What can I do if my insurance claim is rejected?

A rejection letter is the insurer's opening position, not the end of the matter. Insurers are FCA-regulated, so a written complaint puts them under the DISP rules: they must acknowledge it, issue a final response within 8 weeks, and tell you about the Financial Ombudsman Service. If the 8 weeks pass with no final response, you can refer anyway.

Build the complaint before you send it

• Your policy document, schedule and any endorsements — the exact wording, not a summary.
• The claim form and every piece of correspondence, in date order.
• The rejection letter and the precise clause the insurer relies on.
• Independent evidence that contradicts it — a second repair quote, an independent surveyor's report, a specialist medical opinion, or a valuation.
• Anything the insurer or broker said at the point of sale.

Read the exclusion carefully before accepting it applies. Ambiguous exclusion wording is generally read in the policyholder's favour, and where the insurer is relying on non-disclosure it must do better than pointing at an unanswered question. Under the Consumer Insurance (Disclosure and Representations) Act 2012 an insurer can only avoid a policy or refuse a claim where the misrepresentation was careless, or deliberate or reckless. Genuinely forgetting something you were never specifically asked about frequently fails that test, and the ombudsman scrutinises these defences hard — particularly in life insurance and critical illness claims.

Referring to the Financial Ombudsman

The service is free, covers home, motor, travel, life, critical illness, income protection and pet insurance, and also reaches brokers and claims management companies. You need the final response letter, or proof that 8 weeks have passed, and you must refer within 6 months of that response. Simple claim rejections are often decided in a few months; disputes turning on medical evidence take longer.

Income protection refusals deserve a specific line of attack: ask in writing which definition of incapacity is being applied — "own occupation" or "any occupation" — and get your own consultant to address that wording directly. The ombudsman can commission its own independent medical opinion where the evidence conflicts. Accepting a final decision makes it binding and closes the court route, so if the sum at stake is large, take advice before you sign.