How to Make an Insurance Claim and What to Do If It Is Rejected

Before you claim

1. Read your policy. Check that the event is covered, what the excess is and any time limit for reporting.
2. Stop further damage. Take reasonable steps to prevent more loss, such as turning off the water or covering a broken window. Insurers may reduce a claim if you do not.
3. Keep damaged items. Do not throw things away until the insurer has seen them or agreed.
4. Report crimes. For theft or vandalism, report to the police and get a crime reference number.
5. Do not admit liability or agree to pay anything to another party until you have spoken to your insurer.

Making the claim

• Contact the insurer promptly. Most have a claims phone line and an online form. Some policies require notification within a set time.
• Give clear, honest information. Explain what happened, when and where. Make sure the details are accurate, since false or exaggerated claims can be treated as fraud.
• Provide evidence. This might include photographs, receipts, valuations, the police report, medical reports or quotes for repairs.
• Keep records. Note who you spoke to and when, and keep copies of emails and letters.
• Ask about timescales. Find out what happens next and when you can expect a decision.

What insurers must do

The Financial Conduct Authority's rules require insurers to handle claims promptly and fairly, and not to unreasonably reject them. They must:

• Provide reasonable guidance to help you make a claim
• Handle the claim promptly and fairly
• Not unreasonably reject a claim
• Settle the claim promptly once they have agreed to pay

Types of settlement

• Repair: the insurer arranges or pays for repairs.
• Replacement: they replace the item, sometimes with a voucher or a like-for-like product.
• Cash settlement: they pay you a sum, which can be less than the full replacement price.
• Total loss: for a car or other item beyond economic repair, they pay the market value, not the cost of a new one.

Why claims are rejected

• The event is not covered, or an exclusion applies
• You did not meet a policy condition, such as security requirements
• You did not disclose something relevant when taking out the policy
• Premiums were not paid and the policy lapsed
• The claim was made too late
• The insurer suspects fraud
• The loss was due to wear and tear or gradual damage, which most policies exclude

If you think the decision is wrong

1. Ask for the reasons in writing and a copy of the policy wording they relied on.
2. Check the policy yourself. Look at the definitions, exclusions and conditions.
3. Make a formal complaint to the insurer. State what you think went wrong and what you want, and send supporting evidence. Insurers must acknowledge complaints and provide a final response within eight weeks.
4. Go to the Financial Ombudsman Service (FOS). If you are unhappy with the final response, or if eight weeks have passed, you can refer your complaint to the FOSFinancial Ombudsman Service (FOS)The Financial Ombudsman Service is a free, independent service that resolves complaints between consumers and financial firms.Read more →, which is free and independent. You normally have six months from the final response to do so.
5. Consider other help. Citizens Advice can advise on your rights, and in some cases a solicitor or claims specialist may be useful. Be careful with claims management companies, which may charge fees. Their services are not necessary to use the FOS.

Tips for particular types of claim

Think before claiming

Small claims may not be worth it if the excess is similar to the loss, since claims can affect your future premiumsPremiumA premium is the amount you pay for an insurance policy, either as a lump sum or in instalments.Read more →. But do not avoid claiming for something significant, and tell your insurer about incidents even if you are not claiming, if your policy requires it.

Fraud

Exaggerating a claim, claiming for items you do not own or giving false information is fraud. Insurers share data to detect it, and the consequences can include cancellation, difficulty getting cover and prosecution. Be honest, even if you are in a difficult situation.