Claim denials
Pre-existing condition and pre-existing damage exclusions
One of the most common reasons a claim is refused is that the insurer says the condition or the damage was already there before the policy began. The dispute is rarely about whether something existed. It is about whether the insurer proved it existed, and whether it was actually related to the claim.
Motor insurance
Motor Insurance Claim Partially Denied: Pre-Existing Bumper Damage Used to Reject Replacement
A motor insurance policyholder whose vehicle suffered significant rear-end damage in an accident had his bumper replacement claim rejected by the surveyor on the grounds of a minor pre-existing scratch, despite the new damage being clearly caused by the accident.
Health insurance
Health Insurance Claim Denied for Alzheimer's and NPH Based on Symptom History, Not Diagnosis
A policyholder's mother had her hospitalisation claims for NPH and Alzheimer's disease rejected after porting her health policy, with the insurer citing behavioural symptom descriptions in discharge summaries as evidence of pre-existing conditions, despite no prior diagnosis existing before the policy was issued.
Motor insurance
Motor Insurance Claim Rejected for "Minor Pre-Existing Marks" on Bumper After Accidental Damage
A policyholder's motor insurance claim for a damaged rear bumper was rejected on the grounds of minor pre-existing marks, despite no prior claims history, and the authorised workshop charged an undocumented cash fee for a damage estimate.