Appeal a declined income protection claim
Why are income protection claims rejected?
Insurance companies pay out on thousands of income protection claims every year. Unfortunately, a small percentage of these claims are refused.
Insurers decline to pay out on income protection claims for a number of reasons. Our team find that the top three reasons insurers decline to pay these claims are:
1. The insurer says you are fit to return to work
Sometimes, an insurer might say that you are well enough to return to work, even when you don’t feel able and your own doctors have provided medical evidence to support your claim.
In situations like this, when the insurance companies claims assessors and Chief Medical Officer (CMO) disagree with your own medical professionals opinions, our team uses their experience and training to argue whose opinion should be given more weight.
2. The insurer has said that you didn’t tell them something about your health or lifestyle before your income protection policy started
This is known as non-disclosure which is a type of misrepresentation. You can read more about non-disclosure misrepresentation in our guide.
Our team has vast experience of assessing and forming complaints and appeals in this complex area of claims management.
3. Your illness is not covered under the policy terms
Sometimes an insurance company may decline to pay out as they say that the illness or condition which is preventing you from working is not covered by the policy terms and conditions.
Often, insurance companies make the correct decision in line with their policy terms, but our team has experience of overturning insurance companies’ decisions when they get it wrong.
What do I do if my income protection claim is refused?
Let Appeal Avenue handle the appeal for you
Our team is experienced in gathering information and medical evidence to support income protection claims. We will use our knowledge and expertise to form complaints and appeals against your insurance companies’ decisions
On our first call, you can expect us to talk to you about your situation. We will ask questions about your health circumstances as well as your job. It’s important for us to understand, in your words, why you aren’t able to work. Our team will give you the time and space to share your story. If you’re happy for us to represent you, we would review your insurance companies decline letter, access your medical records (with your consent) and consider the job role you do. If we think you have grounds to appeal your insurer’s decline decision, we will form a complaint or appeal for you.
We would represent you through the entire complaint and appeals process, meaning that you can focus your time and attention to the things that matter.
You can rest assured that Appeal Avenue will present your complaint in the best way possible.
We offer a no win, no fee advocacy service. This means that you will only pay if we secure a positive outcome for your claim.
Make your own complaint or appeal following our guide below
If you would prefer to write and submit your own complaint and appeal for your declined income protection claim, take a look at our helpful guide below.
1. What are the insurer’s reasons for declining your claim?
If the insurer has provided their reasons in writing, work through this in a logical way- if you don’t agree with what they have said, make notes as you go through the letter, so you can come back to it later.
2. Gather evidence for your appeal.
Depending on the reason for your insurer’s decision, it might be a good idea to gather evidence that contradicts what they are saying. This might involve looking at your medical records or obtaining confirmation and clarification from your doctors.
3. Write your 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- you don’t want to detract from the complaint.
– Reference the evidence you have gathered that contradicts what the insurer has said.
– Always focus on what your policy terms and conditions say.
– If you are in severe financial difficulty- make sure you state this in your complaint letter and request that the insurer prioritises your complaint if possible.
– Make it clear what you are looking for as an outcome to your complaint.
4. Wait
Your 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 your insurance company to make sure they received your letter.
The insurer has 8 weeks to investigate your complaint.
5. Response
Your 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 is 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.