Insurance Claim Rejected? Overturning Your Insurer’s Decision

Insurance Claim Rejected? Overturning The Insurer’s Decision

As a policyholder, you may find yourself in an insurance dispute where your insurance company is not paying you for your loss and the claim is rejected. This can be a confusing and frustrating experience for policyholders. It is essential to know you have several legal options if your insurer has breached the terms of your insurance policy.

Do you need help with overturning a rejected insurance claim? Book a Free Consultation Call by calling 0208 185 0990. We do not deal with any road traffic accident disputes. You should contact your car insurance company if you are involved in a road traffic accident.

What are my rights if my insurance claim is rejected?

If your insurance claim is rejected, you have the right to complain to the insurer and ask for a review. The insurance company is required to give you a written explanation of why your claim was rejected i.e. which terms of the policy have been breached, why the insurance claim is unsuccessful and if you are unhappy with the decision the next stage to challenge the decision.

If you are still not satisfied with the decision, you can appeal the insurer’s decision with the Financial Ombudsman – within 90 days of receiving the insurer’s final decision. The Financial Ombudsman is an independent organisation that can help you resolve disputes with your insurance company.

Why has the insurance company rejected my claim?

Insurance companies can use multiple reasons to reject an insurance claim, some legitimate and some not. Here are some common reasons for rejecting and not covering your claim which leads to an insurance dispute:

  1. Lack of coverage: Your insurer might argue that your claim is not covered by your policy. Examples include a theft, a fire or an accident outside a particular jurisdiction. Always examine the exclusions clauses of your policy to understand what is not covered. Remember that ambiguities within the policy will generally be interpreted in favour of the policyholder, not the insurance company.
  2. Application errors: Your insurance company could claim that your initial application was not completed accurately and this may void the coverage of your policy. This may lead to an allegation of misrepresentation by the insurance company. However, there are ways to challenge and explain any application errors to avoid an insurance dispute.
  3. Insurance claim notification errors: Your insurance company may argue some information was provided during the claim notification process i.e. the first recorded call with the insurer reporting the claim, which allows the insurer to reject the claim. Consult your policy to determine what requirements are in place for notifying the insurer of a claim in order to avoid an insurance dispute. Some notification windows can be as brief as 24 hours.
  4. Insurance fraud: The insurance claim may be suspicious and the insurance company forms an opinion that you have submitted a false or exaggerated claim. Therefore, the exclusion clauses in the policy apply and any fraudulent claim can be rejected.
  5. Bad faith denial: While insurers won’t outright admit this, they may use confusing jargon or numerous justifications to disguise their unwillingness to pay for a valid claim.

How to overturn or challenge a rejected insurance claim?

There are several grounds on which you can overturn an insurance dispute. These include:

  • The insurance company did not properly investigate your claim.
  • The insurance company did not follow its own terms and conditions.
  • The insurance company made a mistake in its decision.

As experienced Insurance Dispute Lawyers, we will carefully review: (a) your insurance policy, the policy wording and certificate of insurance (b) the information/ documents provided when you first reported the claim to the insurer and (c) the insurer’s rejection letter and any other documents to determine if you you can overturn the rejection of the insurance claim. We can then advise you accordingly on your right to challenge the rejected claim.

When To Sue The Insurance Company?

Insurance companies have numerous obligations towards their policyholders, such as abiding by the policy’s terms, acting in good faith and honouring the terms of the policy. Generally, these obligations require that insurance companies refrain from the following conduct:

  • Conducting an inadequate or delayed investigation into the insurance claim,
  • Refusing to pay a claim when liability is reasonably clear,
  • Failing to approve or deny a claim within a reasonable or specified timeframe,
  • Denying a claim with little or no explanation as to the reason.

If your insurance company has engaged in any of these behaviors and violated their contractual obligations towards you, legal action may be warranted. Don’t forget that you have rights as a policyholder under the Consumer Rights Act 2015 and the Financial Conduct Regulations, which the insurer must comply with. You are entitled to receive fair treatment from your insurer.

How Anwar Legal can help you overturn the insurer’s decision?

If your insurance company has rejected your insurance claim, and you want to challenge the insurance company, then we can assist you in overturning the insurance dispute. Mr Usman Anwar, Legal Director, has helped many people overturn rejected insurance disputes.

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The law expects both you and the insurer to have acted reasonably. If the insurer will not fully cover your claim you may have to take legal action against them. The first step is to write a letter of complaint to the insurance company. You can download a Free Templater Letter of Complaint

We have a successful history of dealing with a number of insurance disputes such as:

  • stolen vehicle insurance,
  • buildings and contents insurance,
  • health insurance,
  • other insurance policies.

How long does it take to overturn an insurance dispute?

The length of time it takes to overturn an insurance dispute will also vary depending on the complexity of the case. In general, the process can take anywhere from a few months to a few years.

How much will it cost?

At the very beginning, we will discuss the different ways to fund your case such as fixed legal costs or hourly rates. We will keep your legal costs to a minimum and be clear at the very outset. For more information, see Fixed Legal Costs And Fixed Fee Litigation Advice

We would always suggest entering into Alternative Dispute Resolution/ Mediation which may settle the dispute quickly and avoid Court action. For more information, see Mediation and Alternative Dispute Resolution (ADR).

Contact Us

If you are seeking an insurance dispute disputes lawyer, we can help with your case. To book a Free Consultation Call, with Mr. Usman Anwar Legal Director, you can complete the Contact Us Form or call us on 0208 185 0990.

Still not convinced? Read some of our client’s success stories and testimonials on how they settled their insurance disputes using our legal service.

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