When an insurer declines your claim

A letter declining a claim usually gives a reason: a policy exclusion, late notice, non-disclosure when the policy was taken out, or a dispute about the value of the loss. The reason matters, because each one is answered differently.

Read the policy, not the summary

Start with the policy document and its schedule, not the brochure or the quotation. Find the clause the insurer relies on and read the definitions it uses. Exclusions are generally read narrowly, and an insurer relying on one is usually expected to show that it applies.

Ask for the reasons in writing

If the letter is vague, write to the insurer and ask which clause it relies on and what evidence supports its decision. Ask for a copy of any assessor's or investigator's report used to reach it. Keep a copy of everything you send and receive.

Gather your own record

• The policy, schedule and any endorsements
• The claim form and every letter or email since the loss
• Photographs, receipts, police abstracts or medical reports
• A short timeline: the loss, when you reported it, and to whom

Complaints and court

You can complain to the insurer's own complaints desk and to the Insurance Regulatory Authority. Some disputes are settled there; others need to go to court or arbitration, depending on what the policy says. Time limits apply to court claims, so do not wait for a complaint to run its course before taking advice.

When to speak to an advocate

If the amount is significant, if the insurer alleges non-disclosure or fraud, or if court papers have been served on you, take advice early. A short review of the policy and the correspondence often shows quickly whether the decision can be challenged.