Most insurance claims are approved, but if an insurance company does deny a claim, here’s what you can do:
Check your policy
When rejecting your claim, the insurance company should give a reason and clearly explain how it relates to your policy. Using their rejection letter as a guide, check the relevant sections of your policy carefully. If everything matches up, the insurance company is within their rights to deny the claim. If things aren’t quite right, move to the next step.
Is the wording vague?
The wording in your policy may be ambiguous enough that you can interpret it one way and the company another. The law protects you in these situations, because insurance companies are required to use clear language that remove any ambiguities.
Review the details in your claim
Maybe you communicated the details in your claim incorrectly, or perhaps the person who took your claim made a mistake or didn’t ask the right questions.
If the fault is yours, you may or may not have recourse; but an error on the part of the representative will require the company to reopen the claim.
Speak with the insurance company
If you are confident that the insurance company made an error somewhere along the way, contact them directly with the correct information. Hopefully, the company will accept their mistake and approve your claim. If the company is unreceptive, move on to more formal communication.
Write a letter of complaint
When necessary, send a letter of complaint to the contact listed in the complaints procedure section of your policy. It should include:
- the date
- your name
- your policy number
- why the insurance company’s decision to deny the claim is incorrect
- evidence that supports your claim
- what action you expect the company to take
If the letter does not get the results you want, your final step is to hire a lawyer or contact your ombudsman service.
If you are unhappy with your current insurance provider, speak with an independent broker to find a better fit for you.
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