How to Make a Claim Against an Insurance Company

Making a claim against an insurance company is the process by which an individual or business seeks payment under the terms of an insurance contract. This may arise after an accident, loss, damage or other insured event where the policyholder or an eligible third party believes they are entitled to compensation. Understanding this process, including when and how to contact the insurer, your rights, legal time limits, and what to do if the insurer refuses or delays payment, is essential in England and Wales. This article explains each step in clear, accessible language and includes practical context to help readers with little or no legal knowledge.

1. What Is an Insurance Claim?

An insurance claim is a formal request to an insurance company to pay out under a policy when an insured event occurs. An insured event might include:

• A road traffic accident resulting in vehicle damage or personal injury.
• Damage to a home caused by fire, flood or theft.
• Business interruption following loss of essential premises.
• Personal injury or loss covered under liability insurance.

When you make a claim, you are asking the insurer to investigate the incident and, if it falls within the terms of your policy, to provide compensation or cover the loss described in your contract.

2. Understanding Your Insurance Policy

Before making a claim, check your insurance policy document. This sets out:

• What events and losses are covered.
• Any excess, which is the amount you must pay before the insurer pays.
• Exclusions, or situations where the insurer will not pay.
• Time limits for reporting an incident and submitting a claim.

Reporting an incident promptly is usually required by your policy and helps prevent disputes later. Even if you decide not to pursue full compensation, many policies require you to notify the insurer of the event to preserve your rights under the contract.

3. When and How to Notify the Insurer

Immediate Notification

You should contact your insurer as soon as reasonably possible after an incident. Prompt notification helps the insurer start investigating and reduces the risk of disputes over delayed reporting. Policies often specify a reporting timeframe; in practice, this could be within a few days or weeks, depending on the insurer and type of claim.

Information to Provide

When notifying the insurer:

• Give your policy number and personal details.
• Describe when, where and how the incident occurred.
• Provide initial evidence, such as photos, police reports or receipts.
• Keep a record of all correspondence and phone calls.

Strong documentary evidence at an early stage can improve the speed and outcome of your claim.

4. Investigation and Decision by the Insurer

Once notified, the insurance company will:

1. Acknowledge receipt of your claim. Many insurers do this in writing within a set number of days.
2. Investigate the circumstances, which may include reviewing documents, interviewing witnesses or arranging inspections.
3. Decide whether the claim is valid and falls within policy coverage.

Under contract law and more recent statutory requirements, insurers must pay valid claims within a “reasonable time” after they are accepted. The insurer is entitled to investigate, but unreasonable delay can itself give rise to a legal complaint or claim.

5. Responding to a Denied or Underpaid Claim

Reasons an Insurer May Refuse or Reduce a Claim

An insurer might refuse payment or offer less than you requested if it believes:

• The incident is not covered by your policy.
• You failed to provide necessary information within required time limits.
• You omitted material facts when the policy was taken out or when reporting the claim.

It is important not to admit liability to another party or make statements that could undermine your position before consulting your insurer.

Internal Complaints Process

If you disagree with the insurer's decision, you should:

1. Follow the insurer's internal complaints procedure as outlined in your policy documents.
2. Clearly state why you believe the decision is incorrect and what remedial action you seek.

Keep copies of all letters, emails and responses.

6. Escalating to the Financial Ombudsman Service

If the insurer's final response remains unsatisfactory, you may be eligible to complain to the Financial Ombudsman Service (FOS). The FOS is an independent body that reviews disputes between consumers and financial businesses, including insurers.

Key points about the FOS:

• You must generally escalate the complaint within six months of the insurer's final response.
• The service is free to use.
• The Ombudsman's decision is binding on the insurer if accepted by the claimant.

The FOS considers both sides of the dispute and can direct the insurer to pay compensation or take corrective action.

7. Legal Claims Against the Insurer

If the insurer still refuses or improperly withholds payment, you may consider starting legal proceedings. In most cases such a claim is brought as a breach of contract because the insurer has failed to fulfil its contractual obligations.

Time Limits (Limitation)

Under the Limitation Act 1980, a claim in contract generally must be brought within six years from the date of the breach. For claims relating to late payment, there may also be a one‑year time limit from when payment was due.

Before issuing a claim, it is common to send a formal letter of claim setting out the basis for the complaint and giving the insurer an opportunity to resolve the dispute without court proceedings.

8. Practical Considerations

• Policy Excess: Many policies require the claimant to bear an initial amount of the loss, called the excess, before the insurer pays the remainder.
• Documentation: Keep thorough records of all interactions with the insurer, evidence of loss and communications.
• Professional Assistance: For complex or high‑value claims, legal advice from a solicitor with experience in insurance disputes can be beneficial.

9. Common Questions

Do I need to use a claims handler or solicitor?
No. You can make a claim directly to your insurer. However, insurers sometimes encourage claimants to use intermediaries. You remain entitled to choose how you make your claim.

What if I disagree with the amount offered?
You can challenge the valuation, provide further evidence, escalate to the insurer's complaints process, or involve the Financial Ombudsman Service.

Can I claim compensation if the insurer delays unreasonably?
Yes. Under contractual principles and statutory requirements, unreasonable delay may itself be a basis for complaint and potentially a legal claim for damages.

Key Takeaways

Making a claim against an insurance company in England and Wales involves notifying the insurer promptly, providing necessary evidence, and engaging with the insurer's investigation. If the insurer refuses or delays payment, you can use its internal complaints procedure and, if necessary, escalate to the Financial Ombudsman Service or pursue legal action in court. Understanding your policy terms, documenting all exchanges, and acting within applicable time limits help protect your rights and improve the prospects of a successful claim.