How to Handle a Legitimate Insurance Claim That Gets Refuted
Insurance policies, regardless of what they are covering, are designed to protect you against dangers and risks that are not really foreseeable. For instance, while a car insurance policy protects you against financial damage from an accident, a homeowners’ insurance policy aims to keep you safe from thefts and natural damage.
Your insurance claim can only be rejected on the basis of what is written in your policy document. With the majority of policies, the reasons for claim rejection include providing wrong information, lack of proper care of the insured item on the part of the policy holder, and the nondisclosure of relevant information at the time of purchase.
However, the big question that you are most probably battling with is what to do if your insurance provider rejects a perfectly legitimate claim from you. An insurance claim rejection is not the end of the world because you still have avenues open to you. Consider the following:
1. Validate or refute the reason for rejection:
As mentioned above, the majority of insurance claims are rejected based on four reasons. Therefore, the first thing you need to do the moment you receive an intimation of insurance claim rejection is to validate the reason for rejection.
In order to validate the reason, you will have to go through the insurance policy document that you received with your insurance policy in the first place. Whatever reason the insurance company has cited must be debunked for your insurance claim to be considered genuine.
Check the clauses that are relevant to your situation in the policy document. Moreover, make a list of clauses that strengthen your claim and even those clauses whose wording is ambiguous enough to be used on your side.
2. Get a professional assessment:
Sometimes, it is possible that an insurance company may use some of the facets of an insurance claim to refute it. For example, while you may be saying that damage was a result of an accident, the insurance company may state that it was due to negligence.
Such situations can be very difficult to counter. However, one of the ways of doing this is to get a professional’s expertise on your side. A loss assessor’s expert opinion can make or break your insurance claim.
3. Write a formal complaint to your insurance policy provider:
Once you have followed the first two steps and still find that your insurance claim is irrefutable then it is time for you to contact your insurance policy provider again in the form of a formal complaint. You need to compose a formal complaint letter explaining the whole situation from the beginning.
Things you need to remember to include while formulating this complaint letter is the date, a subject line saying complaint, name and policy number, evidence supporting your claim, and the intention to approach an insurance ombudsman.
4. Approach an insurance ombudsman:
When all else fails, your only way out is to approach an insurance ombudsman with your complaint. The purpose of the insurance ombudsman is to help insurance customers freely with their complaints and claims.
If your claim is genuine and supported by proof, the insurance ombudsman should rule in your favour.
It is common for insurance policy providers to reject the first insurance claim from a customer as some claimants do not try again. However, when it comes to insurance claims, persistence has its rewards.