Insurance Claim Declined


January 20  

What types of insurance claims can be declined?


Life Insurance


Life insurance provides a pay-out of a lump sum or regular smaller payments of money to your loved-one’s/dependents upon your death.

If you have ongoing existing medical conditions, you may not be covered for this insurance or you may require alternative additional cover for those medical conditions at a higher cost to you.

Critical Illness


Critical illness insurance cover provides for a pay-out of a lump sum or an income if you are diagnosed with certain serious illnesses. The following is an example, and not exhaustive, of what constitutes as a serious illness: –

  • Certain types of cancers and certain stages are specified in insurance cover;
  • Strokes;
  • Heart attacks;
  • COPD;
  • If you are left disabled after an illness or injury.

This cover is crucial if your dependents and loved-one’s depend upon your income to meet their day-to-day living expenses.


Travel Insurance


Travel insurance is a cover that provides security to you when travelling abroad, for instance, if you require medical care and assistance whilst travelling abroad. It can also cover the costs of stolen or lost bags or cancelled holidays. It also covers emergency medical expenses, including making arrangements to get you home for further treatment.

Most standard travel insurances do not cover extreme sports or winter sports or any activity which is considered dangerous. These activities will require additional travel insurance cover in order for you to be protected. 


Home Insurance


Home insurance is insurance taken out to protect your home in the event it needs to be repaired or rebuilt, usually due to severe and unexpected weather damage, including floods and in cases of subsidence. 

It does not usually cover general wear and tear of a property due to age and general weathering over time. Mortgage lenders will usually insist upon home insurance being taken by you alongside a mortgage. It is a legal requirement to have home insurance on any home that is owned by you.

What Can I do if my Insurance Claim is Declined?

If your insurance claim is declined, and you feel it is not right or unfair, then there are things you can do to challenge them. 

You should firstly check your insurance policy cover to work out whether the facts the insurance company have given are correct. If you took all reasonable care and answered all the questions put to you by the insurance company when you took out your policy cover, but the insurance company now say that you should have disclosed other information voluntarily that they did not in fact ask you for, then this could be a reason to complain if your insurance claim is rejected for that reason.

If you are not happy with the insurance company’s response to your complaint, or they fail to respond to you within the appropriate timescale (usually eight weeks), then you can refer your complaint to the Financial Ombudsman Service to review your complaint further and adjudicate on whether you should receive financial compensation on your claim. 

Do Many Insurance Claims get Declined?

Many insurance claims unfortunately can and do get declined by insurance companies. 

This can be as a result of incorrect information being given by you to the insurance company. For example, if you had a long-term medical issue and you did not disclose it with your life insurance cover/critical illness cover and then you, or your dependents, had to make a claim, this would probably be rejected, especially if you had not previously disclosed that medical condition when taking the cover.

In respect of many home insurances, these mostly get rejected for not taking reasonable care of your items. For example, if you left your home unlocked when you left it and then it was burgled, you would not have been taking reasonable care of your home by leaving it unlocked. 

If you believe the reasons the insurance company give for not paying out on your claim are unfair, then you do have a right to make a complaint and to ask that it be looked into further by the insurance company and/or the Financial Ombudsman Service.

My Spouse’s Insurance Claim was Declined. What can I do?

If you find yourself in the situation where your spouse’s insurance claim was declined by the insurance company and you do not agree with their reasons, you should: –

  1. Ask the insurance company to set out clearly and fully the basis of their rejection of the claim;
  2. Check the details of the policy of the insurance company to see if the facts given for the rejection are justified.
  3. Ask the insurance company to review their decision based upon the points you raised and request that they compensate you.
  4. If the insurance company does not agree with you and you still feel that the claim should be paid, you have the right to refer your complaint to the Financial Ombudsman.

My Critical Illness Cover Claim was Declined. What can I do?

If your critical illness cover claim was declined, and you do not agree with it, you should firstly get together all the policy documents and information that you have available and look at what is and is not covered. 

You should set out your reasons to the insurance company why you do not agree with their assessment not to pay out on the claim. If they still do not agree or you do not receive a response within the required timescale (eight weeks from the date you sent the complaint), then you may refer your matter to the Financial Ombudsman Service. They have free websites with lots of helpful and useful information on them to assist you with your complaint. 

If you do not feel confident doing this yourself, or you require help and assistance doing this (as we are sure it will be at a difficult time for you and you may not have the time to sift through paperwork and clauses yourself), then we would be delighted to assist you. 

If you do instruct us to assist you with your rejected insurance claims, we will work on a “No Win, No Fee” basis, where if we are successful in securing the pay-out of your claim, we will only charge 24% (inclusive of VAT) of any monies recovered on your behalf.

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