Rejected Insurance Claim Help

How to Challenge A Rejected Insurance Claim

1. Read the rejection letter carefully. Note the specific policy clause cited and the factual basis for the decision.
2. Do not respond emotionally. The first letter back from a frustrated policyholder often hardens the insurer’s position. Pause.
3. Pull the policy document and the schedule. The rejection letter cites a clause; verify it is actually in your policy and that it applies to your facts.
4. Compile every piece of evidence about the loss event. Photographs, receipts, repair quotations, professional reports, weather records.
5. Engage a loss assessor for a second opinion. We routinely overturn first-pass rejections by reframing the cause, evidencing the peril correctly, or pointing to a section of cover the original claim missed.
6. Submit a formal complaint to the insurer. Each Irish insurer has an internal complaints procedure with a defined response time, usually 40 working days.
7. Escalate to the Financial Services and Pensions Ombudsman if needed. The FSPO is independent, free to use, and binds the insurer to its determinations.
8. Engage solicitors only when needed. Most rejected claims are resolved without legal proceedings.

Remember, the first rejection is the start of the conversation, not the end of it. Documentation, the right policy clause, and persistence settle most disputed claims.

Common reasons claims are rejected

• Wear and tear. The most-cited rejection reason. Often arguable.
• Lack of maintenance. Insurers argue the loss was preventable.
• Gradually operating cause. The leak/damage was not a sudden event.
• Policy condition breach. Heating off in winter, alarm not set, vacancy beyond threshold.
• Material non-disclosure. Something on the proposal form was wrong or missing.
• Pre-existing damage. Damage existed before the policy started.
• Cause not insured. The actual peril is not covered.
• Sub-limit reached. Cover applies but the policy cap is hit.

How N.J. Carroll & Associates Can Help

We are one of Ireland’s most experienced loss-assessing firms, established 1988, regulated by the Central Bank of Ireland. The founders bring a combined background in insurance, quantity surveying, and accountancy, the exact mix needed for rejected-claim work. We have overturned first-pass rejections on water, fire, storm, theft, subsidence and accidental damage claims, including ones the policyholder thought were closed.

We act as the insured’s representative throughout. We take the stress and worry off your hands. We ensure that you receive your full entitlement under your policy’s terms. We are wholly independent and committed to your interests alone.

Our standard fee is 8% plus VAT of the recovered settlement, on a no-win, no-fee basis. The initial consultation is free.

If your claim has been rejected or under-settled, please do not hesitate to contact us today. For related claim types, see underpaid settlement claims, water damage claims, and storm damage claims. Reach the local team at loss assessors Dublin.

N.J. Carroll & Associates Ltd are regulated by the Central Bank of Ireland. Our Financial Regulator Certificate number is C41330. Niall Carroll is a member of the Society of Chartered Surveyors and the Royal Institute of Chartered Surveyors. We are also a member of the Irish Claims Consultants Association.

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