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Why providers might reject your insurance claim

If you submit an insurance claim under your policy, the insurer could say that they’ll not make a payment or only pay a portion or all of what you’ve declared. There are many reasons for this to be the case and there are a number of things you can do to deal with the issue.

How can your insurance claim be denied?

There are many reasons claims could be denied either in fairness or not. A few of them are listed below.

Incorrect information

It is possible that you have provided insufficient or incorrect information in your claim, either deliberately or accidentally. For instance, what happened or how it occurred or was damaged.

The insurance company thinks that you didn’t exercise’reasonable care’

Most policies contain a’reasonable care or ‘duty of care’ clause which obliges you to take measures to avoid a claim being made. For instance, if, for example, you put your valuables in your car or while on the train, the insurer might consider this to be an excuse to deny your claim.

Inaccuracies or omissions within your insurance application

The insurance company can deny the claim of a customer if there is 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 declare any medical condition that was pre-existing.

Technical “sticking points”

Insurance companies may find some’small print’ issues to contest your claim. For instance, they could argue that the item that was 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 correct claims procedure wasn’t being followed.

Insurers typically expect their customers to adhere to the rules and may claim that you’re not following their claim process in a way that is sufficient to justify refusing to accept it.

The insurance company insists that it is only responsible for the amount of the claim.

It could occur, for example when your insurance policy doesn’t provide enough insurance to fully cover your losses. You’ll need pay an extra amount in the event that your insurer thinks you’ve undervalued your claim.

If you’re unhappy with the reasons offered by the insurance provider for the decision to deny your claim, then you’re entitled to file a complaint.

Do you need insurance claim rejected help? Contact the experts…

What do you do if believe your claim shouldn’t been denied

Make sure you have the policy documents of your company.

Review 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 is worth challenging the decision in the event that you believe it was unjustly rejected in a way that was unfairly. This is because such rulings can be rescinded (often after submitting this to Financial Ombudsman Service – find out more about this in the following):

Verify that you provided the correct information at the beginning.
Highlight or write down the exact phrase in your policy which states you’re covered . You’ll need it later on.
If the language is unclear or unclear, write it down. Your insurance company is required to give you precise information , and they have to give an explanation that is reasonable for not paying your claim.
The new rules say that insurance companies can’t deny your claim if you did your best to answer all of their questions truthfully in your ability. If your insurer did not request information, but they’re now saying that you should have disclosed it in a voluntary manner and noted that as well.
Did the insurer request for the information it claims you should have disclosed voluntarily? If not, make the note of this.

Find any other documentation related with your policies.

For instance, if you’ve sent the insurance provider a note informing that they had changed your situation (this is your obligation) Try to locate the original letter.

Get in touch with the insurer

After you’ve had a look over your insurance policy you’re now ready to reach out to your insurance provider.

You can call the company and speak with their complaint handlers, or send an official letter of complaint and mail it to the address listed in the complaints procedure of the company.

Your complaint will then go through the internal review procedure. You can request specifics on this process if you wish to.

If you purchased your policy with an agent they may be able to handle your complaint for you. It’s worth askingto spare yourself the trouble.

How to draft an official complaint letter

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

Include your date of birth on the note.
Name and your policy number.
The letter ‘complaint’ should be placed in bold letters on the top.
Include any evidence you can 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.
Declare that you’re not satisfied with the response from the company. You’ll refer the issue up with the Financial Ombudsman Service.

Request an independent assessment

If the issue is one that is technical or specific or specialized, you may want to obtain an independent evaluation. For instance, if the insurance company claims that the damages to your property occurred caused by wear and tear but you’re trying to argue that it was an accident that caused the damage.

It’s worth contacting an assessment specialist (not in the same way as a loss adjuster who is employed by the insurance firm) to assess the damage and provide a statement to an insurance firm to provide evidence.

It is important to know that the company will demand you a cost for representing you.

Even if it doesn’t alter the insurer’s mind 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 an appeal to Financial Ombudsman Service.

The Financial Ombudsman Service is an free, independent service that investigates complaints made 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 reach a fair conclusion that is based on information and facts.

It is only possible to make an official complaint after receiving the process known as a “final response from your insurance provider or when eight weeks have been passed but you haven’t received any response from them.

If they determine that your claim was incorrectly denied The Financial Ombudsman Service have the ability to order their insurance provider:

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

Send it in with the copy of the last answer letter sent by your insurance company as well as any other documents to back your case.

Do I require an “expert for help with my issue?

There’s no need for any assistance or help when you have a complaint.

The Financial Ombudsman Service is a free and informal service that would like to listen to the person you speak to in your own voice.

Everyone is entitled of having someone take action on their behalf.

Many people would like to get somebody from community Citizens Advice or a relative or friend who can 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 could have to cover their expenses yourself.

This could include paying them a portion of any award you receive.