Problems & fixes · Claims and brokers
What to do when an insurance claim is denied or delayed
Last updated 25 October 2026 · 2 sources listed · Reading time about 3 minutes
Short answer
Start by getting the decision in writing with the policy clauses relied on. Compare it with your policy wording and evidence, then use the insurer's internal complaints process. If unresolved, many jurisdictions provide an independent ombudsman or regulator route, with deadlines. Keep records of every call and document. This is general information, not legal advice about your claim.
Who this is for: A policyholder whose claim has been refused, reduced or left unresolved and who wants to understand the next steps.
What to evaluate
Written reasons
A clear explanation lets you test the decision against the wording.
How to check: Request the denial letter citing specific clauses.
Policy wording
The contract decides what is covered.
How to check: Read the definitions, exclusions and conditions that apply to the event.
Evidence
Claims succeed or fail on documentation.
How to check: Gather receipts, photos, reports and correspondence.
Complaint deadlines
Time limits apply to internal and external complaints.
How to check: Note the dates in the decision letter and regulator guidance.
Escalation route
Independent schemes vary by country and product.
How to check: Find the relevant ombudsman or regulator for your insurer.
Comparison
| Stage | What it involves | Typical considerations |
|---|---|---|
| Request reasons | Ask for the decision in writing | Insurers should explain the clauses used |
| Internal complaint | Submit a formal complaint with evidence | Deadlines for a final response apply in many places |
| Independent review | Ombudsman or regulator assesses the case | Time limits and eligibility rules |
| Legal action | Court or arbitration route | Cost, time and limitation periods |
Decision worksheet
Rate up to three options against this guide’s own criteria. It runs in your browser and saves only on this device. It is a thinking aid, not a recommendation.
1. Have you checked each criterion?
0 of 5 criteria checked.
2. Compare options (0 = fails or unknown, 3 = meets it well)
| Criterion | |||
|---|---|---|---|
| Written reasons | |||
| Policy wording | |||
| Evidence | |||
| Complaint deadlines | |||
| Escalation route | |||
| Total (max 15) | 0 | 0 | 0 |
Questions to ask before you commit
- Which policy clause was used to deny or reduce the claim?
- What evidence was missing or considered insufficient?
- Can I provide further information to reconsider the decision?
- How do I make a formal complaint and what is the response timeframe?
- Is there an independent body I can go to if I remain dissatisfied?
- Was an expert report used and can I have a copy?
Typical trade-offs
Provide more evidence and ask for review
- Upside
- Often fastest where the issue is documentation
- Downside
- May not change a denial based on exclusions
Escalate to an ombudsman
- Upside
- Independent and often free to the consumer
- Downside
- Slower and limited to eligible disputes
Take legal advice
- Upside
- Specialist interpretation of complex wording
- Downside
- Cost and time
Common mistakes
- Accepting a verbal denial. Ask for it in writing.
- Missing complaint deadlines. Record the dates when you receive decisions.
- Submitting emotional rather than factual complaints. Link evidence to the policy wording.
- Throwing away damaged items or records before the claim is settled.
Related questions
Can an insurer deny a claim for a late report?
Policies often require prompt notification, and late reporting can lead to a reduction or refusal, especially if the delay harmed the insurer's ability to investigate. Rules differ by jurisdiction and some regulators require insurers to show actual prejudice. If you reported late, explain the reasons and provide evidence, and ask how the clause was applied. Check regulator guidance in your country about fair treatment of notification delays.
What if the insurer says the damage was pre-existing?
Insurers commonly exclude wear, gradual deterioration or conditions present before cover began. Ask what evidence they used, request any expert report and compare it with your own records such as maintenance history, photographs or professional opinions. If you disagree, set out your evidence in a complaint. An independent expert opinion may help but can cost money, so consider whether the amount at stake justifies it.
How long does an insurer have to respond to a claim?
There is no single rule. Many regulators set standards for acknowledging, investigating and deciding claims, and policies often describe the process. Delay without a good reason can itself be grounds for a complaint. Check your regulator's website for timeframes in your jurisdiction and ask the insurer to explain any delay and when you can expect a decision.
Is an ombudsman binding on the insurer?
It depends on the scheme. In some countries the ombudsman's decision binds the insurer if the consumer accepts it, while the consumer can still go to court. In others, decisions are recommendations. Eligibility, time limits and the types of disputes covered vary, so consult the scheme's website to confirm that your complaint qualifies and what the process involves before relying on it.
Should I use a claims management company to challenge a decision?
You are generally free to complain directly to the insurer and to an independent ombudsman or regulator route without paying anyone. Some firms offer to handle disputes for a fee or a share of any recovery, and their value depends on the case. Before agreeing, ask what the charge is, what you could do yourself at no cost and whether the firm is regulated. Read the contract carefully and compare it with the free routes in your country.
Sources and further reading
These pages were reachable when we last checked. They informed definitions and rules referred to above; they do not endorse this guide. Where rules differ by country, check the authority for your location.
- Financial Ombudsman Service — UK Financial Ombudsman Service, retrieved 27 October 2026
- Consumer Financial Protection Bureau — US Government, retrieved 27 October 2026
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