Advice centre

Insurance claim rejected? Here's what to do

A rejection letter isn't always the final word. Here's why claims are turned down, how to challenge the decision and where to go if your insurer won't move.

A woman in an office talking on the telephone
Why it happens

Why insurers reject or reduce claims

Your policy is a contract. An insurer can turn a claim down if it believes the loss isn't covered, you haven't kept to a condition of the policy, or something wasn't disclosed when you took the cover out.

That doesn't mean the insurer is right. Decisions are often based on the loss adjuster's report, and that report is written from the insurer's point of view. Exclusions can be applied too widely, and evidence can be missed or misread.

Read the decision letter carefully. It should tell you which part of the policy the insurer is relying on. That's the starting point for any challenge.

Common reasons we see

Wear and tear or gradual damage

Often used for storm, roof and escape of water claims. It can be challenged when the event, not age, caused the damage.

An exclusion in the policy

Such as unoccupancy, flood in some policies, or poor workmanship. The exact wording matters.

Non-disclosure

The insurer says something wasn't declared when you bought the policy. It must usually show it would have made a difference.

Breach of a condition

For example, alarm or security requirements. Whether the breach had anything to do with the loss can be important.

Not enough evidence

Missing proof of ownership or of what happened. This can often be put right.

Underinsurance

A claim reduced because the sum insured was too low. The calculation is worth checking.

Step by step

How to challenge the decision

Act promptly and keep everything in writing.

  1. Ask for the reasons in writingRequest the policy wording relied on, and a copy of the loss adjuster's report or the key findings.
  2. Check the policy wordingCompare the reasons with the exact wording of the cover, exclusions and conditions in your policy.
  3. Gather your evidencePhotos, reports, receipts, emails and any expert opinions that support your version of events.
  4. Make a formal complaintTell the insurer you want your complaint dealt with under its complaints procedure.
  5. Wait for the final responseInsurers generally have eight weeks to send a final response to a complaint.
  6. Go to the Financial Ombudsman ServiceIf you're unhappy with the final response, or don't get one within eight weeks, you can refer it to the ombudsman.

The Financial Ombudsman Service

The Financial Ombudsman Service settles disputes between consumers and financial businesses, including insurers. It's free to use for consumers and many small businesses.

You generally need to refer your complaint within six months of the insurer's final response, so don't leave it too long. The final response letter should explain your right to refer it.

The ombudsman looks at what's fair and reasonable in the circumstances, not just the strict wording of the policy.

FAQs

Common questions

See all FAQs
Can my insurer reject my claim?

In some circumstances, yes. An insurer can turn a claim down if the loss isn't covered, a policy condition hasn't been met, or it suspects fraud. But insurers can get it wrong, and many decisions can be challenged.

How long do I have to complain?

Complain to your insurer as soon as you can. If you then want to go to the Financial Ombudsman Service, you generally need to do so within six months of the insurer's final response.

Does it cost anything to go to the ombudsman?

No. The Financial Ombudsman Service is free for consumers and many small businesses.

Can a loss assessor help after a claim has been rejected?

Yes. We regularly take on claims that have been rejected or reduced. We'll look at the decision and the evidence and give you an honest view of your chances before you commit to anything.

Keep reading

More from our advice centre

All guides
Loss adjuster vs loss assessorWho they work for, what they do and why it pays to have your own representation. Underinsurance explainedHow being underinsured can reduce your settlement, and how to check your cover. Questions your loss adjuster may askWhat a loss adjuster will ask you, why they ask it and how to answer.

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