What do I do if my insurance claim is turned down?

This is information about the complaints process, not advice on your particular policy. Declined claims fall into a small number of categories — an exclusion, a condition not met, a disclosure problem, or a valuation dispute — and each has a different counter-argument. The first job is finding out which one you are actually dealing with, because insurers often give a short reason that does not identify it.

Step by step

1. Ask for the decision in writing.Request the specific clause, exclusion or condition relied on, quoted in full, with the reasons it applies to your circumstances. A verbal 'it is not covered' is not a decision you can challenge.
2. Read the policy wording yourself.Not the summary or the certificate — the full policy document. Check the definitions section too; insurance disputes often turn on how a single defined word is used.
3. Identify which category the refusal falls into.An exclusion says the event is not covered. A condition says you did not do something required. A disclosure issue says the policy was mispriced or void. A valuation dispute accepts the claim and argues about the amount. They need different responses.
4. Check the wording against the facts precisely.Insurers sometimes apply an exclusion that nearly fits. If the clause says 'gradual' and your damage was sudden, or says 'unoccupied for more than X days' and yours was not, say so with dates.
5. Gather evidence for the version you say is correct.Photographs, timestamps, a tradesperson's written opinion on cause, receipts, weather records. Cause is the most commonly disputed element and independent evidence carries real weight.
6. Make a formal complaint, not a phone call.Use the words 'formal complaint'. That triggers the regulated complaints process and a time limit for their final response.
7. Set out the argument in a structured way.The clause they rely on, why it does not apply, the evidence, and what you want them to do. One page plus attachments beats five pages of narrative.
8. Wait for the final response or the deadline.Firms have a set period to give a final response to a complaint. After that period, or on receipt of a final response, you can go to the ombudsman.
9. Take it to the Financial Ombudsman Service.It is free to consumers and it can consider what is fair and reasonable, not only the strict contract wording. Submit the complaint, the insurer's final response and your evidence bundle.
10. Mind the time limits.There are limits on how long after a final response you can refer a complaint to the ombudsman. Check the current limit on the FOS website and do not sit on it.

Tips

• The phrase to use is: 'please confirm in writing the specific policy term you are relying on and why it applies to these facts'. It changes the conversation immediately.
• The Financial Ombudsman is free and its decisions bind the firm if you accept them. Claims management companies charge a percentage to do the same submission.
• Where cause is disputed, an independent tradesperson's written opinion is worth more than any amount of argument from you.

Common mistakes

• Arguing about fairness before checking the wording — The complaint has to engage with the clause they rely on. An insurer will simply repeat it, and you will have lost weeks.
• Not asking for a final response — The ombudsman route usually opens on a final response or after the firm's allowed period. Without either, a referral gets sent back.

If it doesn't work

Questions people ask