General guidance
This guide currently contains general legal information. Jurisdiction-specific guidance for your location is coming soon. The Concaso assessment will still tailor its questions and analysis based on your jurisdiction.
Tailored versions available: Ontario, United States (General), England & Wales.
Start with the denial letter and the policy
An insurance dispute is a contract dispute. The insurer must normally identify the basis for its decision, and that basis is what the rest of the process examines. A denial that gives only a general reason is worth following up in writing.
Extract these from the denial
- The exact policy wording or exclusion relied on
- The facts the insurer says it relied on
- Whether the decision is a full denial, a partial payment, or a reservation of rights
- The internal review or appeal route, and its deadline
- Any deadline stated for starting a legal proceeding
The usual reasons claims are refused
| Reason | What it turns on | What usually helps |
|---|---|---|
| Exclusion applies | The precise wording, read against the facts | The full policy, including endorsements |
| Not covered peril | How the loss is characterised | Cause-of-loss reports |
| Late notice | When the insurer was told, and any prejudice | Records of first contact |
| Non-disclosure | What was asked and what was answered at application | The original application and broker notes |
| Valuation dispute | Replacement versus actual cash value | Independent estimates and inventories |
| Insufficient proof | Documentation of the loss | Receipts, photographs, proof of loss forms |
Underpayment disputes are more common than outright denials and are usually about measurement rather than principle: scope of repair, depreciation applied, or the basis of valuation in the policy.
The steps that usually come before a claim
1
Ask in writing for the complete policy, the claim file and the reasons for the decision.
2
Use the insurer's internal complaint or review process, in writing.
3
Consider an independent estimate or appraisal where value is the issue.
4
Escalate to the applicable ombudsman or regulator, where one exists.
5
Keep the limitation date in view throughout, since these steps rarely pause it.
Appraisal and dispute clauses+
Many property policies contain an appraisal or valuation clause that either side can invoke to resolve a disagreement about amount, separately from whether the loss is covered at all. It is often faster and cheaper than litigation for a pure quantum dispute.
Deadlines and notice requirementsGeneral guidance
Insurance carries layered timing: policy notice periods measured in days, proof-of-loss deadlines, an internal appeal window, and a statutory or contractual limitation period for legal action. Some policy limitation periods are shorter than the general one for contracts.
Documents to gather
- The complete policy, including schedules, endorsements and renewals
- The application or proposal form you originally completed
- The denial or payment letter and all claim correspondence
- The claim file, adjuster reports and any engineering or cause reports
- Proof of loss forms and inventories submitted
- Independent estimates or quotes for repair or replacement
Evidence that carries weight
- Dated photographs or video of the loss and the property beforehand
- Receipts, invoices and ownership records for items claimed
- A log of every call with the insurer, with names and dates
- Expert or contractor opinion on the cause of the loss
- Broker communications about what coverage was requested
Want both lists in one printable page?
Common mistakes
- Letting the limitation period run while an internal appeal continues
- Discarding damaged property before it is documented or inspected
- Accepting a partial payment without confirming whether it closes the claim
- Not asking for the specific policy wording relied on
- Answering follow-up questions from memory rather than from records
Frequently asked
Can I ask for the insurer's file?
In many places you can request the claim file or your personal information held by the insurer. What must be produced varies, but the request itself is routine.
Does an internal appeal pause the deadline?
Usually not. Internal reviews and ombudsman complaints typically run alongside the limitation period rather than suspending it, so track both.
The insurer paid, but far less than the repair costs. Is that a dispute?
Yes — underpayment is a common form of coverage dispute, and many policies contain an appraisal mechanism designed specifically for disagreements about amount.
What is a reservation of rights?
It generally means the insurer is proceeding with the claim while preserving the ability to deny coverage later. It is not an acceptance of the claim.
Does bad-faith handling matter?
Most systems recognise that an insurer owes duties of good faith in handling a claim, and how the claim was handled can be examined separately from whether the loss was covered.
Assess my situation
Concaso turns what you already know into a structured, confidential report — strengths, weaknesses, missing evidence, and the deadlines that matter. We will start you in the right place based on this guide.
Assess my situationAssessment topics related to this guide
Topics in this guide
Related guides
Recommended next read
Personal Injury Claims
How injury claims are built, why the medical record matters more than anything else, and the deadlines that quietly decide whether a claim survives.
Recommended next read
Breach of Contract
What has to be shown in a contract dispute, how losses are usually measured, and the records that carry the most weight.
Recommended next read
Small Claims Court
How simplified courts work, what they are good for, and how to prepare a claim or a defence without a lawyer.
Related reading
Construction Disputes
How deficiency, delay and non-payment disputes on a building project are usually framed, what records decide them, and the deadlines that come first.
This guide is general information, not legal advice, and Concaso is not a law firm. Reading it does not create a lawyer–client relationship. Deadlines and procedures differ by jurisdiction and change over time — confirm anything you intend to rely on.