Tips on making a complaint or appeal
- 17/07/2025
- Posted by: Appeal Avenue
- Category: FAQs
Every year, thousands of insurance claims are successfully paid out by insurers, but unfortunately, lots of claims are declined.
If your insurance company refuses to pay your insurance claim, they should tell you why. It’s a good idea to ask the insurer to put the reason for their decline in writing. This allows you time to review how they have come to make their decision and is also a good starting point for your appeal.
If you would like our support with making a complaint or appeal, make an appointment with us today and we will chat through what has happened and what your options are – take a look at the fees section of our website for an idea of the costs involved.
Here are some things to consider before submitting your appeal:
1. What are the insurers 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.
If the reason for their decline is because they say you didn’t tell them something about your health or lifestyle when you took the policy out (often referred to as non-disclosure or misrepresentation) visit our non-disclosure and misrepresentation page for more guidance.
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.
If you would like our support with understanding what evidence may help with your appeal, make an appointment with us today and we will chat through what has happened and provide you with some guidance – take a look at the fees section of our website for an idea of the costs involved.
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.
– 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 terminally ill, or 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 your 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.