Reasons Your Insurance Claim Got Denied

Reasons Your Insurance Claim Got Denied

Written by Priyanka Correia
Fact-checked by Caitlin Wood
Last Updated November 30, 2021

You have insurance for a reason: if something happens to you, your home, or your car, your policy will kick in to provide you with the financial coverage so you or your family are not stuck paying a huge bill. If the time ever comes when an incident occurs, you can file a claim and be paid out the benefit as specified in your contract.

But what happens if your claim is denied? And why would it be denied in the first place? Let’s go over some scenarios that may prevent your claim from being approved.

Reasons Your Insurance Claim Got Denied

There are many reasons why your claim may have been denied, including the following:

Damages Were Over Your Coverage Amount 

When you first take out an insurance policy, you’ll have the option to choose various factors of your plan, including the coverage amount. Generally speaking, the higher the coverage amount applied for, the more expensive the insurance policy will be. 

It’s important to carefully assess your needs before selecting a certain coverage amount so that when the time comes to file a claim, you’ll receive enough money to cover the cost of damages. 

But if the claim you file involves damages that are far above your coverage limit, you will have to cover the difference on your own, For instance, if your coverage amount is $50,000 and your claim specifies $80,000 in damages, you’ll need to pitch in that extra $30,000 yourself. 

Find out what happens to debt when you have life insurance.

You Lied On Your Application

When it comes time to file a claim, honesty is imperative. It’s not worth taking the risk of omitting certain pieces of important information or fibbing on others in order to try and get your claim approved or to claim a higher amount of damages. Complete transparency is crucial, as your claim can be quickly denied if your insurer discovers that you’ve been dishonest.

Honesty needs to start from the moment that you apply for a policy. When you first apply for an insurance plan, you’ll be asked a series of questions. The answers you provide will help your insurer determine your eligibility for coverage and the cost of your policy. If you don’t provide accurate information right from the get-go, any claims made going forward may be denied, and your policy may be at risk of being cancelled. 

For instance, when applying for a life insurance policy, if you smoke and do not specify that on your application, you could be denied. When it comes to insurance, honesty is the best policy.

Lookout How To Tell If Your Insurance Agent Is Misleading You

Loans Canada Lookout


Your Claim Was Made During The Contestable Period 

A life insurance policy includes something known as a ‘contestable period’, which gives the insurance provider the chance to make sure your claim is not fraudulent before the benefit is paid out. This period is usually anywhere from 1 to 3 years after a policy is taken out. 

Your insurance company will want to have some time to carefully review your claim and application to make sure it is accurate and that there is no false or missing information. 

If you die during the contestable period, there is a risk that your benefit payment to your beneficiaries may be denied. That said, the insurer is still required to honour the contract, though they still reserve the right to void the claim if they end up finding any false claims on the application. 

Check out why life insurance is more expensive for men than women.

Your Manner Of Death Is Not Covered

If your beneficiaries submit a claim on your life insurance following your death, there’s a possibility that they may not receive the benefit if your cause of death is not covered under your policy. 

Insurance companies usually have a list of death causes that are excluded from policies, such as suicide, pre-existing medical conditions, travelling to a dangerous destination, or being intoxicated while driving, to name a few. Look over your policy to see what types of death are and aren’t covered. 

Find out if your insurance covers your friend driving your car.

You Missed The Time Frame 

If you must file a claim, you should do so immediately or shortly after the incident in question. Waiting too long can risk claim denial. 

You Missed Payments

Your policy will only remain active if you keep up with your premium payments. If you fail to pay your premiums, your policy can be cancelled and you will no longer be covered. 

Your Policy Doesn’t Cover The Incident

Certain incidents are not covered under various insurance policies. For instance, an auto insurance policy may not cover damage done to your car if it was being used for illegal purposes. Or your home insurance policy may not cover a claim if the damage was caused by a flood from an external source — such as sewer backup or a torrential downpour — as separate riders may need to be purchased for these types of issues.  

Looking For A Canadian Insurance Provider?

 Type of Life Insurance Availability Number of Partners
- Term life insurance
- Permanent life insurance
- Term life insurance
- Critical illness insurance
- Term life insurance
- Whole life insurance
- Disability life insurance
- Critical illness life insurance
- No medical life insurance
ON16 logo- Term life insurance
- Permanent life insurance
- Critical illness life insurance
BC, AB, SK, MB, ON, NB, NS50+
- Term life insurance
- Permanent life insurance
All of Canada30+

What Should You Do If Your Claim Is Denied?

If your claim is denied, you may still have some recourse. Consider taking the following steps:

Get In Touch With A Higher Up At The Insurance Company

When you file a claim, you’ll be assigned an adjuster who will deal with your case. If you don’t get the outcome you were looking for, you may be able to speak with someone in a position of more power within the company to see if there is anything else that can be done for your situation.

Contact The Regulators Or Ombudsman

You have the option to file a complaint in writing to the internal ombudsman of your insurance company who can conduct an investigation of your complaint. If you have an issue with the insurance agent, you can get in touch with an insurance regulator in your province who will look further into the conduct and qualifications of the agent or broker

Get A Third-Party Review

There are services available that will take an unbiased look at your case and may help to reverse the decision about your claim being denied. 

Learn the basics and find out what type of insurance is right for you.

How Do You Make An Insurance Claim?

To file a claim, consider the following:

Review Your Policy

Before you file a claim, make sure you are covered for the incident in question. Most policies have exclusions, so you’ll want to make sure your situation is not excluded before you start the claims process. 

Consider If Filing A Claim Is Worth It

In some cases, it may cost you more to pay for your deductible — which is required before your policy kicks in — than it would to cover the cost of damages suffered. For example, if your car insurance deductible is $1,000 and the cost to make repairs is $700, it wouldn’t be worth it to file a claim. 

Call Your Insurance Company Right Away

As mentioned, you will need to file a claim soon after the incident to avoid the risk of your claim being denied. When you do contact your agency, be sure to provide them with as much information as possible, including a description of the damage, photos, receipts, police reports, medical records, and any other info that your insurer will need to assess your claim. 

Insurance Claim FAQs

What does it mean when your insurance policy lapses? 

When an insurance policy has “lapsed,” that means it’s been cancelled due to failure to make payments. When this happens, you will not be covered.

How long does it take to get my insurance claim payout?

Every insurance claim is different, as is the type of insurance policy. Payouts for car or home insurance claims are usually made about a week or so after all paperwork and documentation are reviewed and the claim is approved. Life insurance benefits payouts may take a bit longer, up to a month or two. 

If I drive with a suspended license, can my insurance deny my claim?

Yes, car insurance policies will only provide coverage when you are operating your vehicle lawfully. If you are driving with a suspended license, not only can your claim be denied, but you may be denied coverage altogether.

Final Thoughts

The last thing you want is to have an insurance claim denied, especially after being diligent about making your premium payments. But there are certain things that you may be doing that could put you at risk of having your claim denied. Not only should you keep up with payments, but also make sure that you’re honest in your application, you file your claim in a timely manner, and the incident in question is included in the policy.

Rating of 5/5 based on 1 vote.

Priyanka Correia is a Marketing Coordinator and personal finance expert at Loans Canada. Priyanka completed her Bachelor's degree in Marketing at Concordia University and has published work that has been mentioned in various news media. She is passionate about money management and educating Canadian consumers about how to take control of their financial lives.

Click on the star to rate it!

How useful was this post?

Research & Compare

Canada's Loan Comparison Platform

Largest Lender Network In Canada

Save time and money with Loans Canada. Research and compare lenders before you apply. Share your experiences with Canada's top lenders.

Save With Loans Canada

Special Offers

Borrow $500-$50,000

Borrow $500-$50,000

Don’t pay until March with this offer from our partner, Fairstone.* Ends January 31st.

View Offer
Cashback & Bonus Offer

Cashback & Bonus Offer
Ends March 1st, 2023

New Offer! Get up to $2,000 cashback + a $50 bonus on signing up. Conditions apply.

View Offer
Earn 5% Cash Back With Neo

Earn 5% Cash Back With Neo
No annual fee!

Earn an average 5%¹ cash back at thousands of partners and at least 0.5%² cashback guaranteed.

View Offer
Build Credit For $10/Month

Build Credit For $10/Month

With KOHO’s prepaid card you can build a better credit score for just $10/month.

View Offer
Best Personal Loan Provider by Greedy Rates

Confidential & risk-free

All consultations and conversations with Loans Canada and its partners are confidential and risk-free. Speak with a trusted specialist today and see how we can help you achieve your financial goals faster. Loans Canada and its partners will never ask you for an upfront fee, deposit or insurance payments on a loan. Loans Canada is not a mortgage broker and does not arrange mortgage loans or any other type of financial service.

When you apply for a Loans Canada service, our website simply refers your request to qualified third party providers who can assist you with your search. Loans Canada may receive compensation from the offers shown on its website.

Only provide your information to trusted sources and be aware of online phishing scams and the risks associated with them, including identity theft and financial loss. Nothing on this website constitutes professional and/or financial advice.

Your data is protected and your connection is encrypted.

Loans Canada Services Are 100% Free. Disclaimer

Build Credit For Just $10/Month

With KOHO's prepaid card you can build a better credit score for just $10/month.