Why Claims Are Denied
Common reasons for claim denial include:
- Policy exclusion — The event is not covered (e.g., flood damage when flood cover was not purchased)
- Late notification — You reported the incident outside the required timeframe
- Non-disclosure — You failed to declare relevant information when taking out the policy (e.g., pre-existing medical conditions, previous claims)
- Policy breach — You failed to meet a policy condition (e.g., no burglar alarm fitted as required)
- Insufficient evidence — You could not adequately prove the loss or its value
- Fraud suspicion — The insurer believes the claim is exaggerated or fabricated
Your Rights and Options
If your claim is denied or you disagree with the settlement amount, you have options:
- Request a written explanation — The insurer must explain exactly why your claim was denied, referencing specific policy terms.
- Internal appeal — Most insurers have a formal complaints procedure. Submit a written appeal with any additional evidence.
- Regulatory complaint — If the internal appeal fails, you can complain to the insurance regulator in your territory (e.g., Financial Services Commission in Jamaica, Central Bank in Trinidad & Tobago).
- Independent loss assessor — Unlike a loss adjuster (who works for the insurer), a loss assessor works for YOU. They can review your claim and negotiate on your behalf.
- Legal action — As a last resort, you can take the insurer to court. Consider the cost-benefit before pursuing this option.
Pro tip: Always request claim denials in writing with specific policy clause references. Verbal denials are harder to challenge. Keep records of all communication with your insurer.