Dealing With a Rejected or Disputed Insurance Claim

Buying insurance is very common nowadays. From car insurance to home, health, travel, and much more, you can be sure you will be covered. You may make a claim to your insurance provider to cover a wide variety of situations. However, your claim may be rejected, which means your insurance provider refuses to pay any of the amount that you ask for. Another route your provider may take is to dispute your claim, which means that they refuse to pay some of the amount that you request. In this article, we provide steps which you can follow should such a situation arise. 

The First Route to Resolution: Your Insurance Provider

Your first step should be to contact your insurance provider, who may be able to inform you of their reasoning in rejecting or disputing your claim – reasoning which may help resolve the issue. 

If simply contacting them does not resolve matters, an alternative route is to file a formal complaint. To do so, you may find details on your provider’s website and if not, you can contact your provider and inquire of the steps needed to file such a complaint. In your complaint, include your policy number, reasoning for why they should accept your claim, and ensure that your complaint is covered by your insurance policy. Additionally, mention that if you are not satisfied with your response, you may resort to reporting your provider to the Financial Ombudsman.

If That Doesn’t Work: Meet the Financial Ombudsman

The Financial Conduct Authority (FCA) oversees all insurers. If the steps mentioned thus far in this article fail to invoke a satisfactory response, you may take the issue to the Financial Ombudsman – a free service to employ only if you have followed your insurer’s complaints process. 

Another requirement you must meet before contacting the Financial Ombudsman is that your complaint must be taken to them within six months of receiving a last response from your provider and within six years of the event’s occurrence. If you fall outside of these time restrictions, the only circumstances in which you may take your complaint to the Ombudsman is if your insurance provider does not take issue with you doing so.  

Lastly, to complain to the Financial Ombudsman, you must be an individual consumer or small business with a turnover of £2 million at most with less than ten employees. 

The Ombudsman will attempt to resolve the issue using mediation – if this process proves to be futile, a formal investigation will take place, the decision of which your insurance provider will have to follow.  

Something to make note of is that the Ombudsman is only entitled to award compensation of £150,000 at most but your provider may choose to pay the full amount when higher than this limit if the Ombudsman rules in your favor. 

Using a Solicitor to deal with an insurance dispute

After having followed the procedures listed in this article, if you remain dissatisfied with the outcome, you may pursue legal action. Legal action taken by a solicitor involves the following steps:

  • Reviewing the insurance policy
  • Reviewing the correspondence from the insurers on why a claim is disputed or rejected
  • Outlining the relevant clauses and identifying if they are fair and reasonable
  • Corresponding with the insurers to find a resolution if there is a sound legal argument
  • Escalating the matter to court if the insurers are unwilling to resolve the dispute

It is important to not that using solicitors should be used as a last resort since taking legal action can weigh heavily in both costs and time, and a court will consider the Ombudsman’s decision when ruling on your case.

Leave a Comment