Your insurer refuses your claim
When you try to make a claim on your insurance policy, you may find that your insurer refuses your claim or does not pay out the full amount you are asking for.
This page tells you why an insurer might decide to do this.
Why your insurer might refuse your claim
Your insurer may refuse to pay your claim because:
- the policy was not in force when what you're claiming for happened
- the policy is invalid because you didn't tell the truth when you applied for insurance or failed to disclose something which could affect your claim (for policies taken out, renewed or changed before 6 April 2013)
- the policy is invalid because you deliberately or carelessly withheld information or misled your insurers (for policies taken out, renewed or changed after 6 April 2013)
- the item is not covered by your policy
- there is an exclusion clause in the policy which means that you can't claim for what's happened
- you've missed some of the instalments of your premium
- you didn't tell your insurer about a change in your circumstances
- you haven't followed the claims process correctly
- you haven't kept to a condition of your policy
- you have exaggerated the claim and are trying to claim for more than you should.
Your insurer must give you a reason for refusing to pay your claim. Check the details of your policy carefully to make sure that their decision is reasonable.
If you think your insurer is being unreasonable in refusing your claim, you can try to negotiate with them. If you are still not satisfied with the way your claim has been dealt with, you can make a complaint using their complaints process.
- More on when your insurer can refuse your claim when you don’t give relevant information - for polices taken out, renewed or changed before 6 April 2013
Uninsured losses and your excess
Sometimes a claim will not be covered by your policy. This is called an uninsured loss. For example, a power cut may mean that your freezer contents have to be thrown away but your policy may not cover the cost of replacing them.
If your insurance policy includes an excess, this is also a type of uninsured loss. An excess is the fixed amount of any claim, for example the first £50, that you must pay yourself.
If you lose out financially and you're not insured but what's happened is not your fault, you may be able to take the person or company who caused your loss to court to recover your expenses.
Paying excess for a car accident that isn’t your fault
When you pay the excess for a car accident which isn’t your fault, you may need to claim this back from the insurance company of the driver who caused the accident once the claim is settled, if you don’t have legal expenses cover to pay this for you. If you have trouble getting your money back, you can take the insurance company or driver to court.
If your insurance company have dealt with the claim, they should claim the excess back for you. If you have a no fault accident, a credit hire company can also make a claim on your behalf.
Your insurer will not pay out the full amount
Your insurer may agree to pay some of your claim, but not the full amount. This may be because:
- you have under-estimated the total value of your claim and do not have enough insurance to cover your losses. This is called being underinsured.
- your insurer thinks that you have put an unrealistic value on your claim, and will only pay you part of it
- unless you have a new for old policy, the item for which you are claiming was old, and your insurer will pay you less than the cost of replacing it with a new item. This is because you have already had some use from it
- there is a limit in your policy on the amount the insurer will pay for any one item
- you have to pay an excess
- you deliberately or carelessly withheld information or misled your insurers when you took out, renewed or changed your policy and the insurer would have charged a higher premium because of this.
If you think your insurer is acting unreasonably in refusing to pay the full amount of your claim you should try to negotiate with them to reach an agreement. If you’re not satisfied with what your insurer offers, you can complain using your insurers complaints process.
Other useful information
- To find out about the Financial Ombudsman’s approach to dealing with disputes about insurance at www.financial-ombudsman.org.uk
Contact your local Citizens Advice bureau or Advice Direct Scotland's consumer service if you need more help.
Advice Direct Scotland's Consumer Service
Freephone: 0808 164 6000