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Why might your insurance claim be rejected?

If you submit an insurance claim under your policy, the insurer could say that they’ll not pay you or only pay a portion from the total amount made a claim for. There are a variety of reasons for this to occur and a variety of ways you can do to deal with the issue.

How can your insurance claim be denied?

There are a variety of 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 details in your claim, either deliberately or by error. For instance, what happened or how it occurred or was damaged.

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

The majority of policies have a’reasonable care or ‘duty to care’ clause which obliges you to take measures to avoid a claim being made. For instance, if, for example, you have left your valuables out in your car or while on the train, your insurance company might consider this to be an excuse to deny your claim.

Click here for insurance claim rejected help.

Inaccuracies, omissions or mistakes within your insurance application

The insurance company can deny the claim of a customer if there is a reason to believe that you didn’t exercise reasonable precautions to answer all questions on your application truthfully and in detail. An example of this is the failure to declare any medical condition that was pre-existing.

Technical “sticking points”

Insurers may discover some’small print’ issues to contest your claim. For instance, they may challenge whether an item stolen or lost was used for business or personal purpose. If the latter the item may not be covered under the policy.

The proper claim procedure wasn’t being followed.

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

The insurance company insists that it will only pay the amount of the claim.

This could occur, for example when your insurance policy doesn’t provide enough insurance to cover your losses. You’ll need to pay an additional amount when the insurance company believes that you’ve exaggerated the amount of your claim.

If you aren’t satisfied with the reasons offered by the insurance company in refusing to pay your claim, you’re 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’s worth challenging the decision in the event that you believe that it was wrongly denied. This is because such rulings can be rescinded (often when you take this to Financial Ombudsman Service – find out more details about this in the following):

Verify that you provided 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, write it down. Your insurance company is required to provide you with clear and concise details and must provide an explanation that is reasonable for not paying your claim.
The new rules stipulate that insurance companies can’t refuse to accept your claim if they were able to answer all of their questions in a timely manner as well as to your best ability. If your insurance company didn’t request information, but they’ve now said you must have disclosed the information in a timely manner the information, so note that down as well.
Did the insurance company ask you to provide the information it claims you should have divulged? 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 written note to inform that they had changed your situation (this is your obligation) Try to locate an original copy of the letter.

Get in touch with the insurer

If you’ve looked over your insurance policy now is the time 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 company’s complaint procedure.

Your complaint will then go through the internal review procedure. You may request more details about this if wish to.

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

How do you write an official complaint letter

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

Place an inscription on your letter.
Please provide your name and the your policy number.
The letter ‘complaint’ should be placed prominently on the top.
Include any evidence you can to back up your claim.
Write what you want your company’s response to make things right.
Be clear in your explanation of your complaint and explain why your claim shouldn’t be denied.
Declare that you’re not satisfied with the response from the company. You’ll submit the issue before the Financial Ombudsman Service.

Request an independent assessment

If the issue is a technical issue or a specialist issue or specialized, you may want to seek an independent opinion. For instance, if the insurance company claims that the damages to your property occurred caused by wear and tear but you’re saying it was caused by an accident.

It’s a good idea to get an assessment specialist (not in the same way as a loss adjuster who is employed by the insurance firm) to evaluate the damage and provide a assessment to insurance companies to provide evidence.

You should be aware of the fact that these companies will charge you a fee to represent 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 complaints procedure, you’re entitled to the right to bring complaints to Financial Ombudsman Service.

The Financial Ombudsman Service is an free, independent service that examines complaints by people about financial firms.

If you bring your issue with them, they’ll look at all sides of the issue, look at the evidence and try to reach a fair conclusion that is based on evidence and the commonsense.

It is only possible to make an official complaint after receiving the term “final response from your insurance company after eight weeks been passed but you haven’t 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 authority to force an insurance firm:

Define the actions of the company.
apologize and
Pay compensation or take the appropriate actions to alter the result.

Make sure you send it along with the copy of the last answer letter sent by your insurance provider and any other documents to support your claim.

Do I require an “expert to assist me in my problem?

You shouldn’t require any help or assistance when you have a complaint.

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

Every person has the right of having someone represent them.

A few people may prefer to ask somebody from community Citizens Advice or a relative or friend assist people with their complaints.

However, if you choose to engage someone else to present your case on your behalf – for instance, the claims management company you may have to cover their expenses yourself.

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