Having an insurance company deny your claim can leave you feeling hopeless. Don’t worry, though – there are still several ways forward if you feel the decision was unjustified or unfair!
In this article, we’ll be explaining exactly what to do when your insurance claim is denied.
Let’s get started!
What to do when an insurance company denies your claim
- Contact your policy provider
- Review your evidence
- File a formal complaint
- Contact the Financial Ombudsman Service
- Seek legal advice
The first thing you should do in a situation where an insurance claim has been denied is contact your insurer to better understand their decision. In some cases, you’ll find that their decision is based on some clause or section of the policy that you misunderstood or missed entirely.
Once you understand your insurance provider’s reasoning, you need to review and curate the evidence you collected to better support your claim. We recommend assembling this in an easily shareable Google Drive or Dropbox folder.
There are a few kinds of evidence you’ll want to prioritize, including:
- Photos (e.g., damage, injuries, setting, etc.)
- Videos (e.g., dashcam videos – if claiming back your car insurance excess, incident videos, security camera, etc.)
- Policy (e.g., coverage information, plan information, etc.)
- Witness Testimony (e.g., statements, admissions of liability, etc.)
Any new evidence you can collect will be extremely helpful for the appeals process ahead.
This process is also key when trying to make a successful mobile insurance claim.
3. File a formal complaint
The next step is to file a complaint using their internal complaints channel. To find out where and how to submit a formal complaint, check your policy documentation on the insurer’s website. In many cases, it’s as simple as submitting an email to the correct department.
Insurers sometimes respond to formal complaints with a remediation offer, although it’s often less than the requested amount.
Note: In the U.K., the Financial Conduct Authority (FCA) requires that all insurers respond to formal complaints within eight weeks. If you don’t get a response within this timeframe, your insurer is in violation of the law.
4. Contact the Financial Ombudsman Service
If you decide that you’re not satisfied with your insurer’s response, the next step is to submit a complaint to the Financial Ombudsman Service (FOS). The FOS is an independent body that’s responsible for mediating issues that arise between consumers and financial service providers.
How to submit an insurance claim complaint
To submit a complaint, head over to the Financial Ombudsman Service website and follow the steps they outline. You’ll need to provide them with some basic information, including:
- Basic Information: Identifiers like your name, address, and date of birth.
- Problem Information: Information about what went wrong and how you believe the problem can be solved.
- Details: Relevant details like your policy number and account number.
The FOS then collects information from your insurer about their side of the story. Once they assembled all the information they need, they deliberate and make a decision.
Both you and the insurer have the right to appeal this recommendation. If one party does decide to appeal, the FOS begins the process again. However, the new decision is final and legally binding.
How long do I have to make an insurance claim complaint?
You have 6 months to make an insurance claim complaint to the Financial Ombudsman Service. Any longer and the complaint loses its eligibility.
5. Seek legal advice
If you’re unhappy with the FOS decision you receive, you’re entitled to take the matter to court. Before doing so, it’s helpful to seek out legal advice to determine the strength of your case and the best way forward.
In fact, legal advice is helpful at every stage of the process as it helps ensure that protocols are followed correctly and that the insurer’s actions are in accordance with their legal responsibilities.
Note: The FOS is unable to mediate incidents involving claims of more than £150,000. In these cases, you’ll need to seek legal council and take the matter to court if it isn’t resolved internally.
Can my insurance company deny my claim?
Yes. Your insurance company can deny your claim and they do so often. If you want to know why your claim was denied, you can ask them for the reasoning and they must give it to you. If you feel that their reasoning is not fair or correct, you can follow the above steps.
Why would an insurance company deny a claim?
The main reason an insurance company would deny a claim is they think you did not tell the truth on your application. Or they will deny it if you carelessly filled out the claim application, missing crucial information.
There are many other reasons an insurance company will deny a claim and you could see the most common here.
When your insurance company denies a claim, it can be a very frustrating experience. But don’t give up! There are things you can do to fight the denial and get the money you deserve. Appeal the denial, contact a lawyer, and talk to an expert for help.
With these steps, you’ll be on your way to getting the money you need. But by following some of our other insurance guides, such as making a successful water leak insurance claim, we hope you don’t need to use them!
James Banerjee is a Senior Account Manager who graduated from the University of Kent in 2014. He works in SEO on clients such as HSBC UK and Nestle and he has a keen interest in personal finances and money-saving advice.