Why Your Insurance Company May Refuse to Pay an Insurance Claim

Insurance as a product of necessity

Globally, insurance is never seen as a necessity but a product of luxury. As observed in some quarters, insurance is majorly ‘sold and not bought’. Many insurance professionals will gladly agree to this postulation but the need for insurance in our daily lives and existence keep giving way to its continued propagation and eventual patronage by the same customers who neglect its importance.

Given the level of negative outlook and regulatory sanctions that could hit insurance companies, one would naturally expect any claim submitted by insurance customers be paid without any form of denial, rejection or partial acceptance of payment. Well, your guess is as good as mine – they always come up with several reasons not to pay (Lol😄).

Now, let’s expound some of the reasons why your insurance company may refuse to pay your claim:

a. the policy was not in force when what you’re claiming for happened. Example are expired or delayed renewal of insurance policy

b. Refusal to disclose information that could affect your policy at the time of claim. Good examples include, renewing insurance for a damaged vehicle, expired driver’s license, lack of information about a negligent party etc.

c. the policy could become invalid if you carelessly withheld some vital information.

d. the item damaged or lost is not covered by your policy. Example are attached accessories in your vehicle except specifically stated and value attached to each of the accessories.

e. there is an exclusion clause in the policy. Examples are normal wear and tear of the vehicle, damage caused to the vehicle due to driving without a valid driving license or driving under the influence of drugs or alcohol etc.

f. missing out some of the instalments of your premium (This happens a lot; Never ever forget🦧)

g. You didn’t inform your insurer about a change in your circumstance. Examples are, change of location either within or outside the state, additional insured or assigning the vehicle to a new driver etc

h. Have you followed the claim processes correctly?

I. you haven’t kept to a condition of your policy. A good example is, never drive with an expired driving license

j. Inflating amount to be claimed.

Your insurer must give you a reason for refusing to pay your claim.

Also, ensure you read your policy document (contract of insurance) carefully when you buy an insurance policy.

If you think your insurer is being unreasonable in refusing your claim, negotiate with them. If not satisfied with the way your claim has been dealt with, you can make a complaint by writing directly to National Insurance Commission (NAICOM) and other alternative dispute resolution agencies.

If you have questions relating to your insurance policies and do not understand the technical jargons, we can assist you with a FREE POLICY REVIEW to ascertain the level of cover you have and how to achieve more with your insurance policy. We are just a chat away on WhatsApp.

Was this article valuable? Read more of our published articles on Insuranceblitz.

Acknowledgment

The author would like to thank and acknowledge the contributions made by Adebiyi Muhammed, a Team Lead, Schemes and Retail with YOA Insurance Brokers Limited in their Lagos office. He can be reached at muhammed.adebiyi@yoainsurance.com.