Insurance Encyclopaedia

Claim

An insurance claim is when you make a formal request to your insurer to put you back into the same position as before the damage or loss occurred, i.e. an insured event.

What can I claim for?

You can only claim for something that is covered under your policy or for something that you have specifically bought cover for. To make sure that you’re covered, read through your policy wording in detail.

When will my insurer not pay my claim?

To get the full details the best place to start is reading your insurer’s policy wording, however, the most common reasons are: • Your loss is smaller than your excess (the amount you have to contribute to the claim); • The event that caused the loss is not covered by your policy. For example, repairing the damage that is a result of wear and tear like your house roof leaking due to old age; • If you were involved in illegal activity, like if you crashed your car just after robbing a bank or after drinking; • If the loss/damage happened before your policy started (usually referred to as pre-existing damage); • If you cancelled your cover before the claim happened; or • If you did not tell the truth at the time of taking out the policy or when you submitted the claim. For example, if you are running a business from home and tell your insurer that your home is purely used for residential purposes.

How long will my insurance claim take?

How long it takes to get paid out depends on what you are claiming for and your specific insurer. Relatively small and simple claims, like cracks on your windscreen or a stolen cell phone, are normally quick to assess and could even be approved instantly and settled in a day or two. More complex claims, such as damage to your home from an attempted break-in or a fire can take longer – even sometimes running into weeks or months. The main reason for this is that the insurer will need to send someone out to assess the damage and then engage contractors to repair or replace the loss or damage, which could take some time.

Will withdrawn/rejected claims count against me?

If you withdraw a claim or if your claim is rejected by your insurer it will usually count towards your claims history if your insurer has already spent money on the process. For example, if they’ve sent out an assessor to assess your claim, they would have paid them and because of that the claim would count, even if the damage is, for example, below your excess. If your rejection leads to cancellation it could also make it hard for you to take out cover with a different insurer. Most insurers will ask if your cover has ever been cancelled by another insurer. If the answer is yes it would at best result in a higher premium or at worst in them being unwilling to cover you. If your claim is rejected for fraudulent or criminal reasons the implications are even more severe. In those circumstances, your insurer will be obliged to hand over all documents and findings to the police and they will then take action against you, which could lead to a criminal record.

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