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Pursue a claim under an insurance policy

We will hold the insurer to the policy it wrote, and to the time it is taking.

An insurance policy is a contract, and a declined claim is a contractual position rather than a final answer. Insurers decline for reasons that range from sound to arguable to simply wrong. An exclusion read broadly, a condition said to be breached, or non-disclosure alleged years later. The policy wording decides most of it, and insurers are also bound by a duty of utmost good faith that runs in both directions. A decline is the start of the conversation.

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The wording tested, not accepted

Exclusions are construed narrowly, and an insurer's broad reading is often not the one a court would adopt.

Delay treated as a problem

A claim that is never decided generates no decline letter, and the duty of utmost good faith answers that.

Told when the decline is right

Pursuing a claim that cannot succeed costs money and time, and we will say so.

What actually happens when an insurer declines a claim?

A decline is the insurer’s view of the policy applied to the facts it has gathered. It is not a determination. The insurer relies on the wording. That is usually an exclusion, a condition of cover, or an allegation that something was not disclosed when the policy was taken out. Whether that view is right is a question of construction, and the answer often turns on a few words. Insurers also owe a duty of utmost good faith, which constrains how a claim is investigated and how quickly it is decided. Where the decline stands, there are review and dispute pathways before litigation becomes necessary.

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Is a declined claim the end of it?

No. A decline is the insurer’s view of its own policy, not a determination. Exclusions are construed narrowly and are often read more broadly by insurers than a court would. A properly argued response changes the outcome in a meaningful number of cases.

They say I did not disclose something. Where does that leave me?

In a better position than it sounds. The insurer has to establish what you were asked, and what a reasonable person in your circumstances would have disclosed. It must also show what it would have done differently. Each of those is a real hurdle rather than a formality.

My claim has not been declined, it is just not moving. Can anything be done?

Yes. Insurers owe a duty of utmost good faith, which covers how promptly a claim is handled as well as how it is decided. Persistent delay and repeated requests for material already provided are answerable, and the external dispute pathways take these complaints seriously.

Do I have to go to court?

Usually not. Most claims that are worth pursuing resolve through a properly argued written response or through external dispute resolution. Those pathways are free to the insured, considerably faster than litigation, and binding on the insurer in the ways that matter.

Send us the policy and the decline letter

We will read the wording the insurer relied on, tell you whether the decline holds, and set out what should happen next.

A declined claim is an opinion, not a decision

You paid for cover, something happened, and the insurer has said no. Or it has said nothing for months while asking for more documents. The letter cites clauses you have never read in a document you have probably never read either. What you need to know is whether the reason given actually works on the wording, and that is not something the letter will tell you.

We will read the policy wording the insurer has relied on.
We will tell you whether the reason given for the decline actually holds.
We will prepare a written response setting out why the clause does not apply.
We will test any allegation of non-disclosure against what was actually asked.
We will escalate through the external dispute pathways where the insurer will not move.

The claim has been declined or has simply stopped moving

There has been a fire, a theft, a business interruption, a professional claim or an illness. You lodged the claim, cooperated with the investigation, and provided everything asked for. Then either a decline arrived citing a clause, or the requests for information simply kept coming and nothing was decided. Meanwhile the loss is real and the money the policy was bought for has not arrived.

What's included in your insurance claim service

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Review of the policy wording and the schedule.
Assessment of the reason given for the decline or delay.
A written response to the insurer.
Non-disclosure analysis where it has been alleged.
Duty of utmost good faith submissions where the claim has stalled.
External dispute resolution and, where necessary, proceedings.

Why declines are worth testing

Most declined claims are never challenged. The insured reads the letter, accepts that a clause applies, and absorbs the loss.

That is often the wrong conclusion. Exclusions are construed narrowly, and an insurer’s broad reading of one is frequently not the reading a court would adopt. Non-disclosure allegations require the insurer to establish what a reasonable person in your position would have known to disclose. It must also show what it would have done differently. Conditions said to have been breached often turn out not to have been conditions at all.

Delay is the other problem, and it is less visible. A claim that is never decided does not generate a decline letter to challenge. It simply sits there, with the insurer requesting further material, while the insured carries a loss they insured against. That is a duty of utmost good faith issue, and it is answerable.

From a decline letter to a claim that gets paid

We start with the policy rather than the correspondence. The wording is what the insurer has to justify its position under. The decline usually rests on a handful of words that repay close reading.

Then we respond properly. That means a written answer setting out why the clause does not apply on the facts, supported by the evidence the insurer has not weighed. Where non-disclosure is alleged, we test what was actually asked and what a reasonable person would have understood the question to require. Where the problem is delay rather than a decline, we press the duty of utmost good faith. We use the external dispute pathways, which are faster and cheaper than proceedings and often enough on their own.

How we pursue a declined claim

Read the wording, answer the reason given, then escalate.

Read the policy

We work from the wording the insurer must justify its position under, not from the letter.

Answer the reason

We respond in writing, setting out why the clause does not apply on your facts.

Escalate if needed

We use the external dispute pathways, which are faster and cheaper than proceedings.

The decline tested against the policy the insurer actually wrote

Being declined by your own insurer is a particular kind of powerlessness. You have paid for years, something has gone wrong, and a letter explains why that does not matter.

We are an ISO 9001 accredited practice. We act for insured parties in declined and delayed claims, including property, business interruption, liability and life policies. We will also tell you when the decline is right, because paying to pursue a claim that cannot succeed helps nobody.

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Have the decline tested properly

Send us the policy, the decline letter and the correspondence. We will tell you whether the reason given holds up, and what it would take to change the outcome.

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