What to Do If Your Insurance Claim Is Rejected
Fecha: 2024-12-09
You report your claim, follow all the steps, and wait for your payment… only to receive a letter saying your claim has been denied. That same insurer that smiled when you signed the policy now seems to be working against you.
Here’s what to do if your insurer says “no” — and how to fight for what’s yours.
1. Read the Rejection Letter Carefully
Insurers must give a reason for denying a claim. Check:
The reason provided — does it make sense or sound like an excuse?
Clauses or laws they mention — do they really apply?
Your deadline to appeal — don’t miss it.
2. Review Your Policy
Your contract contains all the coverage details. Look for:
Exclusions (what’s not covered)
Your obligations for reporting a claim
Coverages you’ve been paying for
Take notes of anything unclear. Some rejections have no legal basis — insurers count on you not fighting back.
3. Contact the Insurer
Stay calm but firm. Request:
Detailed explanation of the rejection
A review of your case
A copy of your claim file (you have the right to this)
4. File a Formal Appeal
If they still refuse, it’s time to escalate:
Write a clear, direct appeal letter
Include arguments and policy references
Attach all evidence (photos, invoices, reports)
Send it within the given deadline.
5. Go to External Institutions
If the insurer keeps ignoring you, you can go to:
The company’s Ombudsman
The Directorate-General for Insurance and Pension Funds (DGSFP)
Consumer associations (like OCU, FACUA)
These procedures are free.
6. Consider Legal Action
If nothing works, consult a lawyer specialized in insurance claims. Sometimes, just the threat of legal action pushes the insurer to settle.
Conclusion: Don’t Give Up
Insurers want you to give up — but now you know your rights.
Steps to Remember:
Read the rejection and review your policy.
Speak to the insurer and demand explanations.
File a formal claim.
Contact external organizations if needed.
Seek legal help if necessary.
If you pay your premiums, your insurer must fulfill their promise.