What To Do If Your Insurance Claim Is Rejected

Published on Oct 29, 2014
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When it comes down to it, insurance is a great way of making sure you can protect the people and things you love during tough times. But sometimes, even when you have insurance, things may not go as smoothly as you’d hoped.

If you lodge a claim with your insurance company and it’s rejected, does this mean the end of the road? Not always.

Here’s our handy guide for the next steps you can take:

1. Do your research

While it may seem obvious, make sure that what you’re claiming for is covered in your policy document. For example, if your house was burgled but your alarm wasn’t on at the time, your household contents insurance claim may not be valid.

2. Contact your insurance company

If you still feel that your claim was unfairly rejected, contact your insurance company and tell them you’re unhappy. All insurance companies are required by law to have a formal complaints process, so following this process will get you the fastest possible resolution. In most cases, a written complaint is best for keeping your facts straight. If you do phone a call centre though, think details: the name of the person you spoke to, what was said, the date and time of the call, and a reference number if possible.

3. Stick to the facts

Above all, take a deep breath and stay calm: being objective even if you’re upset or angry means you’ll be understood more easily, which can hopefully resolve the matter quickly. Then, when you do complain, state the facts as clearly as you can and in a logical order. Make sure you include relevant details like your claim number and policy number.

4. Get an independent assessment

Once you have the specific reason from the insurer why your claim was rejected, an external party can be a good option for getting an objective point of view. Note that this is only in the case of a short-term claim, such as car or home insurance. Called independent loss adjusters, these people will look at the damage objectively and send a report to your insurer. Note that the insurer won’t bear the cost of an independent loss adjuster.

5. Go to the Ombudsman

If you still feel your claim was unfairly rejected, there’s still hope - you can take your complaint to the Ombudsman for Short-Term Insurance. The Ombudsman is a free, independent service that investigates complaints from ordinary people towards insurance companies. They look at the complaint objectively to reach an outcome that is hopefully fair for both parties.

6. Choose the right ombudsman

In South Africa, you can choose between both a short-term (www.osti.co.za) and a long-term ombudsman (www.ombud.co.za). You’ll need to fill out a complaint form and send it back to them, along with supporting documentation about your claim. From there, they’ll take the matter up with your insurance company and let you know the outcome as speedily as possible.

7. Seek legal advice

While the Ombudsman’s decision is based on law, remember that they don’t give legal advice. If you’re still not happy, your next option is to get legal advice from an attorney about taking your insurer to court. 

If your insurance claim is rejected, following the steps above could mean you’ll be well on your way to a fair and just outcome. This means you’ll be able to get closure on the situation so you can get back in the saddle as soon as possible.

Click here for more information on the insurance claims process, call your Hollard-accredited financial advisor or call Hollard directly. The Hollard Insurance Company Ltd and Hollard Life Assurance Company Ltd are authorised financial services providers.

The Hollard Insurance Company. Ltd (Reg No 1952/003004/06) is an authorised Financial Services Provider.