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Problems with claiming insurance

What happens if your insurer won't pay out on your claim? Read on for premium quality advice.

If you think you might be able to make a claim on an insurance policy the first step is to check the policy carefully. Even if you think you know what's covered, it's worth taking a close look since the language of policy documents isn't always easy to follow.

If in any doubt, start by calling the insurance company themselves. If you're not satisfied with their response then contact your local Citizens Advice Bureau (CAB).

If you decide to make a claim, do it as soon as possible and follow the procedure set out in the policy document. Don't be tempted to exaggerate your claim, it's illegal and you will run the risk of getting nothing

Claim met in part

There could be many reasons why your insurer offers to pay less than the full amount you claim for.

A spokesperson for Direct Line insurance says that this the most common problem they find with home contents insurance is people under-estimating the total value of their possessions. "Your contents include everything that would fall out if you imagine your home was tipped upside down. That means things like books, tables, couches, towels, bed linen - it all adds up. And it's also important to raise the valuation on your policy when you buy things such as a new kitchen or a sofa. If you aren't covered for the full value of these things and the worst does happen, like a fire, you will only get what you were insured for."

If the item for which you are claiming on contents insurance was old, your insurer will pay you less than the cost of replacing it with a new item as you've have already had some use from it. However, if you have an 'old for new' policy you'll get the full cost of a brand new item.

Another problem might come from underestimating the costs of the action you insured against - for example, an injury or illness whilst overseas

Finally, for any number of reasons, the insurer might think that your claim is unrealistic. For example, if you are insured against a personal injury you might argue that it prevents you from working for a certain amount of time and they might not accept that. If you think your insurer is being unreasonable, you can try to negotiate. If you are still not satisfied with the way your claim has been dealt with, you will need to make a complaint (see below).

Excess and no-claims bonus

Most insurance policies carry an excess charge - a fixed fee that you have to pay if you make a claim. That might mean that for small items it's not worth making a claim.

Most motor insurance policies carry a no-claims bonus - a reduction based on how long it's been since you made a claim. Again, this might put you off making small claims.

Claim refused

Your insurer may refuse to pay your claim because the incident you are claiming for is not covered by your policy. Situations aren't always clear cut, so it's important to read the policy carefully before signing up.

Failure to pay some of the instalments of your premium could also lead to them refusing to pay, unless you can somehow prove this was their fault - for example, if they omitted to send you a bill.

Other reasons for claims being refused include a failure to:

  • Notify your insurer of a change in your circumstances (for example, your contents insurance could be affected by you sub-letting a room)
  •  Follow the claims procedure of your policy correctly (for example, not informing the police after a burglary)
  • You have not kept to a condition of your policy.

Uninsured losses

Sometimes an incident can result in expenses that your insurance policy does not cover - these are known as uninsured losses.

If you suffer a financial loss for which you are not insured, and which is someone else's fault, you may be able to take them to court to recover your expenses. Your local Citizens Advice Bureau (CAB) can give you advice about what action you can take in this situation.

Complaining about a claim

If you're not happy with the outcome of your claim, follow the insurance company's complaints procedure.

If you're still not satisfied, you can contact the Financial Ombudsman Service on 0845 080 1800.

If you can't track down your insurer and want to either them an intermediary, or broker, then contact the Financial Services Authority's Moneymadeclear service on 0300 500 5000

If your claim has not been settled because your insurer has gone out of business, you may be able to get help from the Financial Services Compensation scheme.  If your insurer is a member of Lloyds, you should contact the complaints department at Lloyds on 020 7327 5693.

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Updated: 17/10/2011

Written by Tom Green


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