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How to make an Insurance complaint & get compensated quickly.

When you buy an Insurance Policy, there is a chance that the insurance company may not pay for the losses that you may incur.

Lately, there has been a growing list of common complaints that insurance policy holders have with their insurance companies.

Don’t give the insurance company an excuse to reject your claim. It’s important for you to know how to avoid all this when you incur losses.

If you are suffering from a loss whether it’s a catastrophic, devastating loss or a small claim that impacted just part of your life or business.

It’s important that you promptly call in your claim to the insurance company. The goals with all these insurance claims are for you to get back to your pre-loss conditions.

We all know that insurance companies love to ensure that you pay a premium. However, they are not always as quick to give you a playout when you make a claim.

The Negative Perception of the Insurance Companies on Customer Engagement 

One thing that you need to understand as a policyholder is that you should make sure to inform the insurance company of the event and its nature immediately after its occurrence.

To avoid back and forth with the insurance company, you should Include all details of what had happened.

Commonly, Insurance companies are banking on information provided by the policyholder. They may either delay or compensate you based on the clarity of your information.

In one way or another, you may feel that you have been denied an insurance payout, treated unfairly or you think that you have been defrauded by an insurance company.

Don’t worry you still have some options to challenge that.

Below are 3 steps you can take to ensure that insurance companies honour their claims obligations.

1. Contact the Insurance directly

Contacting your insurance company directly is extremely a very important part of the claims process.

The nature and process of your communication with the firm makes a world of difference with your complaint and claim request.

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This might determine how you get assisted, the amount of benefits you get compensated and how fast you get reimbursement.

You may try to contact the insurance company either by telephone, in person meetings or through mails and letters.

The most important thing to consider throughout all this process is that you must make sure that everything gets documented in writing.

As a policy holder, it is very important to understand how insurance companies are usually structured.

Each personnel you interact with at an insurance company has a great influence on how your claim or complaint can get settled.

Most insurance claims departments hierarchy are many times organized as follows:

  1. Adjuster
  2. Supervisor
  3. Unit Manager
  4. Claims Manager

As you move up the hierarchy, your chances of being assisted get better and better.

One of the many things that can trigger the insurance company to settle an issue is a focused complaint that makes personnel above the adjuster pay attention.

When lodging your complaint, documentation is everything.

For example, if you write to an adjuster, send a copy to his or her supervisor and formally ask for a written feedback clearly giving a deadline for when you wish to hear back from them.

If you don’t hear from them during the set time frame, follow up with a phone call to confirm that your letter was received.

If there is an issue over coverage or procedure, ask your insurer to point you to the specific part of the policy that explains it.

Do this as quickly as possible and in the form of a letter so you have a written record of what was said or agreed.

Make sure you include details of what happened, dates of who you spoke with, terms when and a deadline for when you wish to hear back from them.

If you can show your insurance company that the decision was incorrect, the situation can be handled administratively, without involving a financial ombudsman or court processes.

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2. Contact the Financial ombudsman

A Financial ombudsman is an independent body set up to resolve disputes between customers and financial firms such as Banks, Insurance companies, Investment firms, financial advisers.

Before the ombudsman can help you with your complaints, you must first show the insurance company that you are unhappy with the outcome of your complaint or claims.

The insurance company will have a maximum of 8 weeks to resolve the complaint. If they do not resolve it within 8 weeks or perhaps you are still unhappy with the outcomes.

You can then refer your complaint to the financial ombudsman service for help.

How the process works

For most financial ombudsman, lodging a complaint with them can be achieved with admirable ease and won’t cost you a penny. 

When you contact them for the first time, they will need to know:

  • Some basic information about you e.g.  your name and address.
  • The nature of the problem and how you want it resolved.
  • Insurance policy details such as the policy number.

Once they have assessed your complaint and found out that it is something they can help, they will start to investigate the matter.

During their investigations, the financial ombudsman will look into your complaint and:

  • Ask the insurance company for their side of the story.
  • Weigh up the facts of what has happened, without being biased.

Once they have all the information they need, they will let you know what they think about the whole issue.

If they think it was just a misunderstanding or you have not lost out financially, they will advise you how to get your claim or solve the matter with your insurance company.

But if they decide you have been treated unfairly, they will request the insurance company to fix the problem. they can do that in a number of ways including paying you compensation.

If you or the insurance company express a different opinion with the initial assessment of your complaint, either of the 2 parties can ask for a final decision.

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The ombudsman will do things afresh. They have the power to make legally binding final decisions.

If you reject the ombudsman’s final decision, they will not take your complaint further but you can still take legal actions and take the matter to court instead.

3. Take the matter to Court

Convincing insurance companies to reverse a decision is difficult. But to the surprise, the insurer usually takes complaints more seriously when a lawyer is involved in the case.

If you are having a problem with your insurance company, one of the many ways to resolve the matter is to seek professional legal advice.

With complicated matters, you may want to seek help or support from a lawyer who specializes in this type of complaint.

When meeting with your attorney you should consider and discuss the following points:

  1. Strength of the Case
  2. Money and Damages
  3. Questions for the Plaintiff
  4. General Concerns

The attorney will make sure you understand your rights and get justice as well.

When your insurance company refuses to give you what you deserve, and your lawyer thinks you have a strong case, you have no other choice but to take legal actions against the insurer.

By taking legal actions you have the possibilities of receiving much more compensation if you take your claim to court.

For instance, the court rulings could include more money for pain and suffering, something your insurance companies try to cut back.

The negative side of legal actions is that taking a disputed matter to court can be an expensive and time-intensive process.

You will need to consider the time, money and effort involved.

So, if you ever disputed with an insurance company, that’s how to complain about it.

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