Insurance claim rejected? Here’s what you can do - Martyn James

Insurance is one of those vital expenses that we can’t afford to do without. But insurance contracts vary considerably and sometimes when you come to make a claim, you might find that you get turned down.

Surprisingly, lots of people aren’t aware that they can complain about a rejected claim or that they can ask the free Financial Ombudsman Service to sort out a dispute if they aren’t happy.

So here’s my guide to why claims get turned down – and what you can do about it.

Policy exclusions

Insurance is designed to cover you for all kinds of situations. However, there are some things you can’t claim for. Some of these exclusions make sense, while others can be random or unfair. Common exclusions involve:

· Health issues and medical conditions.

· Specialist products

· Previous claims.

· Risky activities or behaviour.

· Poor maintenance or products reaching the end of their lifespan.

· Catastrophes.

That last exclusion includes acts of war, natural disasters and international incidents. You can still make a claim, but what you can claim for might change. For example your travel insurance might get you home if your holiday destination is swept by wildfires like Greece was last year, but won’t necessarily pay out if you want to get a refund on a holiday after the fire is out.

How to appeal: Just because there’s an exclusion in the contract doesn’t mean it’s fair. You can appeal if you weren’t made aware of any ‘key facts’ when you took out the contract.

Non-disclosure

When you take out insurance, you’ll be asked to ‘disclose’ all relevant information that the insurer needs to determine if they can offer you a policy and how much you’ll pay in premiums, based on the risk of having to pay out. They must ask you clear questions so you know exactly what to tell them.

It’s easy to forget some things, or not realise that other facts are important. Confusion over disclosable medical conditions is the most common problem, but non-disclosure can also be applied to inaccurate descriptions of what you’re insuring (like your house), previous claims histories and other factors.

How to appeal: If you made a genuine mistake due to unclear or ambiguous questions, or if the reason for rejecting your claim isn’t fair, you can complain.

Policy limits

All insurance policies have limits and excess fees. The first is the maximum amount a policy will pay out, the second relates to the amount of money you have to pay towards any claim. So if your travel insurance has a maximum policy limit of £10,000 for personal possessions but the excess is £1,000 the maximum you can claim for is £9,000. You will need to prove that you genuinely owned the items and must explain what happened to them too for your claim to succeed.

How to appeal: Policy limits should be highlighted clearly in a ‘key facts’ document. If this wasn’t made clear, or the contract was confusing, take it further.

Wear and tear

Over time, everything starts to show its age. This is known as ‘wear and tear’. If your fence falls down in a storm and you claim on your home insurance policy, the insurer will send out a loss adjuster. But if they conclude the fence was poorly maintained they can reject your claim due to ‘natural wear and tear’.

How to appeal: Wear and tear is highly subjective. Just because the insurance experts say it’s your fault doesn’t make it right. Dig out some photos and documents proving you’ve maintained the item as part of your complaint.

Time limits

‘Non-claimable periods’ or ‘initial exclusion periods’ are timescales during which you can’t make a claim. This is partly to stop people trying it on by not disclosing the thing they want to claim for, then taking out a policy to cover it. But they also ensure that high value claims aren’t made too quickly.

How to appeal: Claim deadlines are ‘key facts’ – so if you weren’t warned, make a claim.

Martyn James is a leading consumer rights campaigner, TV and radio broadcaster and journalist. Visit martynjamesexpert.co.uk.