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What to do if you feel your insurance claim shouldn’t have been rejected

If you file claims on your insurance policy, the insurer could inform you that they will not pay you or only pay a portion from the total amount declared. There are many reasons this could 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. The reasons are listed below.

Incorrect information

It is possible that you have provided insufficient or incorrect details in your claim, either deliberately or accidentally. For instance, what happened or how it 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 displayed in your vehicle or in the car, the insurer 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 a reason to believe that you did not take reasonable precautions to answer all questions asked on the application honestly and in detail. An example of this is the failure to reveal an existing medical condition.

Technical “sticking points”

Insurers may discover some’small print’ issues to dispute your claim. For instance, they may argue that an item stolen or lost was utilized for personal or business reasons. If the latter is the case then it may not be covered under the policy.

The proper claim procedure wasn’t being followed.

Insurers typically expect their customers to adhere to the rules and may make use of evidence that you are not following their claims procedure in a way that is sufficient to justify declining the offer.

The insurer claims it is only responsible for only a portion of the claim.

This could occur, for example when your insurance policy doesn’t provide enough insurance to cover your losses. You’ll need 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 reasons offered by the insurance provider for refusing to pay your claim, you are 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 in your policies to determine whether the information you have provided is in line with your reason for rejecting the policy.

It is worth challenging the decision in the event that you believe it was unjustly denied. This is because such decisions are sometimes overturned (often when you take them to Financial Ombudsman Service – find out more details about this in the following):

Verify that you provided necessary information in the beginning.
Highlight or write down the exact phrase in your insurance policy that states that you’re covered. This is because you’ll require it in the future.
If the words are unclear or poorly explained, take note of the wording down. The insurance company has a responsibility to give you precise details and must provide an adequate explanation as to why they are refusing to settle your claim.
The new rules say that insurance companies aren’t able to deny your claim if you were able to answer all of their questions in a timely manner in your ability. If your insurance company didn’t request information, but they’re now saying that you should have disclosed it in a voluntary manner the information, so note that down as well.
Did the insurer request to provide the information it is now claiming you must have disclosed voluntarily? If not, make an note of it.

Find any other documentation which is related with your policies.

For instance, if you’ve sent an insurance firm a written note to inform the company of changes in your situation (this is your obligation) You should try to find an original copy of the letter.

Get in touch with for insurance claim rejected help.

Make contact with your insurance provider

If you’ve looked over your insurance policy you’re now ready to contact an insurance firm.

Contact the company and speak with their complaint handlers, or send an official letter of complaint and mail it to the email address provided in the company’s complaint procedure.

The complaint should be processed through the internal review procedure. You may request specifics on this process if you wish to.

If you purchased your policy via an insurer they could handle your claim for you. It’s worthwhile to ask, in order to save yourself the headache.

How do you write an official complaint letter

Here are some helpful suggestions for how to write your letters of complaint:

Include an inscription on your letter.
Name and your policy number.
Write the word ‘complaint’ prominently on the top.
Include any evidence that you have to back up your claim.
Tell us what you would like for the business to take action to fix things right.
Make your complaint clear and explain 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.

Request an independent assessment

If the issue is one that is technical or specific It may be beneficial to obtain an independent evaluation. For instance, if your insurance company claims that the damages to your property occurred due to wear and tear but you’re saying it was caused by an accident.

It’s a good idea to get an assessor (not in the same way as a loss adjuster who is employed by the insurance firm) to evaluate the damages and submit their statement to an insurance firm for evidence.

You should be aware of the fact that these companies will charge you a cost for representing you.

Even if it doesn’t alter the mind of the insurance company but it could be helpful data to keep for later.

Visit the Financial Ombudsman Service

If you’re still unsatisfied after having gone through the complaints procedure, you’re entitled to the right to bring complaints to Financial Ombudsman Service.

The Financial Ombudsman Service is an independent, non-profit service that examines complaints by customers about financial companies.

If you submit your complaint directly to the authorities, they’ll take into consideration all sides of the story, take a look at the documents and try to come up with a fair solution that is based on evidence and the commonsense.

You are only able to file an appeal after you’ve received the process known as a “final response from your insurance provider after eight weeks gone by and you’ve not received an answer from them.

If they determine that your claim was incorrectly denied The Financial Ombudsman Service have the authority to force an insurance firm:

Define the actions of the company.
apologize for your actions, and
make compensation payments or take actions to alter the result.

Make sure you send it along with an original copy of the final reply letter you received from the insurance provider and any other documents to back your case.

Do I require an “expert to assist me with my issue?

There’s no need for any help or assistance in the event of a complaint.

The Financial Ombudsman Service is a non-cost and informal service. We we would love to hearing from people in the form of your personal words.

Every person has the right for someone else take action on their behalf.

Many people would like to ask somebody from neighborhood Citizens Advice or a relative or friend assist the person with their complaint.

However, if you choose to engage someone else to present your case on your behalf, for instance, an insurance company that handles claims – you may have to cover the costs themselves.

This could include paying them a portion of the compensation you’re awarded.