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Why was my insurance claim refused?


There are several reasons why a claim could be refused:

  1. Inaccurate or withheld information (also known as misrepresentation and non-disclosure) – Your policy is based on your answers to questions the insurer asks about you and your property. An incorrect or incomplete answer could invalidate your cover, reduce the amount paid if you need to claim, or stop your claim being paid.
  2. Property not maintained – if it is found that damage or a loss was due to the building being neglected then your insurer can refuse to pay your claim.
  3. Contents not specified – some policies insist that you specify certain items worth more than particular amounts. If you have not done so, your insurer can refuse to pay your claim. 
  4. Partial pay out – your insurer might refuse to pay the full amount of your claim if you have under-estimated the total value of your cover (known as 'being under-insured').

What to do when an insurer denies your claim

There are a number of rules governing what insurance companies can and can't do when it comes to rejecting claims. According to the Financial Conduct Authority's Insurance Conduct of Business Rules, an insurer must not 'unreasonably reject a claim made by a customer'; and (except in cases where there is evidence of fraud) must not refuse to meet a claim on the grounds of non-disclosure of information that the customer could not reasonably have been expected to disclose, or (except where a misrepresentation was negligent) on the grounds of misrepresentation of information.

Your insurance provider must give a fair reason for rejecting your claim. You should then check your policy documents if you disagree with your insurer’s decision.

Check that the details you have shared are accurate and note any policy wording that is either ambiguous or which states that you should be covered. If relevant, get an independent opinion. You might find it necessary to do this if you are claiming for accidental damage for instance and do not agree with the insurer’s loss adjuster.

If your claim has been refused and you don’t believe you have been treated fairly then you can take steps to address the issue. You should first contact the complaints department and give them eight weeks to respond. You can then get in touch with the Financial Ombudsman if a fair and reasonable outcome cannot be agreed.

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