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Claim rejection

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How can my insurer reject my claim?

  1. If you have been advised that your claim has been rejected, then insist on seeing a formal letter of rejection from the Insurer, not just what your Broker has told you or written to you, but the actual communication from the insurer formally rejecting the claim.
  2. The letter should convey to you clearly the detailed grounds upon which the Insurer bases it’s rejection of the claim. If the grounds are not clear, ask for clarity, and if you do not receive it, this is probably in itself a good reason to approach the Ombudsman or your legal advisors.
  3. Read those grounds carefully in conjunction with the Policy itself. If you are not in receipt of the Policy wording, then you are entitled to one from your Broker or your Insurer.
  4. There are numerous grounds on which an insurer may reject a claim, depending on the type of claim and the extent of the cover being provided.  You must bear in mind that the intention of an insurance contract is not to cover every loss under all circumstances.  Further, by the very nature of it, an insurance contract, like all other contracts, contains terms and conditions, which allows the insurer to exclude liability in certain instances.

What steps do I take once a claim has been rejected?

  1. Having examined the Policy and the grounds of repudiation you must make a preliminary decision as follows:-
    • Are the facts set out as justifying the grounds of rejection correct?
    • Do those facts, in terms of the Policy conditions or exclusions, entitle the Insurer to reject
    • If the answer to either or both of these questions is "No", then you may well have valid grounds for complaint. However, please bear in mind that where facts are in dispute, that usually means the issue can only be determined by evidence and you need to consider the strength of the evidence in support of your version of the facts, and against the Insurer's version.
  2. Before considering what step to take next, look at it OBJECTIVELY and put to yourself the questions posed. Finally, don't delay in dealing with the matter.  The Policy contains a Clause which states that you may make representations to the insurer and request further information regarding the rejection.  Further, if you don't institute legal proceedings or lodge a complaint with our office within a certain period after the rejection then you are precluded from doing so thereafter.