Complaints & Rejected Claims

Why claims are rejected

Common reasons include a claim falling outside what the policy covers, an exclusion or condition not being met, or the insurer believing information was not disclosed accurately. Since the Consumer Insurance (Disclosure and Representations) Act 2012, a consumer only has to take reasonable care not to make a misrepresentation — an insurer cannot refuse a claim over an innocent, honest mistake in the same way it once could.

If a claim is turned down, ask the insurer to explain in writing which policy term it relied on. That gives you a clear basis to challenge the decision if you think it is wrong.

How to complain

Complain to the insurer first, setting out what went wrong and what you want it to do. The firm has up to eight weeks to give you a final response. If it does not resolve things, or you disagree with its decision, you can refer the complaint to the Financial Ombudsman Service, which is independent and free to use. You normally have six months from the date of the final response to do this.

What the Ombudsman does

The Financial Ombudsman Service looks at the evidence from both sides and decides what is fair and reasonable in the circumstances. If it upholds your complaint it can tell the insurer to reconsider the claim, pay what is owed with interest, or compensate you for any distress or inconvenience caused. Its decision is binding on the firm if you accept it.