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If you disagree with a decision by your insurer — a rejected claim or an insufficient payout — you do not have to accept it. You can first lodge a complaint with the insurer, then turn to a dispute resolution body such as Kifid, and, if necessary, go to court. The policy conditions are not the final word.
The policy conditions are not sacrosanct
An insurer bases its decision on the policy conditions, but these are not decisive. The conditions must be interpreted with due regard to the law, reasonableness, and the way in which judges have previously interpreted similar clauses. Moreover, unclear provisions are often interpreted in your favor, especially if you are a consumer.
Step 1: File a complaint with the insurer
Start by filing a substantiated complaint with the insurer itself. Explain why you disagree with the decision and refer to the policy and the facts. There is often an internal complaints procedure. Sometimes, good substantiation alone leads to a review.
Step 2: to a dispute resolution body
If that does not help, as a consumer you can turn to the Financial Services Complaints Institute (Kifid), which handles disputes between consumers and financial service providers. Different avenues may apply to business insurance. Such a procedure is often more accessible than going to court.
Step 3: to court
If you are still unable to resolve the matter, you can take the case to court. A solid substantiation—with the policy, the facts, and the applicable rules—is decisive in this regard. Seek advice on your chances before litigating.
Frequently Asked Questions
Should I accept my insurer's decision?
No. You can file a complaint, appeal to a dispute resolution body such as Kifid, and, if necessary, go to court. The policy conditions are not the final word.
How are unclear policy conditions explained?
With due observance of the law and reasonableness; unclear provisions are often interpreted in favour of the insured, especially in the case of consumers.
What is Kifid?
The Financial Services Complaints Institute, which handles disputes between consumers and financial service providers.
Disagree with your insurer?
Our legal experts review your case and defend against a rejection. View our legal assistance or our contract lawteam, or schedule a free consultation.
