Problems with an insurance claim

Insurance gives you extra protection if things go wrong. However if you need to make a claim, you may have a problem with making the insurance company pay you. For example, your insurer may refuse to pay you anything or may pay you less than you have claimed for. This page tells you what you can do if you have a problem with your claim.

Contact your insurer

There may be a good reason why your insurer has made their decision about your claim. Before you do anything, check your policy document to make sure that what you want to complain about is covered by your policy.

If it is, write to your insurer, giving details of your complaint, and telling them what you would like them to do about it and giving them a time in which to reply. You should keep a copy of your letter and send any correspondence by recorded delivery.

If you’re not satisfied with your insurer's reply you can make a formal complaint using your insurer's official complaints process. To find out how the complaints process works, look at your policy documents or on your insurer's website.

If you are still not satisfied with the outcome of the formal complaints procedure, you can consider taking the complaint further.

If your insurer is a member of Lloyds, you can make a complaint to the Policyholder and Market Assistance Department. If you are not satisfied with the outcome of this complaint, you can then complain to the Financial Ombudsman Service.

Using the Financial Ombudsman Service

All insurers must be covered by the rules of the financial watchdog, the Financial Conduct Authority (FCA). This means that if you have a complaint about an insurer, you can take it to the Financial Ombudsman Service. This is a free service available to you if you have already followed your insurer's complaints process.

The Financial Ombudsman Service will try to sort out your complaint using mediation. If the dispute cannot be resolved in this way, the Financial Ombudsman Service will begin a formal investigation.

The final decision given at the end of this investigation is binding on your insurer. This means they have to stick to the terms of the decision made by the Ombudsman.

However, if you do not agree with it, you can take your insurer to court.

Going to court can be stressful and cost you money. You should consider this as a last resort. Also a court will take into account any decision that's already been made by the Ombudsman.

Time limits for taking your complaint to the Ombudsman

You must take your complaint to the Ombudsman within:

• six months of receiving a final response from the trader. This response has to mention that you have a six month time limit to go to the ombudsman

• six years of the event you are complaining about. If it’s more than six years from the event, you have three years from when you knew, or could reasonably have known, you had a reason to complain.

However, if you’re outside these time limits, you can still refer the complaint to the Ombudsman. They may still investigate your complaint, as long as the trader doesn’t object. If the trader objects because the time limits have passed, the Ombudsman will not investigate your complaint.

• There are different time limits for complaints about mortgage endowments. See www.financial-ombudsman.org.uk.

Next steps

• Check your policy documents to make sure there is a not a good reason why your insurer won't pay you

• Write to your insurer using their complaints process

• If you can't sort the problem out directly with your insurer, you may be able to complain to the Financial Ombudsman Service.

Other useful information

More information about the Financial Ombudsman Service

Tel: 0800 023 4567.

To find out about the Financial Ombudsman’s approach to dealing with disputes about insurance at www.financial-ombudsman.org.uk

Lloyds Policyholder and Market Assistance Department

Tel: 020 7327 5693

Contact your local Citizens Advice bureau or Advice Direct Scotland's consumer service if you need more help.