How to read a refusal letter from an insurance company, identify the ground, check deadlines and reach an informed decision about what to do next.
The precise ground
Establish whether the refusal rests on the functional definition, mental frailty, a pre-existing condition, the period of insurance, an exclusion or a missing document. Each ground calls for a different examination.
The seven details
Read the letter in full rather than only the heading.
- The date of the decision
- The period examined
- The clause of the policy relied on
- The documents that were considered
- The findings of the assessment
- The deadline and the route for a further approach
- Information about prescription
Compare it with what was submitted
Check whether a material document is missing, whether there is a factual error, or whether the report describes a situation different from the routine. Mark concrete points with a reference to the document.
Not every next step is the same
The options may include completing documents, a review, an appeal or a legal process. The choice depends on the policy and the case. Where a legal question or a near deadline arises, seek appropriate advice.
Frequently asked questions
What do we check first in a refusal letter?
The precise ground: whether the refusal rests on the functional definition, mental frailty, a pre-existing condition, the period of insurance, an exclusion or a missing document. Each ground leads to a different course of action.
How long do we have to respond to a refusal letter?
The deadline is usually stated in the letter itself and varies with the policy, the insurer and the type of procedure. Do not put the check off, even if the eventual decision is to take no action.
Do we have to attach the whole file to an appeal?
No. Flooding the file with material unrelated to the dispute does not improve the prospects and sometimes lengthens the review. A response addressing each ground in turn, with a reference to the supporting document, is better.
What do we do when the refusal relies on an assessment report?
Request the report, check what was recorded in each area and compare it against the actual situation and the documents. It sometimes turns out that a whole area was mistakenly recorded as independent.
When should we approach a lawyer?
Where a legal question, a complex dispute, an issue of prescription or the need for a court process arises. Guidance in organising a claim does not constitute legal advice.
Official sources for further checking
This is general information and does not replace personal medical, legal or insurance advice. Eligibility is determined by the documents and rules that apply to each case.
