Guide: How to Appeal a Denied Home Insurance Claim

Filing a home insuranceclaim can feel overwhelming. If your claim gets denied, it can feel even worse. But don’t worry, a rejection doesn’t mean you have no options. Often, you can appeal the decision to try and change it. This guide will help you understand why claims are often denied. It will also explain how to deal with the complaints process and what actions to take for a rejected insurance claim.

What Are the Common Reasons for Home Insurance Claim Denials?

Understanding why your home insurance claim got rejected is the first step to deciding how to appeal. Here are some common reasons why this happens:

Lack of Cover

Your home insurance policy might not cover the specific damage you are claiming. For instance, standard buildings insurance usually does not include subsidence unless it is mentioned in the policy wording. Some policies also do not cover damage from burst pipes, which is often a common reason for water claims.

Lack of Due Care

Insurance companies have a duty of care clause. This means they expect homeowners to take reasonable steps to keep their homes safe. For example, if you leave your front door unlocked and a burglary happens, the insurer might deny your claim. They could say it is due to negligence. The same goes for homeowners who do not take care of their property. This neglect can lead to issues like dampness or leaks that could have been avoided.

Incorrect Information

Giving wrong or unclear information when you buy your policy or make a claim can result in rejection. This includes not sharing past claims, changes to your home, or details about security. Some homeowners might accidentally give incorrect information about the structure of their home, which can make claims harder to handle.

Lack of Maintenance

If your home experiences water damage because of a forgotten leak or a lack of maintenance, your insurance might deny your claim. They could say it was something that could have been avoided instead of being a covered event. To avoid this, it’s good to take care of your property regularly. This includes looking for any signs of storm damage and making sure your heating system works well during the cold months. Doing these things can help stop claim denials.

Exclusions in the Policy

Many insurance policies do not include certain damages. For example, they often exclude damage from escape of water, storm issues, or accidental damage unless you buy extra coverage. It is important to read your policy wording to know about any exclusions. Home emergency cover is usually an extra option. This means that regular policies might not cover urgent repairs, such as when your boiler breaks down or if there are plumbing issues.

High Excess

Some claims are turned down because the repair costs are less than your excess. For instance, if your insurance excess is £500 and the repair cost is just £400, your insurer will not pay. Think about your excess amount when buying home insurance. It’s important that it matches your financial situation.

Delayed Claims

Many insurance companies ask you to file claims within a reasonable time after an incident. If you wait too long to report the damage, the insurer may deny your claim. They could say that the delay made the situation worse. For example, if you don’t report a roof leak quickly, it could lead to more flood damage later on. This makes it less likely that your claim will be approved.

Fraudulent Claims

If an insurer thinks there is fraud, like saying damage is worse than it is or making up losses, they will deny the claim. They might also begin legal actions. Insurers use many methods to spot fraud. This includes checking consistency in past claims and looking at previous claim histories.

What Steps Should You Take If Your Claim is Denied?

1. Review the Rejection Letter and Policy Documents

Start by reading the insurer’s detailed explanation of the denial carefully. Look for the exact clause or condition they used to deny your claim. Then, compare this with your home insurance policy. Make sure that the insurer’s choice matches with what is in your contract.

2. Gather Additional Evidence

If you think your claim is correct, gather supporting documentation like:

• Receipts for items that are damaged or stolen
• Emails and correspondence with the insurer
• Photos and videos showing the damage
• Independent assessments from builders, plumbers, or loss assessors
• Police reports when there is theft or vandalism
• Witness statements if there are any

3. Contact Your Insurance Provider

Contact your insurance provider and request a clearer explanation. If you notice any mistakes in their reasoning, feel free to question them politely and share additional evidence. If your claim involves a landlord insurance policy, make sure you have all the necessary tenant-related documentation ready to help your case.

4. Submit a Formal Complaint

If the insurer does not rethink their decision, you should file a formal complaint using their complaints process. This should include:

• A clear message saying that you disagree with their decision
• The reasons you think the claim should be paid
• Any proof that supports your case
• Mention of past cases handled by the Financial Ombudsman Service (FOS) where the policyholder won

Make sure to keep a record of the date when you sent your complaint.

5. Wait for the Final Response

Insurers must give a final response within eight weeks. If you are not happy with their decision, you can take the complaint further.

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What to Do If Your Complaint Is Rejected

Take the Case to the Financial Ombudsman Service (FOS)

The Financial Ombudsman Service (FOS) helps solve problems between people and insurance companies. If you still feel unhappy after the insurer’s final response, you can take your case to the FOS.

How to File a Complaint with the FOS

Make sure to get in touch with the FOS within six months after you get the final response.

You can submit your case online or by mail. Include all important documents like:

• Insurance policy wording
• Claim rejection letter
• Correspondence with the insurer
• Additional evidence (photos, reports, receipts)

How Long Does the Process Take?

The FOS wants to solve complaints in 90 days, but some tricky cases might take more time. If they decide in your favour, the insurer could have to reinstate your claim and pay you for inconvenience and distress.

Additional Options for Challenging a Claim Rejection

Legal Action

If you try all ways to complain and still feel that your claim was turned down unfairly, you might think about taking legal action. You should only do this if your claim is important, because legal fees can be expensive.

Hiring a Claims Management Company

Some homeowners choose to hire claims management companies to manage their appeals. These companies are skilled at guiding people through the claims process. However, they usually charge a fee or take a portion of any payout.

Tips to Strengthen Your Appeal

• Follow the Right Claims Procedure: Make sure you reported the event quickly and sent all needed documents.
• Point Out Any Unclear Terms: If the insurance company’s denial is based on unclear language, explain that the policy wording was confusing.
• Get Expert Help: A report from a loss assessor can give a professional view of the damage.
• Keep Trying: If your first appeal is turned down, keep pushing it through the right steps.
• Look at Other Policies: If your insurer says no to your claim, you might find better coverage with a different company later.

By following these steps and knowing your rights, you can boost your chances of successfully appealing a denied home insurance claim.

Correct as of 26 February 2025

FAQs About Home Insurance Claim Appeals