Challenge an Insurance Rejection

If your insurer has rejected your claim verbally or with a vague letter, write back immediately and request the rejection in writing with specific reasons citing the policy clause they are relying on.

Under the Consumer Protection Code 2012, insurers must provide clear reasons for claim decisions. A vague “your claim does not meet our criteria” is not good enough.

Once you have the specific reasons, read your policy document carefully:

• Find the exact clause the insurer is relying on
• Check if the exclusion is clearly worded and specific
• Look for any ambiguity — under the Consumer Insurance Contracts Act 2019, ambiguous terms are interpreted in your favour
• Check if the insurer pointed out the relevant exclusion to you at the time of purchase
• Verify the exclusion actually applies to your specific circumstances

Send a Subject Access Request to your insurer. This forces them to disclose everything in your claim file, including:

• Loss adjuster or assessor reports
• Internal notes and decision memos
• Correspondence between the insurer and third parties
• Any investigation reports or surveillance
• Records of calls or meetings about your claim

This is often where you find the evidence that the rejection was poorly reasoned or based on incomplete investigation.

If the rejection relates to the value of damage, cause of loss, or condition of property, get your own independent expert assessment. This could be:

• An independent loss assessor (works for you, not the insurer)
• An engineer's report for structural or mechanical issues
• An independent valuation for disputed amounts
• A medical report if the claim involves injury

Common grounds for challenging an insurance rejection:

• Vague or ambiguous exclusion: The policy wording is unclear, and under the Consumer Insurance Contracts Act 2019 ambiguity favours you
• Exclusion not highlighted at point of sale: The insurer failed to draw your attention to the exclusion (Section 8, CICA 2019)
• Improper investigation: The insurer did not properly investigate the claim before rejecting it
• Inconsistency: The insurer's own file (obtained via SAR) contradicts their rejection reasons
• Proportionality: The insurer rejected the entire claim for a minor technicality
• Late notification not prejudicial: If rejected for late notification, argue the delay did not prejudice the insurer's ability to investigate

Write a formal complaint letter setting out:

1. The claim reference number and date of rejection
2. Why you believe the rejection is wrong, referencing specific policy clauses
3. The legislation that supports your position (CICA 2019, Consumer Protection Code)
4. Evidence from your SAR that undermines the rejection
5. Your independent assessment, if you have one
6. The remedy you want (claim paid, reassessment, specific amount)

Send by registered post and email. The insurer must acknowledge within 5 business days and provide a final response within 40 business days.

The insurer has 40 business days to issue a Final Response Letter (FRL). This letter will either uphold your complaint, partially uphold it, or reject it.

If they do not respond within 40 business days, you can proceed to the FSPO without waiting further. The FRL (or expiry of the 40-day deadline) is your ticket to the next stage.

If the insurer rejects your complaint or you are not satisfied with their response, file a complaint with the Financial Services and Pensions Ombudsman.

The FSPO can:

• Order the insurer to pay your claim
• Award compensation for distress and inconvenience
• Direct the insurer to change how they handled the claim

If your disputed amount is under EUR 2,000 and you prefer a faster route, you can take the insurer to the Small Claims Court instead of or alongside the FSPO.

The Small Claims process costs EUR 25, does not require a solicitor, and can be filed online. It is particularly effective for straightforward claim disputes where the facts are clear.

From start to finish, maintain a complete paper trail:

• Keep copies of every letter, email, and form you send
• Note dates, times, and names of anyone you speak to on the phone
• Follow up every phone call with an email confirming what was discussed
• Keep registered post receipts and tracking confirmations
• Store SAR responses, independent reports, and your policy documents safely