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Getting a “no” from your insurer when you need it most can be frustrating and disheartening. After paying your premiums for years, you expect your insurance to step up — but it doesn’t always happen.

Every year, hundreds of people see their claims denied with vague or unfair explanations. The good news is that all is not lost: you can appeal that decision and secure the compensation you deserve.

This article explains why insurers deny claims, what steps to take if it happens to you, and how to enforce your rights.

Why Can an Insurer Deny a Claim?

There are many reasons why a claim may be denied — but not all of them are valid or final. Some denials stem from misinterpretations or unfair assessments.

Common denial reasons include:

“The damages are not covered by the policy.”

“The claim was not reported in time.”

“Insufficient documentation or evidence.”

“The cause is pre-existing or not accidental.”

“It’s an extraordinary event not covered by insurance.”

Many of these can be challenged if you know how to respond.

Step One: Review Your Policy Carefully

Before taking action, carefully review your contract. Check:

What coverage is included

What exclusions apply

Any limits or deductibles

Insurers may interpret policies narrowly, but that doesn’t mean they are right.

Step Two: Analyze the Reason for Denial

Your insurer must inform you in writing of the reason for rejection. The document should be clear, well-founded, and reference your policy.

If you haven’t received it, request it immediately — it’s your right.

Step Three: Gather Documentation

To prepare an appeal, compile:

Full policy

Claim report

Photos and videos of damages

Technical reports or estimates

The rejection letter

Adjuster’s report (if any)

The more complete your file, the stronger your case.

How to Proceed If Your Claim Is Denied

1. File a formal complaint with the insurerWrite to the insurer’s Customer Service department, stating why you disagree, providing evidence, and requesting a review or second assessment. The insurer has two months to respond.

2. Request a second assessment (counter-appraisal)You can appoint your own expert if you believe the insurer’s assessment is incorrect. This process, called contradictory appraisal, may involve a third independent expert whose decision is binding.

3. Escalate to the Insurance Ombudsman or the DGSFPIf no resolution is reached, you can appeal to the Insurance Ombudsman (if your insurer has one) or the Directorate-General for Insurance and Pension Funds (DGSFP). Their report is not binding but carries weight.

4. Contact specialized professionalsIf the process is complex or overwhelming, experts like MataSeguros can handle it for you.

Conclusion

If your claim has been denied, don’t give up. Many denials stem from misinterpretations, unfair assessments, or lack of evidence.

With the right information, professional support, and a clear strategy, you can overturn the decision and obtain the compensation you deserve.

At MataSeguros, we help people like you every week to successfully appeal claim denials. If you’ve received a rejection letter, we’re here to fight for you.

Tell us your case — we only get paid if you do.