Insurance Claim Rejected? How to Fight Back and Win

Insurance claim rejected? Don't accept it as final. Many rejected claims are overturned when challenged properly. Here's how to fight back and get what you're owed.

Why Claims Get Rejected

Common reasons insurers reject claims:

• Non-disclosure - You allegedly didn't tell them something material
• Policy exclusions - They claim an exclusion applies
• Missed time limits - You apparently reported too late
• Insufficient evidence - They say you haven't proved your loss
• Terms and conditions breach - You allegedly broke a policy term

Many of these rejections can be challenged successfully.

Your Rights Under UK Law

The Insurance Act 2015

This law changed everything in consumers' favour:

• You only need to take reasonable care to answer questions honestly
• Insurers can only reject claims if your non-disclosure was deliberate or reckless
• For innocent mistakes, they must pay a proportionate settlement
• They can't rely on obscure policy terms you weren't clearly told about

FCA Rules

Insurers must:

• Treat customers fairly
• Handle claims promptly
• Give clear reasons for rejection
• Tell you about your complaint rights

Step-by-Step: Challenging a Rejection

Step 1: Get the Written Reasons

Ask for a detailed written explanation of why your claim was rejected. They must provide this.

Step 2: Review Your Policy

Read your policy carefully. Look for:

• The specific exclusion or term they're relying on
• Whether that term was made clear to you
• Any ambiguity you can exploit (ambiguity is interpreted in your favour)

Step 3: Gather Your Evidence

Collect everything that supports your claim:

• Photos and videos
• Receipts and valuations
• Witness statements
• Expert reports
• Communications with the insurer

Step 4: Write a Formal Complaint

Send a detailed complaint to the insurer including:

• Why you believe the rejection is wrong
• Evidence supporting your position
• What resolution you want
• Reference to the Insurance Act 2015 if relevant

Step 5: Escalate to Financial Ombudsman

If the insurer maintains their rejection (or doesn't respond within 8 weeks), escalate to the Financial Ombudsman Service (FOS).

The Financial Ombudsman Service

Why It's Powerful

• Free for consumers
• Independent of insurers
• Can award up to £445,000 (as of April 2025)
• Decisions are legally binding on insurers
• Can consider what's fair and reasonable, not just the letter of the policy

How to Complain to FOS

1. Complete their online form at financial-ombudsman.org.uk
2. Include all correspondence with the insurer
3. Explain what happened and why you disagree
4. State what you want as an outcome

Timeline

• FOS will acknowledge within 2 weeks
• A caseworker is assigned within 1-2 months
• If you disagree with the initial assessment, request an Ombudsman decision
• Final decision is binding on the insurer

Common Rejection Excuses (And How to Fight Them)

"You didn't disclose X"

Your counter: Under the Insurance Act 2015, you only needed to answer their questions honestly. If they didn't ask, you weren't required to volunteer information. For innocent or careless non-disclosure, they must pay a proportionate claim.

"This is excluded under clause Y"

Your counter: Was this exclusion made clear at the point of sale? Was it a significant or unusual exclusion? The FCA says unusual exclusions must be specifically drawn to your attention. If it was buried in small print, challenge it.

"You reported too late"

Your counter: Did you report as soon as reasonably possible? Were there circumstances that prevented earlier reporting? Late notification is only grounds for rejection if the insurer was actually prejudiced by the delay.

"You haven't provided enough evidence"

Your counter: Have you provided what's reasonably available? The insurer can't demand impossible levels of evidence. For many claims, photos, receipts, and your statement should be sufficient.

"The policy wasn't in force"

Your counter: Check payment records. If you paid premiums, you had cover. Direct debit failures should have triggered notifications before cover lapsed.

Types of Insurance Claims

Home Insurance

Typical disputes:

• "Pre-existing damage" claims for storm damage
• Valuation disagreements
• Accidental damage vs wear and tear

Car Insurance

Common issues:

• Fault determination disputes
• Write-off valuations too low
• GAP insurance claim complications

Travel Insurance

Frequent problems:

• "Pre-existing condition" rejections
• Insufficient documentation for theft
• Cancellation claim disputes

Life and Critical Illness

Serious disputes:

• Medical non-disclosure allegations
• Definition of "critical illness"
• Evidence of disability or illness

Getting Expert Help

Loss Assessors

For significant claims (especially home insurance), a loss assessor works for you to maximise your payout. They typically charge a percentage of the settlement.

Solicitors

For complex or high-value disputes, consider a solicitor specialising in insurance disputes. Many offer free initial consultations.

Citizens Advice

Free initial guidance on your rights and options.

Success Statistics

The Financial Ombudsman upholds around 30-40% of insurance complaints. This means insurers reject many claims that shouldn't be rejected.

Take Action

Don't accept an unfair rejection. Know your rights, gather evidence, and escalate through the proper channels. Use our complaint letter generator to create a formal challenge to your insurer.