Insurance Arbitration – Has Your Home Insurance Claim Been Denied?

Insurance Arbitration – Has Your Home Insurance Claim Been Denied?

Has your home insurance claim been denied? We understand just how stressful a situation this is, but there are options available. If your policy contains an arbitration agreement, then you can ask an independent arbitrator to settle your dispute. Otherwise, you may want to consider litigation through the courts.

We can determine the best legal strategy in your case, working on your behalf to reverse the insurance company’s decision.

Has your home insurance claim been denied?

When you take out a home insurance policy, you expect it to provide the necessary cover, should you ever need to make a claim. So we can only imagine the horror of finding out that your insurance claim has been denied, meaning your policy was effectively worthless all along. You may face significant losses as a result, potentially amounting to many thousands of euros. If your home has been damaged by a fire, flood or explosion, you may even lose the roof over your head. This puts you and your family in a very distressing situation.

Why has your insurance claim been denied?

Unfortunately, home insurance claims are denied all the time. If this has happened to you, then you are by no means alone. There are various reasons why an insurer may reject your application. Some of the most common include:

  1. Failure to pay

If you fail to pay your insurance premiums, then your insurance policy is void. This remains true, even you made a genuine error – for example, your debit card expired and you forgot to update your payment method.

  1. Failure to report

Some insurance companies demand that you report the incident within a specified time frame, or at least within ‘good time’. If you delay in contacting your insurer, they may refuse your claim on the basis of late notification.

  1. Failure to disclose material facts

If your insurer discovers that you have previously made a claim – which you failed to disclose when you took out the policy – then it amounts to non-disclosure of material facts. This provides the insurer with the grounds to reject your claim.

  1. Failure to disclose a change in circumstances

If your circumstances change during the policy, you must inform your insurer, who may then adjust your premium or product based on the new calculation of risk. This might happen, for instance, if you move out of your home and let the property to tenants. A failure to keep the insurer updated can void the policy.

  1. Failure to meet the terms

Some insurance policies demand that you meet certain provisions in order for the policy to be effective. For example, many home insurance policies stipulate that the property must be occupied. This is something to be wary of, particularly if your loved one has recently died, leaving a property empty.

  1. Policy exclusions

Insurance policies always exclude certain events and scenarios. These may be expressly stated.  Or, the exclusion may be dependent on your actions (or inactions). So, a home insurance claim may be rejected if the damage occurred due to a lack of maintenance.

  1. Non insurable interest

You can only insure something that you own, or that would cause you to suffer financial loss if it were damaged or destroyed. This is known as an insurable interest. This means that if your laptop is damaged at home, it will not be covered by your home insurance because it does not technically belong to you.

What can you do?

Whatever the reason for the rejection, the fact remains that your home insurance claim has been denied. This puts you in a very difficult and stressful position. You are probably asking yourself: what now? Insurance companies are huge corporations with legal teams and a ready cash flow. This makes them intimidating opponents. Often, when they say ‘no’, there is little room for negotiation. The metaphorical shutters may come down, leaving you with nowhere to turn.

But please do not give up straightaway. There may be action you can take.

The first step is to look through your insurance policy and check whether there is an arbitration agreement. If you’re not sure, contact us at Gibson & Associates. We can check the policy for you and advise whether such an agreement exists. This will determine the options available to you.

What is an arbitration agreement?

Lots of insurance policies in Ireland now contain an arbitration agreement – even if you did not realise it when signing up to the policy. These stipulate that should a dispute arise between the insurer and the policy-holder, then the dispute must be resolved by way of arbitration, rather than litigation through the courts.

If you fail to comply with this clause and your case ends up before a judge, he/she may actually stay proceedings, on the basis that you entered into an arbitration agreement.

What is insurance arbitration?

Arbitration is a form of alternative dispute resolution (ADR). It is used to settle all kinds of disputes, including insurance disputes.

This is how it works: your case is heard by an independent third-party known as an arbitrator. You and the insurer have the opportunity to present your case, along with any evidence that supports your claim. The arbitrator will consider all the information and decide how to resolve the dispute. In the context of an insurance dispute, the arbitrator will determine whether to uphold or reject your insurance claim. In the event that your claim is accepted, the arbitrator will verify exactly how much you should receive from the insurance company.

The arbitrator’s decision is final and legally-binding. If you do not like the outcome, you cannot pursue the matter in court instead. There are very limited grounds for appeal, as you must show there has been a fundamental error of law or procedural mistakes.

Do I need a solicitor for insurance arbitration?

Due to the finality of arbitration, it is essential that you instruct a solicitor to represent you. At Gibson & Associates, our experienced team can help you achieve the best result possible. We regularly act on behalf of policy-holders who have had their home insurance claim denied. We will review your policy documents to confirm whether you are subject to an arbitration agreement. If so, we will manage the process on your behalf, representing you throughout proceedings.

In theory, you could represent yourself. However, just like a court of law, you will have the opportunity to present your case to the arbitrator. It is vital that you get this right. You must show exactly why the insurance company is wrong to reject your claim, providing compelling evidence to support your argument. Without this, the arbitrator is likely to find against you. This will be the end of the road for your dispute, as the arbitrator’s decision is final and legally-binding.

Therefore, by instructing a solicitor, you are giving your claim the best chance of success.

Insurance appraisal vs arbitration

It should be noted that insurance arbitration is different to insurance appraisal. Insurance arbitration is a form of dispute resolution which is used to resolve disputes between insurance companies and policy-holders. Insurance appraisal is when an asset or personal possession undergoes a professional valuation, thereby allowing the policy-holder to secure the correct amount of insurance coverage.

Other options

If you are not bound by an arbitration agreement, then there may be other ways of resolving your home insurance dispute. One option is to pursue litigation through the courts. Depending on the value and nature of your dispute, your case may be heard by the Small Claims Court, Circuit Court, High Court or Commercial Court. As with arbitration, both you and the insurer will have the chance to present your case and supporting evidence. The judge (not a jury) will then make a ruling, outlining exactly how your claim should be settled.

Get expert legal advice

Litigation is generally considered to be more expensive and time-consuming than arbitration. Also, court proceedings are not private, aside from exceptional circumstances. This means your dispute will be heard in the public domain, something which may or may not influence your thinking. Arbitration is entirely confidential.

Either way, the decision to pursue litigation or arbitration is not something that should be taken lightly. You need to ensure that your claim stands a good prospect of success before embarking on legal action. Otherwise, it will only serve to drain your energy and your resources. You must, therefore, get expert legal advice. A solicitor from our team can explain whether the insurance company has acted reasonably, or whether you have grounds to take your insurance dispute further.

How can we help you?

At Gibson & Associates, we help those whose home insurance claim has been denied. We know how difficult these situations can be. You may have had significant assets or valuable possessions stolen. Your property may have been ruined by a fire, flood or explosion. Or you may be dealing with other types of damage, such as water damage from burst pipes. Whatever the case may be, we are here to offer our support.

The first thing we’ll do is to listen to the details of your situation. We’ll ask you about your losses, your interactions with the insurance company and the reasons they gave for denying your claim. Then, we’ll review your insurance policy documents before advising on the best possible recourse.

If there is an arbitration agreement contained within the policy – and we think there is a solid legal basis for your claim – then you can let us manage the process for you. We’ll put together a strong argument and deliver this to the arbitrator, doing everything we can to recover the money you are due.

If litigation is the preferred route, then you can rest assured that our solicitors are skilled advocates. We can represent you in court, providing a persuasive argument as to why your home insurance claim should be accepted.

Contact us now

Have you just been told that your home insurance claim has been denied? Contact us now for expert legal advice. We promise to do everything in our power to recover the funds needed, whether for repairs, replacements or simply as a form of redress.

Complete our online enquiry form, or phone us on 01 872 3143 today.

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