Why insurance claims are rejected

April 15, 2016 6:32 am

We wrote recently about the fact that one in five home insurance claims are rejected, with the most common reason being the complexity of policies. Many people simply don’t understand the small print of their policies.

Specific areas where policyholders are at risk have been explained very clearly by one insurance provider. The Policy Expert cites three key points which could lead an insurer to reject a home insurance claim: wear and tear, incorrect levels of cover, and non-disclosure of material facts. It’s worth reading this in full, but to summarise:

Wear and tear: your policy will probably state that your property has to be kept in good condition and be well maintained. So, for example, if you claim for damage following a burst pipe, the insurer may claim that the pipe wasn’t kept in good condition and this was the reason for it splitting rather than the weather. Other examples are if roofs are damaged by a storm but they haven’t been well maintained, or if there’s water damage originating from the bathroom but the grouting of the bathroom tiles was not in good condition.

Incorrect levels of cover: this is all about ensuring that the amount you are covered for really does cover the rebuilding costs of your property or the value of your possessions. What’s important is to review this regularly to ensure your cover reflects current day values.

Non–disclosure of material facts: if you haven’t told the truth, then your claim is likely to be rejected. Common falsehoods include not disclosing previous claims or that you’ve had a County Court Judgement made against you. But it may also be rejected if you make ‘honest’ mistakes: for example, not having the required locks, or stating you have a burglar alarm but never turning it on.

As a professional loss assessor, we see these types of problems all the time. Sometimes there is nothing we can do, but often we successfully overturn the insurer’s decision. Our customer stories  include examples of where we have achieved this and show how important it is to have professional representation when entering the extremely complicated area of insurance law.