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Insurance Dispute Solicitors

An insurance policy should provide you with peace of mind. But, what happens if your insurer denies your claim, reduces your payout, or even makes counterclaims against you? If this has happened to you, our network of specialist insurance dispute solicitors is here to provide fast, affordable advice and guidance. 

Contact us today for a free case evaluation and take the first step toward resolving your insurance dispute. With our network of solicitors, you get affordable fixed fees and prompt, legal advice.

• What is an insurance dispute?
• Why might my insurance company reject my claim?
• What are the different types of insurance disputes?
• How do I dispute an insurance claim decision?
• Can you argue with an insurance claims loss adjuster?
• How to complain about your insurer to the Financial Ombudsman Service
• How are insurance disputes dealt with?
• How do you prevent insurance claim disputes?

What is an insurance dispute?

An insurance dispute happens when a policyholder files a claim with their insurance company, but the insurer rejects it. If the customer disagrees with the reasons for the denial and still wants to pursue their claim, both sides enter into an insurance dispute. 

These disputes often come about when there's a disagreement between the policyholder and the insurer about what's covered under the policy.

Why might my insurance company reject my claim?

Your insurer may refuse to pay your claim because:

• The policy wasn’t active when the incident happened.
• Your policy is invalid because you didn't provide accurate information when applying for the insurance or you didn't disclose something important that could affect your claim.
• Your policy isn’t invalid because you intentionally or negligently withheld information or misled your insurer.
• The item isn’t covered by your policy. 
• An exclusion clause in the policy prevents you from claiming.
• You missed some payments.
• You didn’t tell your insurer about changes in your circumstances.
• You didn’t follow the claims process correctly. 
• You didn’t meet a condition of your policy.
• They think you exaggerated the claim. 

What are the different types of insurance disputes?

Disputes can happen when insurance companies increase their premiums without a clear reason or if an insurer claims a customer gave the wrong information when applying for insurance. 

Depending on the type of policy you hold there are several common insurance disputes that you may find yourself caught up in: 

Health Insurance Claims Disputes 

A health insurance claim dispute arises when there is disagreement between the policyholder and the insurance company regarding coverage, reimbursement, or the handling of a claim related to medical treatment or healthcare services. 

Examples of health insurance claim disputes could include: 

• The insurance company refuses to cover a medical treatment, procedure, or medication that the policyholder believes is necessary for their health due to the treatment not being included in the policy's list of covered services, deemed experimental or investigational, or considered not medically necessary.
• The insurance company reimburses the policyholder for a medical expense at a lower rate than expected, citing reasons such as fee schedules, usual and customary charges, or out-of-network provider rates.
• The insurance company denies coverage for a medical treatment or procedure because it was not pre-authorized or pre-approved by the insurer
• The insurance company takes an unreasonably long time to process a claim, resulting in delayed reimbursement or payment for medical services. 

Income Protection Claim Disputes 

Income protection is designed to provide financial support to policyholders who are unable to work due to illness, injury, or disability. Examples of income protection claim disputes include:

• The insurance company disputes the policyholder's eligibility for benefits, claiming that the illness, injury, or disability does not meet the policy's definition of incapacity or that the policyholder failed to meet the waiting period or elimination period specified in the policy.
• The insurance company disputes the medical evidence provided by the policyholder or their healthcare provider, questioning the severity or extent of the illness, injury, or disability, or alleging that the condition is pre-existing or not covered under the policy.
• The insurance company disputes the policyholder's occupation definition, claiming that the policyholder is capable of performing alternative work or that the policyholder's occupation is not covered under the policy.
• The insurance company interprets the policy terms and conditions differently from the policyholder, leading to disputes over the scope of coverage, benefit amounts, or exclusions under the policy.

Home Contents and Buildings Damage Claim Disputes 

Home contents and building damage claim disputes happen when there is disagreement between the policyholder and the insurance provider regarding the settlement of a claim for damage to the contents or structure of a home covered under a home insurance policy.

These disputes can arise for various reasons, including coverage denials, disputes over the extent of damage, valuation disagreements, or delays in claims processing

Motor Vehicle Claim Disputes 

Motor vehicle claim disputes come up when: 

• The insurance company denies coverage for damage to the policyholder's motor vehicle, arguing that the damage is excluded under the policy terms or that it does not meet the policy's definition of covered perils.
• If two drivers involved in a road traffic accident each claim that the other driver was at fault, there may be disagreements over liability, which can delay the settlement of the claim
• The insurance company disputes the valuation of the damage claimed by the policyholder, arguing that the repair or replacement costs are excessive or unreasonable.

How do I dispute an insurance claim decision?

As you can see there are many scenarios where claims can be disputed and while yours may fit into one of the above categories, each claim is unique. Insurance disputes can quickly become complicated.

In the first instance, if your insurance claim is denied and you think it’s unfair, you should review your policy documents to see if you’re entitled to claim. Once you’re sure your claim is valid, you can appeal the decision and ask them to reconsider.

If this course of action doesn’t result in a positive outcome and you still believe you’re entitled to claim, you might consider exploring making a complaint to the Financial Ombudsman Service, exploring alternative dispute resolution to negotiate a settlement, or, if things still don’t work out, taking legal action against your insurer. 

Our network of insurance dispute solicitors is on hand to help you take action to enforce your rights. Contact us today to get started with your claim.  

For your claim, you’ll need the following:

• The claim rejection letter from your insurer
• Your insurance policy and any associated guidance
• Any communication between you and your insurer since the start of the dispute
• A copy of the statement of fact when the insurance policy was taken out
• Policy details specifying high-value items or special conditions.

Can you argue with an insurance claims loss adjuster?

Insurance loss adjusters work to understand the details of an insurance claim and who might be responsible, looking at the facts, assessing the damage, and following the law. 

It is possible to debate the position of an insurer’s adjuster. However, arguing or trying to intimidate an insurance claims loss adjuster simply isn’t going to work. There are better ways of going about getting your point of view heard and setting things right. 

If you believe an adjuster’s opinion is wrong or unfair, you can question it. 

Loss adjusters work for insurance companies to keep payouts low. So, while they should be fair, they often lean toward the insurer’s side.

Loss adjusters ask open-ended questions that are designed to get more information out of you than you are legally obligated to give, such as: do you have video or photo evidence? How would you value the damage? What are your usual expenses?

You don’t have to answer these questions. Instead, Stick to the facts and avoid admitting fault or guessing. You can also refuse to give a recorded statement. 

How to complain to the Financial Ombudsman Service

You can make a claim against your insurer to the Financial Ombudsman Service (FOS) if you feel your insurer has acted unfairly to you. The FOS is the public body that settles claims between financial organisations and their customers. 

You can read more about how to complain on the Financial Ombudsman Service website, or we can act on your behalf. The help of an experienced solicitor can save you time when you want to process your complaint quickly.

The FOS will consider:

• The policy wording
• Any relevant laws and regulations
• Industry codes of conduct and best practice
• Any relevant evidence like medical reports, photos, application and claims forms 

When making a complaint to the FOS you should be prepared to wait one to two months for your case to be allocated. 

How are insurance disputes dealt with?

Insurance disputes are often handled through arbitration, a common form of alternative dispute resolution. In arbitration, you and your insurer discuss the issue with the help of an independent third party, known as an arbitrator. Their job is to guide the discussion toward a solution

Arbitration is preferred because it avoids lengthy and stressful legal action, and settlements are usually cheaper than going to court. However, in some circumstances, you may need to consider litigation. During legal proceedings, the court will hear evidence from both sides and make a final, legally binding decision. 

If you do, you’ll need to find a lawyer who specialises in insurance disputes to advise and represent you.

How do you prevent insurance claim disputes?

To reduce the chances of a claim dispute when you need to use your insurance, make sure you have a good understanding of what the policy covers.

Most importantly, the wording of the policy should match your needs and you should be clear on what could lead to a claim denial. If you're unsure about any terms, ask the insurance provider to clarify what they mean in writing. 

When making a claim, you should provide enough evidence to support it, as insufficient evidence often leads to rejections. Accurately stating the value of your claim can also improve your chances of it being accepted.

How can Lawhive help?

Our network of lawyers is experienced in dealing with insurance company disputes.

To get an understanding of how we can help, book a free case assessment with our Legal Assessment Specialists today.

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