Getting a letter from your insurer saying they won't pay is a horrible thing to open. Whether it arrives during the chaos of a house fire or weeks after a flood you're still trying to recover from, the instinct is often to accept it, to assume the insurer must know their own policy better than you do and that the decision is final.
It's usually worth questioning that assumption. A declined or repudiated claim is not always the end of the road, and understanding what's actually happened, and what your options are, can make a considerable difference to what comes next.
People often use these terms interchangeably, and insurers may not always distinguish clearly between them in their correspondence. There is a distinction worth knowing, though.
A denied or rejected claim is typically turned down before it's been properly processed, often because of something at the application stage: a delay in reporting, a standard policy exclusion, or a concern about the information provided when the policy was taken out. The claim doesn't get far enough to be assessed on its merits.
A repudiated claim is different. Here, the insurer has assessed the claim and decided that the loss isn't covered under the terms of the policy in place. It could be because the cause of the damage falls outside the policy's scope, because a policy condition wasn't met, or because the insurer believes there was non-disclosure of something relevant. The claim has been processed, but the insurer won't accept liability for it.
In practice, both leave you in the same position: no payout, and the feeling that the whole thing is now your problem to deal with. The steps below apply to either situation.
This sounds obvious, and it is, but it's also where a lot of policyholders give up too early. The repudiation or rejection letter should set out the specific grounds for the decision, the clause or exclusion being relied on, and the section of the policy that supports it. Read that letter against your actual policy document, not a summary or a renewal notice.
A few things to look for: is the wording in the letter consistent with what the policy actually says? If the policy language is ambiguous, that ambiguity often favours the policyholder under the general principles of insurance contract law. Has the insurer relied on a condition that wasn't clearly explained when you took out the policy? Under the Insurance Act 2015, insurers cannot repudiate a claim on the basis of non-disclosure if you took reasonable care to answer their questions honestly at the time.
If the policy runs to fifty pages of dense technical language and you're also trying to organise emergency repairs and find somewhere to live, getting through all of it on your own isn't always realistic. Which is where step two comes in.
Before contacting the insurer, before instructing contractors, before putting anything in writing to anyone: get independent advice from a qualified loss assessor who works for policyholders rather than for the insurance company.
This matters more than it might sound. Once you've submitted a formal appeal, or agreed to certain repairs, or signed anything, the shape of the dispute changes. A loss assessor who comes in early can review the policy with fresh eyes, identify arguments the insurer may not have considered, and approach the insurer on your behalf in a way that doesn't inadvertently close off options.
David, a legal professional in Altrincham, found himself with a repudiated claim after water ingress appeared in his cellar years after a conversion. His insurer concluded the cause was defective design or workmanship and refused liability. When Harris Balcombe reviewed the policy, something emerged that the insurer hadn't flagged: under the trace and access clause, the insurer had a duty to fund further investigation where the cause was unclear, before drawing any conclusions. Harris Balcombe engaged the insurer directly and, after sustained negotiation, the insurer agreed to cover the investigation. It found a natural cause. The claim came back into scope and the cellar was fully reinstated.
You can watch David talk through the experience here
His verdict: 'Based on my experience, I'd have no hesitation whatsoever in recommending Harris Balcombe to anyone in a similar situation.'
David Walton had a similar experience, arriving at Harris Balcombe with low expectations after a bad experience with his insurer: 'After having a bad experience with the insurance company I had no expectations. I didn't expect we would be successful. Harris Balcombe engaged with the insurance company and the insurance company accepted they would have to cover my claim. I would have no hesitation in recommending Harris Balcombe.'
The same principle applies to commercial claims. Garth Christie at Hazel 4D faced the aftermath of a warehouse fire that destroyed over 50,000 square feet of their operation, and chose Harris Balcombe specifically because he wanted people with no conflicting interests. 'We wanted experts who could fight our corner and act entirely on our behalf, with no vested interests.' The professionalism, knowledge and attention to detail, he said, was outstanding.
If independent advice suggests the repudiation was incorrect or unreasonable, the next step is a formal challenge. Every FCA-regulated insurer is required to have a complaints process, and submitting a formal complaint, with a written summary of why you believe the decision was wrong and what evidence supports your case, is the standard route.
If that doesn't resolve it, the Financial Ombudsman Service can review the insurer's decision independently. The FOS is free to use for policyholders, and its decisions are binding on the insurer. This route does take time, which is one reason why having a loss assessor involved from the start of a repudiation dispute tends to produce faster results than going through the formal complaints process alone.
What's worth knowing is that the loss assessors vs loss adjusters distinction matters particularly in repudiation cases. A loss adjuster was appointed by the insurer to reach the decision you're now challenging. A loss assessor works for you, which means their interests and yours are pointing in the same direction throughout.
You can read more about what to do if your home insurance claim has been rejected and the options available at that stage.
The consistent picture from Harris Balcombe clients is that a declined claim is rarely the final word, and that independent advice sought early gives considerably more room to manoeuvre than the same advice sought after an appeal has already been submitted and rejected.
Graham Wilson, at Mainetti UK, put it plainly after a major commercial fire destroyed their entire recycling site: 'You have to go and find people who deal with this on a daily basis, deal with insurers on a daily basis, and understand what makes them work and what doesn't.' His estimate was that without Harris Balcombe, the settlement would have come in at 70 to 80 per cent of what was eventually recovered.
If you've had a claim declined or repudiated and you're not sure what to do next, Harris Balcombe offer free initial consultations with no obligation. The 24/7 helpline is 0330 022 9179, or you can reach the team at info@harrisbalcombe.com.
If this article is useful, the pieces below cover territory that tends to come up alongside it. Each one stands on its own, but together they build a fuller picture of how the claims process works and where it can go wrong.
At this point, you would hope that your insurance company is there to help but unfortunately, this is not always the case. We have known families who have felt intimidated by insurers and have been treated as though they have done something wrong, or are in some way to blame for their situation.
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