Insurer rejects your claim: when should you contact a lawyer?

1. Identify exactly what the insurer is rejecting

A claim may stall over coverage, the cause of the damage, the amount claimed or cooperation with the investigation. Do more than record that the insurer will not pay. Note the event you reported, the amount requested and the specific explanation in the letter. A dispute about repair costs requires a different file from a dispute about an exclusion.

Request the full position if you only received an answer by telephone. Also ask which version of the terms and which reports were used. Keep the original dated letter. List missing information separately rather than filling in an unclear explanation yourself.

2. Compare the policy, claim notification and timeline

Start with the policy schedule applicable around the event. Add the terms, special clauses and correspondence about changes. Separately arrange the dates of the incident, notification, expert visits, requests for information and rejection. Preserve original documents and make your own annotations on copies.

Check whether the rejection concerns the same event you reported. A photograph of damage does not by itself establish when its cause arose. Note what each file demonstrates and which question remains unanswered. This helps an adviser identify the evidence still needed.

3. Support the disputed part of the claim

For a disagreement about the amount, quotations, invoices and an itemised repair estimate are useful. For a technical disagreement, a focused expert report may help more than numerous general photographs. Before instructing an expert, ask which question the investigation will answer, what it costs and whether a later inspection remains possible.

Before obtaining a second expert opinion, have the policy’s provisions on costs and procedure checked. Do not assume every expert you choose will automatically be reimbursed. Retain damaged items where safe and practical; discuss necessary repairs and document the condition beforehand. This preparation does not guarantee that the insurer will accept liability or coverage.

4. Submit a focused internal complaint

The AFM recommends first complaining to the financial firm in writing and requesting a written reply. Address the reason for rejection: give the file number, briefly identify the disputed position, explain which evidence you believe has been overlooked and state the solution you seek. Keep proof of sending and receipt.

Distinguish a request for clarification from a substantive complaint. Send an organised selection of relevant documents with an index. The AFM says you may expect a substantive response within eight weeks. Monitor other possible deadlines separately: an ongoing complaint does not generally confirm that all your rights have been preserved.

5. Check whether Kifid can handle your complaint

Kifid is a possible next step for many financial complaints, but not every dispute qualifies. Check the provider’s registration, the type of insurance, your position as a consumer or business and the current rules. Kifid’s eligibility test and information can assist this initial assessment. Rejection by your insurer does not automatically mean Kifid has jurisdiction.

For an online complaint, Kifid asks for an explanation, the desired solution, estimated financial loss and correspondence. Prepare this selection carefully before submitting it. If uncertain, also ask what choosing binding advice would mean for your later options. Do not start several proceedings over the same claim at once without advice.

6. When can an insurance lawyer help?

Seek specialist help if interpretation of coverage is decisive, the claim affects your financial position or the insurer alleges misinformation or fraud. Also obtain advice if you must sign a settlement agreement or do not understand a deadline mentioned in a letter. A lawyer can identify the legal issue and compare procedural options with you.

At the first meeting, agree who the client is, which documents will be examined, the price of an initial assessment and which further steps require separate authorisation. If you have legal expenses cover, ask whether it may cover this dispute. Reporting to the AFM can provide a supervisory signal; the AFM does not resolve your individual compensation dispute.

7. Fictional example: a leak and a disputed cause

Suppose a homeowner seeks reimbursement for ceiling repairs after a leak. The insurer refers to an exclusion and refuses payment. The owner wants to sue immediately, but the complete expert report and the clause relied on are missing from the file.

A focused first step is to request both documents and gather photographs and the original claim notification. An expert or lawyer can then assess whether the disagreement concerns the cause, interpretation of the clause or both. This fictional example shows how to narrow the question; it says nothing about the outcome of an actual leak claim.

8. Checklist for your first advice meeting

Bring an organised file and state your desired outcome in one sentence. Note the practical effects of delayed payment as well. An adviser can then distinguish a longer-term solution from any urgent measure.

• The policy schedule, terms and special clauses relevant to the claim.
• Claim notification, every rejection and a timeline of sending and receipt dates.
• Photographs, expert reports, quotations and invoices, with a brief explanation of each.
• Your internal complaint, the reply and letters referring to deadlines.
• An overview of the amount claimed, payments received and outstanding investigation questions.