Appeal a declined life insurance claim
Why are life Insurance claims rejected?
A declined life insurance claim can be devastating — emotionally and financially — especially when you’re grieving a loved one and depending on that money. But a rejected claim doesn’t necessarily mean the decision is final.
Insurers refuse to pay out on life insurance claims for a number of reasons, we will take you through the ones our team have come across the most:
Policy exclusions: Some policies exclude certain causes of death, such as an exclusion period for suicide. Others may not cover claims related to pre-existing health conditions, meaning if you’ve had a prior diagnosis, future claims for the same condition may be excluded.
Missed premium payments: If premiums are not maintained, the policy may lapse, preventing a payout.
Mis-selling: If an adviser provided incorrect or misleading information when setting up the policy, it could impact the validity of a claim.
Non-disclosure or misrepresentation: Failing to declare medical conditions, smoking, drug/alcohol use, or lifestyle habits during the application process. Even unintentional omissions can lead to claim rejection. You can find out more about this on our ‘non-disclosure and misrepresentation page’).
Fraud or dishonesty: Insurers may investigate cases where deliberate misrepresentation is suspected, such as withholding key health details or providing false information. If an insurer determines the policyholder knowingly misrepresented their circumstances, they may decline the claim entirely rather than reassessing the policy terms. For further information please read our guide on ‘Non-Disclosure and Misrepresentation Insurance Declines’
How do I appeal an insurance company’s decision to refuse a life insurance payout?
Let Appeal Avenue complain on your behalf
Appeal Avenue, specialise in supporting people who’ve had life insurance claims rejected.
We understand how challenging and difficult these appeals can be. Our team are trained to ask questions and gather information in a sensitive and empathetic way.
If you are happy for us to act on your behalf, we would request a copy of the decision letter from the insurer. We would then look at the policy terms and your loved one’s medical records. If we believe the decision may be incorrect, we’ll formulate a complaint or appeal for you.
Appeal Avenue will advocate on your behalf through every aspect of the declined insurance appeals process, giving you time and space to focus on the things and people that matter.
Using our vast knowledge and experience of this very niche and complex area, we can write every letter, speak with the insurer and support your complaint every step of the way. Rest assured your insurance appeal is in safe hands with Appeal Avenue.
We offer a no win, no fee advocacy service where we can handle the appeal on your behalf. You’ll only pay if we’re successful.
Make your own complaint or appeal following our guide below
If you would prefer to submit your own complaint or appeal, follow the process below. We are here, if you find this process overwhelming, or if you need any support.
1. What are the insurer’s reasons for declining your claim?
To get started, request a copy of the decision letter from the insurer. This should explain why the claim was refused — look out for mentions of exclusions, non-disclosure, or unclear medical definitions. Many declined claims can be successfully challenged, especially if there’s been a misunderstanding or a procedural error.
Work through this letter in a logical way- if you don’t agree with what they have said, make notes, so you can come back to it later.
If the reason for their decline is because they say your loved one didn’t tell them something about their health or lifestyle when they took the policy out (often referred to as non-disclosure or misrepresentation) visit our non-disclosure and misrepresentation page for more guidance.
2. Gather to support your appeal.
Depending on the reason for the insurer’s decision, it might be a good idea to gather evidence that contradicts what they are saying. This might involve looking at your loved one’s medical records or obtaining confirmation and clarification from their doctors.
3. Write the complaint.
– We would always suggest making your complaint in writing, this gives you the opportunity and time to plan, consider and reflect on what you want to say.
– Try to be as logical as possible and refer to the points that the insurer has made in their decline letter.
– Include a timeline of what has happened and put the date you send the letter of complaint at the top.
– Try to remain calm and professional- we know this is a difficult and distressing time, but it’s important to not detract from the complaint.
– Reference the evidence you have gathered that contradicts what the insurer has said.
– Always focus on what the policy terms and conditions say.
– Make it clear what you are looking for as an outcome to your complaint.
4. Wait
The insurer should send you an acknowledgement within a couple of weeks to let you know they have received your complaint and are investigating it- if you don’t receive this acknowledgement, you should contact the insurance company to make sure they received your letter.
The insurer has 8 weeks to investigate your complaint.
5. The insurer will respond to your complaint in writing.
If they ‘uphold’ your complaint (which means that they agree there has been a mistake) they will tell you what they plan to do to put things right.
If they don’t uphold your complaint (they still disagree), they will tell you why. They will also tell you what you can do next if you wish to pursue the complaint further.
6. Escalate your complaint to the Financial Ombudsman Service
If the insurer did not uphold your complaint and you are still unhappy with their decision, the next step is to take it to the Financial Ombudsman Service.
The Financial Ombudsman Service are there to independently review your complaint. They will consider the facts of what has happened and will listen to yours and the insurers opinions. They will then give an unbiased decision on what should happen next.
There are two ‘tiers’ within the Financial Ombudsman Service. Your complaint will firstly be reviewed by an ‘Investigator’ who will consider the facts of the case and issue their viewpoint.
If you, or the insurer, disagrees with the Investigators decision, you can ask for it to be reviewed by an Ombudsman. The Ombudsman will independently review the facts of the case and will issue their ruling. The Ombudsman’s decision is binding on the insurer.
If you disagree with the Ombudsman’s decision, the next step would be to seek legal advice from a qualified solicitor.
Ready to get started?
Start a new claim or get help with your appeal for declined critical illness insurance today.