If you file an insurance claim under your policy, the insurer could say that they’ll not make a payment or only pay a small portion or all of what you’ve made a claim for. There are many reasons for this to occur and a variety of ways you can do about the issue.
What could cause your insurance claim to be denied?
There are a variety of reasons claims could be denied in a fair or non-fair manner. The reasons are detailed below.
Incorrect information
You may have provided incomplete or incorrect information in your claim, either deliberately or accidentally. In this case, for example, how something occurred or was damaged.
The insurance company believes that you didn’t use ‘reasonable caution’
The majority of policies have a ‘reasonable care or ‘duty of care’ clause which will require you to take the necessary steps to avoid a claim occurring. For instance, if, for example, you have left your valuables out displayed in your car or left your phone in the car while on the train, your insurance company could consider this to be the reason to challenge your claim.
Inaccuracies or omissions on your insurance application
The insurer may deny the claim of a customer if there is a reason to believe that you didn’t exercise 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 any medical condition that was pre-existing.
Visit Resolute Claims for insurance claim rejected help.
Technical “sticking points”
Insurers may discover small print issues to contest your claim. For instance, they could argue that an item stolen or lost was utilized for personal or business reasons. If the latter is the case the item may not be covered under the policy.
The proper claim 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 claims procedure precisely enough to justify refusing to accept it.
The insurance company claims it will only pay only a portion of the claim.
This could occur, for instance in the event that your policy does not provide enough insurance to cover your losses. You’ll be required 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 reason given by the insurance company in the decision to deny your claim, then you are entitled to lodge a grievance.
What should you do if think your claim shouldn’t been denied
Review the policy documents of your company.
Examine the specifics that you have included in the policy determine what the policy says about the reason behind the rejection.
It is worth challenging the decision in the event that you believe that it was wrongly denied. This is because such decisions are sometimes overturned (often when you take the matter before The Financial Ombudsman Service – find out more about this in the following):
Make sure you have provided all necessary information in the beginning.
Highlight or write down the exact words in your policy which states that you’re covered. This is because you’ll need it later on.
If the words are unclear or unclear, take note of the wording down. The insurance company has a responsibility to provide you with clear and concise information , and they have to give you an acceptable reason for refusing to settle your claim.
New rules stipulate that insurance companies aren’t able to refuse to accept your claim if they were able to answer all of their questions in a timely manner 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 insurer request to provide the information it claims you should have disclosed voluntarily? If not, take an note of it.
You can also look up any other documents related with your policies.
If, for instance, you wrote the insurance provider a note informing the company of changes in your situation (this is your obligation) Try to locate the original letter.
Make contact with your insurance provider
After you’ve had a look over your insurance policy now is the time to contact an insurance firm.
Contact the company to speak with their complaints handlers . You can also compose an official letter of complaint, and send 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 ask for the more details about this process if would like to.
If you purchased your insurance via an insurer 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 suggestions for how to write your letters of complaint:
Place an inscription on your letter.
Name and your policy number.
Write the word ‘complaint’ in bold letters on the top.
Include any evidence that you have to back up your claim.
Write what you want your company’s response to fix things right.
Be clear in your explanation of your complaint and explain why your claim shouldn’t be denied.
If you’re dissatisfied with the response of the company. You’ll submit the issue before the Financial Ombudsman Service.
Request an independent assessment
If the issue is one that is technical or specific It may be beneficial to seek an independent opinion. For instance, if your insurer claims that damages to your property occurred due to wear and tear but you’re trying to argue that it was an accident that caused the damage.
It’s a good idea to get an assessment specialist (not in the same way as a loss adjuster who is employed by an insurance firm) to assess the damages and submit their statement to an insurance firm to provide evidence.
You should be aware of the fact that these companies will charge you a cost for representing you.
If it doesn’t change 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 not satisfied after having gone through the insurance firm’s complaints procedure, you’re entitled to the right to submit 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 with them, they’ll look at all sides of the issue, look at the evidence and try to come up with a fair solution that is based on information and facts.
You are only able to file a claim after receiving 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 The Financial Ombudsman Service have the ability to order their insurance provider:
* explain the reasons behind its actions
* apologize and
* make compensation payments or take the appropriate actions to alter the result.
Send it in with a copy of your closing response letters from the insurance provider and any other documents to support your claim.
Resolute Claims
18 A Livingstone Terrace, Dunlop, Kilmarnock KA3 4AB
0333 050 8792
resclaim.co.uk
