Insurance Claim Disputes: When Insurers Refuse to Pay

Unfortunately, insurance companies aren’t always as understanding and empathetic as they could be. This is because at its heart, every insurance provider worldwide is a for-profit business that’s out to make money. Precisely why insurers hire skilled strategists and analysts for the sole purpose of finding creative ways not to pay out on customers’ claims.

If your insurance claim is rejected, it can be difficult to know where to turn. Along with having no real knowledge or expertise of such matters, you may also be aware of the fact that you’re up against potentially manipulative professionals.

Nevertheless, you are perfectly within your rights to file an appeal against any rejected insurance claim. But before formally submitting your appeal, consider the following guidelines to help support your case:

1. Establish exactly why your insurance claim was rejected

Before going any further, you’ll need to establish why your claim was rejected in the first place. If you simply were not covered for the eventuality in question or you failed to read the small print when taking out your policy, you’re unlikely to have a valid case. Only proceed if you genuinely think the insurer’s grounds for rejection are unjustified.

2. Don’t beat around the bush

Much as you would like to communicate your disappointment and dissatisfaction, this should be saved for the closing paragraphs of your letter. It’s vital that you get the insurer’s full attention right away, so you should get straight to the point with the details of your appeal. Provide your policy number, a brief sentence explaining your claim and a short summary of why you are appealing. Bullet points can be more impactful than blocks of text when presenting your arguments.

3. Provide evidence and supporting documentation

In theory, you should have already provided all the evidence and documentation necessary when submitting your claim in the first place. However, there may be additional supporting documentation you can use to improve the strength of your appeal. Letters from doctors, mechanics, travel companies and so on written directly to the insurer often carry a good amount of weight.

4. Be firm but fair

Resorting to an aggressive tone and abusive language isn’t going to yield positive results. Remaining pleasant and personable at all times is essential, but so too is making it clear that you are serious about your appeal. Inform your insurer that you expect and demand a prompt and positive response to your appeal, as you are ready to escalate the issue if you are dissatisfied with the outcome.

5. Consult with a solicitor

If you have any questions or concerns regarding your eligibility for an appeal, consult with a solicitor at the earliest possible stage. During your free initial consultation, it will usually be possible to determine whether or not you have a case. For obvious reasons, appeals and disputes lodged via solicitors and legal offices tend to be taken more seriously by insurers. In addition, independent legal advice could help you avoid wasting time and money, if you do not have a valid case to press.

For more information on insurance claim disputes or to discuss our legal services in more detail, contact a member of the team at Aristone Solicitors anytime.

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Litigation - Civil and Commerical

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