Visit the Financial Ombudsman Service
If you’re still unsatisfied after having gone through the complaints procedure, you’re legally entitled to the right to bring an appeal to Financial Ombudsman Service.
The Financial Ombudsman Service is an free, independent service that examines complaints by customers about financial companies.
If you submit your complaint with them, they’ll take into consideration each side of the story, take a look at the evidence and try to reach a fair conclusion that is based on information and facts.
It is only possible to make an official complaint after receiving the term “final response from your insurance company or when eight weeks have gone by and you’ve not received any response from them.
If they find that your claim was not properly denied If they decide that your claim was rejected incorrectly, the Financial Ombudsman Service have the authority to force their insurance provider:
Define the reasons behind its actions.
apologize for your actions, and
make compensation payments or take actions to alter the result.
Make sure you send it along with the copy of the last reply letter you received from the insurance company as well as any other documents to support your claim.
Do I require an “expert for help with my issue?
You shouldn’t require any help or assistance in the event of a complaint.
The Financial Ombudsman Service is a free and informal service that we would love to hearing from people in the form of your personal words.
Everyone is entitled of having someone take action on their behalf.
A few people may prefer to ask an individual from the community Citizens Advice or a relative or friend who can assist people with their complaints.
However, if you choose to hire someone to argue your case on your behalf, such as the claims management company you may have to cover the costs themselves.
This could include paying them a portion of the compensation you’re awarded.