Why was My Insurance Claim Declined?

Once an insured risk occurs, you file a claim with your insurer to get compensation. But did you know that an insurance firm has the right to decline your claim in some instances? Yes. If you recently received an email regarding the rejection of your insurance claim, you may be asking the following questions:

• Can an insurance company decline a claim?
• Why was my claim declined?
• What do I do when my insurance claim is declined?

After lodging a claim, your insurer can also take the actions below:

• Approve
• Request more information

As a policyholder, you have the right to know why your claim was declined. Here are 5 common reasons why your claim may be declined:

1.      If the Risk is Excluded

When you secure insurance coverage, your insurer will issue a policy document, which stipulates the key aspects of the contract. The document highlights the limits of coverage, conditions for coverage, and excluded risks. 

If you experience a loss caused by a risk that is not stipulated in the policy, your insurance company can reject your claim. For example, if a loss occurs due to political or terrorist events and the risks are excluded in the policy document, your insurer may not accept the liability.

2.      If the Policy Has Already Expired

When you sign up for insurance coverage, your insurer indicates the policy period (the timelines the policy will be in force). If a risk occurs outside the stipulated timeline, your claim can be declined. Can my insurance company reject a claim if the loss occurs outside the policy period even if it is as a result of an insured risk? Yes.

3.      Violation of the Law

An insurance policy is a legally-binding contract and failure to adhere to the applicable laws can result in the rejection of your claim. This can also happen even if you have an active policy with the right scope of coverage at the time of the occurrence of a loss. For instant, driving without a valid driver’s license or running illegal operations are common reasons for the decline of an insurance claim.

4.      Fraudulent Claims

One of the key principles of insurance is the Utmost Good Faith. Every party in the insurance contract is obliged to be honest and disclose any critical information. A violation of this key principle may entail alterations regarding the occurrence of an accident or hidden pre-existing conditions in health insurance.

5.      Late Reporting of Claims

As the insured, you are obliged to report the occurrence of a loss to your insurer within the stipulated timelines. The right reporting period is highlighted in your policy document. Generally, you should report an incident to your intermediary or insurance company immediately.

What Can I Do if My Insurance Claim is Declined?

In some cases, you may feel that the rejection of your claim was unjust. As a policyholder, you can appeal the decision and request your insurer to review the decision. How can Bowman Consultancy Insurance Agency assist? 

We understand the rejection of your claim can be a major setback in your life and we are here for you! We understand the legal basis of declining a claim and will help you to appeal in such cases to ensure you get compensation as per the policy conditions.

Please contact us via 0724 055 534 or info@bowman.co.ke. You can also visit our website, https://bowman.co.ke/ for assistance.