If you submit claims on your insurance policy, the insurer could inform you that they will not pay you or only pay a small portion from the total amount made a claim for. There are many reasons this could occur and a variety of ways you can do about the issue.
How can your insurance claim be denied?
There are many reasons claims could be denied either in fairness or not. The reasons are detailed below.
Incorrect information
You may have provided incomplete or inaccurate information during your claim, either intentionally or by error. 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 occurring. For instance, if you have left your valuables out on display in your vehicle or in the car, your insurance company could see this as an excuse to deny your claim.
Inaccuracies or omissions within your insurance application
The insurer may deny the claim of a customer if there is grounds to believe that you did not take reasonable precautions to answer all questions asked on the application honestly and in a timely manner. An example of this is the failure to reveal an existing medical condition.
Did you know? Resolute Claims are on hand to provide insurance claim rejected help.
Technical “sticking points”
Insurers may discover inconsistent reasons to dispute your claim. For example, they may argue that an item stolen or lost was utilized for personal or business purpose. If the latter is the case then it may not be covered under the policy.
The correct claims process was not followed.
Insurers typically expect their clients to follow the law and could make use of evidence that you are not following their claim process in a way that is sufficient to justify refusing to accept it.
The insurance company claims it is only responsible for the amount of the claim.
It could occur, for instance when your insurance policy doesn’t provide enough insurance to cover your losses. You’ll be required to pay an additional amount when the insurance company believes that you’ve undervalued your claim.
If you aren’t satisfied with the reasons offered by the insurance provider for the decision to deny your claim, then you’re entitled to file a complaint.
What do you do if think your claim shouldn’t been denied
Review 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 your reason for rejecting the policy.
It’s worth challenging the decision If you feel the decision was erroneously denied. This is due to the fact that these rulings can be rescinded (often after submitting the matter into The Financial Ombudsman Service – find out more details about this in the following):
Make sure you have provided all necessary information in the beginning.
Highlight or write down the exact phrase in your insurance policy that states you’re covered . You’ll require it in the future.
If the words are unclear or unclear, take note of the wording down. Your insurance company is required to provide you with clear and concise details and must provide an adequate explanation as to why they are not paying your claim.
The new rules say that insurance companies can’t refuse to accept your claim if they were able to answer their questions truthfully in your ability. If your insurance provider didn’t request for any information, and they claim that you should have provided it, and be aware of that as well.
Did the insurance company ask you for the information it claims you should have divulged? If not, take an note of it.
You can also look up any other documents related the policy.
For instance, if you’ve sent the insurance provider a note informing the company of changes in your situation (this is your obligation) You should try to locate the original letter.
Make contact with your insurance provider
After you’ve had a look through your policies, you’re now ready to contact an insurance firm.
You can call the company to speak with their complaints handlers . You can also send an official letter of complaint and mail it to the email address provided in the complaints procedure of the company.
The complaint should be processed through the internal review procedure. You may request more details about this process if wish to.
If you purchased your insurance with an agent they may be able to handle your complaint for you. It’s definitely worthwhile to ask, in order to spare yourself the headache.
How do you draft an official complaint letter
Here are some helpful guidelines for writing your letter of complaint:
Place your date of birth on the note.
Please provide your name and the 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 your company’s response to make things right.
Make your complaint clear by stating the reasons why your claim shouldn’t be denied.
Declare that 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 It may be beneficial to obtain an independent evaluation. For instance, if the insurer claims that damages to your property occurred due to wear and tear but you’re saying it was an accident that caused the damage.
It’s worth contacting an assessor (not in the same way as a loss adjuster who is employed by an insurance firm) to assess the damage and provide a assessment to insurance companies for evidence.
It is important to know that the company will demand you a fee to represent 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 not satisfied after having gone through the insurance firm’s complaints procedure, you’ve got the right to bring an appeal to Financial Ombudsman Service.
The Financial Ombudsman Service is an independent, no-cost service that examines complaints by customers about financial companies.
If you bring your issue 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 using the information and facts.
It is only possible to make an appeal after you’ve received the term “final response from your insurance company after eight weeks gone by and you’ve not received any response from them.
If they find that your claim was incorrectly denied If they decide that your claim was rejected incorrectly, the Financial Ombudsman Service have the ability to order their insurance provider:
* provide a rationale for its actions
* Apologize for the inconvenience, and
* make compensation payments or take the appropriate actions to alter the result.
Make sure you send it along with a copy of your closing response letters from the insurance provider and any other documents that can support your case.