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Some rejections fall over the moment someone reads the wording properly. Others are correct, and pursuing them costs months for nothing. Five questions, an honest answer, and no sign-up. If the insurer is probably right, this will say so.
1. What reason did the insurer give?
2. Did they give it to you in writing?
3. Do you have the full policy wording, not just the schedule?
4. Have you complained to the insurer's own grievance cell?
5. How long since the insurer's decision?
Almost every dispute turns on the policy wording rather than the schedule. The schedule tells you the sum insured and the premium; the wording tells you what is actually covered, and it is the document claims desks quote and policyholders rarely have. Getting it is the single most useful thing you can do, and the insurer must give it to you.
The second thing is written reasons. A refusal you cannot quote is a refusal you cannot challenge, and the Ombudsman will ask for it. If the decision came over the phone, ask for it in writing before anything else.
Complain to the insurer's grievance officer first, in writing. If the reply does not satisfy you, or 30 days pass in silence, take it to the Insurance Ombudsman for your area. It is free, needs no lawyer, and its award binds the insurer but not you, so you keep every right you had. Do it within a year of the insurer's reply.
We publish what actually happens at each of the 18 Ombudsman centres: how fast they are, and how often the award goes to the policyholder rather than the insurer.
A broker that promises to fight every rejection is selling hope. Some claims are excluded, and the honest answer saves a year of correspondence and the disappointment at the end of it. When we say a claim is not worth pursuing we are turning down work, which is the only reason to believe us when we say the opposite.
No. Every insurer must give its reasons in writing, and you can ask it to reconsider. If that fails you can go to the Insurance Ombudsman free of charge, and after that to a consumer forum. What matters is whether the reason they gave actually holds under the policy wording.
Not on its own. Insurers do reject for late intimation, but a delay that did not prejudice the investigation is a weak ground for refusing an otherwise genuine claim, and both the Ombudsman and the courts have taken that view repeatedly. It is worth arguing, particularly if you can show why the delay happened.
It depends on whether the undisclosed fact was material to the loss that actually happened. For life policies, section 45 of the Insurance Act bars an insurer from questioning a policy on grounds of misstatement after three years, with narrow exceptions. For health, an unrelated omission is far more arguable than one that goes to the cause of the claim.
Nothing. No fee, no lawyer required. The award binds the insurer but not you, so if you reject it your right to go to court survives. That asymmetry is why it is usually worth trying before anything more formal.
Complain to the insurer first. If you are not satisfied, or 30 days pass with no reply, you can approach the Ombudsman, normally within one year of the insurer's reply. Leaving it longer than that is the most common way a good complaint dies.
No. It is a rough sort based on how these disputes usually go, meant to save you months on a complaint that was never going to succeed. Nobody can judge your claim without reading the policy wording and the rejection letter.
Related: Ombudsman outcomes by centre · which insurers attract most complaints · claim-settlement ratios.