Where to start

Start with the reasons given, the policy wording and the information considered. The next step may be insurer clarification, a complaint or dispute process, not automatically a sales enquiry.

Key points

Check what happened

The facts of the event, treatment, loss or timing need to be clear before comparing them with the policy.

Read the policy wording

A claim decision depends on the wording, definitions, benefits, limits, exclusions and any special terms.

Ask for reasons in writing

Written reasons make it easier to understand what the insurer relied on and whether a complaint or clarification is needed.

Keep evidence together

Documents, correspondence, claim forms and proof should stay together so the decision can be reviewed properly.

The policy controls the promise

A claim is about both what happened and whether that event fits what the policy covers. The wording, definitions, benefits, limits and exclusions all matter.

Start with the written reason

Ask for the reasons in writing if they are not already clear. Written reasons make it easier to see which fact, definition, exclusion or process step the insurer relied on.

Evidence and process matter

Insurers may ask for documents or proof. Keep claim forms, invoices, correspondence, medical or repair records and any decision letters together.

A complaint is different from buying new cover

If the decision is disputed, provider complaint processes and external dispute schemes may become relevant. That is a different route from a sales or switching conversation.

What to check next

  • Whether a claim should have been paid depends on the policy wording, facts and insurer decision.
  • Keep the policy wording and insurer decision together.
  • Use complaint and dispute channels where appropriate.

A useful next step

Review the wider health-insurance context

For advice about your personal circumstances: Finding licensed financial advice.

These links are official information about finding advice. You can also send a minimal enquiry to Ralenvo for owner review below. Submission does not send information to an adviser.

Sources and dates

Information was checked on 28 September 2026. Open the current official page before relying on a rate, threshold, eligibility setting or process that may have changed.