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Insurance claim dispute resolution
Insurance is often the safety net relied upon to protect a range of issues relating to both businesses and their commercial transactions and for individuals in connection with accidents, theft and financial losses. It is well known that the clauses in insurance policies are often interpreted differently by the insurer than by the insured, resulting in claims being rejected and disputes arising.
Here, we look at types of insurance disputes that commonly arise and disputes can be resolved. The following frequently asked questions assist in giving a broader understanding.
Click on a link to that section:
Read the different types of insurance disputes that commonly occur.
Learn what steps to take to dispute an insurance claim denial.
Find out what you can expect from an insurance dispute.
We answer frequently asked questions on dealing with insurance claim disputes.
Different types of insurance disputes
There are many different types of insurance disputes that you may find yourself involved with.
Home insurance compensates you for things like fire damage to your home, or theft of your belongings. It'll pay out to replace your property or repair your house if something unforeseen happens.
Home contents insurance only, which is commonly held by tenants and leaseholders as they may not have responsibility for buildings insurance. This is one of the most commonly disputed insurance claims. Claims are made following a break-in or burglary for the resulting theft and damage.
Health insurance claims including such issues as medical negligence following surgery or a period of healthcare, whether at home or overseas. Medical negligence claims require comprehensive evidence to support a claim, often drawn from third-party medical experts, as claims can be denied on the basis of a lack of proof of responsibility by a healthcare organisation or their staff.
Another form of damage to the property, such as weather damage often results in rejection, according to new research by the Association of British Insurers (ABI). As many as one in five home insurance claims are rejected – often leading to disputes.
Legal expenses insurance is commonly added to a general insurance policy. This provides insurance against legal costs for certain kinds of litigation.
Car insurance claims, which usually take place after a road traffic accident, often lead to third-party claims. A third-party claim is when the claimant raises a claim based on damages that have been caused by the first party.
How do you dispute an insurance claim rejection?
When an insurance claim is denied, you may still feel that your claim is valid and has been unfairly rejected. You will need to thoroughly check your policy documents wording and establish whether you are correct in your belief that you are entitled to claim. The wording of policy documents can be complex and confusing and you should consider seeking legal advice from an expert in insurance matters at this stage to ensure that your policy does relate to the issue you are attempting to claim to enable you to rebut the rejection.
Once you are clear that your claim is valid you can then explain to your insurer why you believe their response is incorrect and that they should reverse their decision. Your legal adviser will be able to clarify whether you require expert witness evidence to support your claim.
If you cannot easily reach a resolution with your insurance company you may consider mediation or other form of alternative dispute to reach a satisfactory decision. If the matter still remains unsatisfactory from your point of view you may have to consider taking your insurer to court. Our insurance team of expert lawyers at Giambrone will aim to resolve your dispute in the most cost-effective and least time-consuming way possible.
How can an insurance dispute be dealt with?
Arbitration is often the recommended first step in dealing with insurance disputes, enabling you to discuss the situation amicably with your insurance provider and with an impartial third party to assist in keeping the focus on a solution. If successful this will avoid legal expenses and lengthy courtroom proceedings, and as such, is the preferred option for many insurance companies. In many cases, a settlement is reached during arbitration. If arbitration is suggested by your insurer you have the right to refuse, although it is the less expensive and stressful option. Find out more about our arbitration service here.
Litigation may be required if you cannot reach an agreement through arbitration. In this event, you will require legal advice and require a lawyer to represent you who specialises in insurance disputes. The court’s decision, after having considered the evidence provided by both yourself and your insurer will be legally binding.
How can getting legal advice help you in an insurance dispute?
Getting expert legal guidance can be a vital part of an insurance dispute. Giambrone can help you by examining your claim and clarifying a) whether your challenge is valid and b) what the likely outcome of your dispute will be. Before embarking on a lengthy legal dispute Giambrone’s lawyers will guide you as to what your expected legal costs may be.
If you have a disputed claim, you can get in touch to discuss your case and requirements today.
Preventing insurance claim disputes from occurring in the future
When choosing an insurance policy, make sure you are completely clear on the cover you are being offered. Be absolutely sure of all the clauses which could be invoked to invalidate a claim or actions that you may take that could be construed as breach of contract, as this could lead to a claim being rejected.
If you have concerns about the terms of the policy Giambrone’s insurance lawyers can provide guidance and advice as to the most appropriate insurance policy for your needs.
Frequently asked questions
Reasons an insurance company reject an insurance claim
Your insurance company may reject your claim if:
- They feel you have overestimated the value of the claim amount.
- They suspect insurance fraud.
- Your claim may also be rejected due to a lack of evidence of the detriment caused to support your claim.
If you have missed payments due for your insurance policy.
The insurers can also cancel your policy.
How do you complain to the Financial Ombudsman Service?
You can call the Financial Ombudsman Service between 8.00 am and 5.00 pm, Monday to Friday, on 0800 023 4567. You will then be able to speak with someone who will be able to listen to the outline of your complaint and advise you on how to move forward.
Do insurance companies investigate claims?
When a claim is filed, the insurance company will investigate whether the claim is legitimate, genuine, and meets the policy requirements.
Can you argue with an insurance claims loss adjuster?
If you believe an offer is too low you can discuss the claim and your reasons with the insurers’ loss adjuster, explaining the points of your claim, and the financial aspects.
How do insurance loss adjusters determine the validity of a claim?
Insurance loss adjusters will try to build a picture of what has happened that gives rise to a claim. The loss adjuster must establish the full facts in all circumstances (such as a car accident), assess the damage, and also look at local laws in an attempt to determine how the event occurred and whether there is fault on the part of a person or organization which leads to the claim being made by the insured.
Why complain about an insurance company?
If an insurance company is refusing to abide by the terms of your agreement, you are within your rights to lodge a complaint about them. Yes, if you believe the insurer has no justifiable reason to waive the terms of your agreement you can complain to The Financial Conduct Authority (FCA) that regulates how these firms behave, as well as more broadly the integrity of the UK's financial markets. Also, the Financial Ombudsman can investigate.
Do you need travel insurance?
Travel insurance is not obligatory when going abroad. However, it is strongly advised to take out such insurance, as, in the event of an accident, illness or loss or damage to property you will be able to rely on the insurance policy for financial assistance for any of the previously mentioned events that might arise during the course of your trip.
Do you need life insurance?
While life insurance is a personal choice, it is sensible to have some sort of life insurance plan in place, especially if you have dependents that would be left out of pocket if you died unexpectedly.
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