Insurance Claim Refused: What to Do Next
An insurer refusing a claim is not the end of it, it is the start of a regulated complaints process with fixed deadlines, and a free, independent ombudsman waiting at the end of it if the insurer will not move. This applies whatever kind of policy it is, home, motor, travel, pet, or life. This guide covers the single most common wrongful refusal, 'non-disclosure', why insurers still lean on it more than the law actually allows, and exactly how to escalate for free if your complaint gets nowhere.
- ✓Complain to the insurer in writing first. Under the FCA's rules, they must send a final response, or explain why they can't yet, within 8 weeks.
- ✓If they reject your complaint, or 8 weeks pass with no final response, you can take it to the Financial Ombudsman Service (FOS) for free, and its decision is binding on the insurer.
- ✓You have 6 months from the insurer's final response to refer it to the FOS, and generally 6 years from the event (or 3 years from when you found out about it, if later).
- ✓"Non-disclosure" does not automatically kill a personal claim. Since 2013 the law grades how careless the mistake was, and even a careless one often means a reduced payout, not a refused one.
- ✓Keep everything in writing. A phone call refusal is worth far less as evidence than the same refusal in an email or letter you can quote back to the insurer or the Ombudsman.
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"Non-disclosure": the most misused reason for refusing a claim
Insurers often refuse a personal (non-business) claim by saying the policyholder failed to disclose something when they took the policy out. Since the Consumer Insurance (Disclosure and Representations) Act 2012, that is no longer an all-or-nothing question, it depends entirely on how careless the mistake was.
| How the mistake happened | What the insurer can do |
|---|---|
| Deliberate or reckless | Refuse the whole claim and keep the premium |
| Careless, and they would never have offered cover at all | Refuse the claim, but must refund the premium |
| Careless, but they would have charged more or applied different terms | Pay the claim, reduced in proportion to what you actually paid versus what you should have, or apply the different terms instead |
| Honest and reasonable, not careless at all | Must pay the claim in full |
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Other common wrongful refusals
- Yes: A general policy exclusion applied to your specific facts without the insurer actually explaining how it applies, rather than just quoting the clause
- Yes: The claim was under-valued, rather than refused outright, without a proper independent assessment or with a report you have not been shown
- Yes: A delay treated as a refusal: the insurer simply stops responding rather than giving a decision, which is itself something to complain about
- Yes: A pre-existing condition or prior damage claimed as the cause, without evidence connecting it to the specific loss you are claiming for
The complaint and escalation timeline
- Yes: The insurer must send a final response, or explain why it can't yet, within 8 weeks of receiving your complaint (DISP 1.6.2R)
- Yes: You can refer the complaint to the Financial Ombudsman Service as soon as either the final response rejects it, or the 8 weeks pass with nothing
- Yes: You then have 6 months from the date of the final response to refer it to the FOS
- Yes: Separately, the FOS generally cannot look at a complaint about something that happened more than 6 years ago, unless you did not know, and could not reasonably have known, about it until later, in which case you get 3 years from when you found out
- Yes: The FOS is free to use, and if it upholds your complaint, the insurer must do what it says
Building your complaint
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Frequently asked questions
Can an insurer refuse my claim for non-disclosure?
Only within limits. Since the Consumer Insurance (Disclosure and Representations) Act 2012, a deliberate or reckless misrepresentation lets the insurer refuse the whole claim, but a careless one usually means either a reduced payout or, if they would never have offered cover at all, a refusal with your premium refunded. An honest, reasonable mistake must be paid in full.
How long does an insurer have to respond to my complaint?
Under the FCA's DISP 1.6.2R, the insurer must send a final response, or a written explanation of why it cannot yet do so, within 8 weeks of receiving your complaint.
How do I escalate an insurance complaint if the insurer refuses?
Refer it to the Financial Ombudsman Service. It is free, independent, and its decisions are binding on the insurer. You can do this as soon as you get a final response rejecting your complaint, or once 8 weeks have passed without one.
What is the time limit for complaining to the Financial Ombudsman?
6 months from the date of the insurer's final response. Separately, the Ombudsman generally cannot consider something that happened more than 6 years ago, unless you did not know and could not reasonably have known about it sooner, in which case you get 3 years from when you found out.
Does the Financial Ombudsman charge for making a complaint?
No, it is free for consumers to use. The insurer pays a case fee, not you, and if the Ombudsman upholds your complaint, its decision is binding on the insurer.
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