Reasons why an insurance company could reject the payment of compensation

A keyboard with a green button Insurance

The insurance companies receive an amount of money from the client and are obliged in the event of a claim or what is indicated in the contract, to indemnify or provide the agreed service for the damage caused.

However, there are reasons for refusing to pay the compensation that may generate dissatisfaction to the client by not obtaining the expected results. The problem arises when insurance is taken without clearly understanding the duties and rights acquired at the time of signing the contract until its expiration.

Consequences of breach of contract

The reasons for which the Insurance Company may terminate the insurance contract in advance, is for breach of the obligations indicated in the contract by the beneficiary.

Below is a list of the homework that everyone must comply with before contracting any type of insurance:

  • Inform yourself, read thoroughly and conscientiously the documents that are presented to you to understand the characteristics of the services offered.
  • Inform or declare clearly and honestly the risks that you wish to insure, in order to allow the Insurance Company to identify the insured object and appreciate the extent of the risks that it will assume.
  • Take care of the insured assets to prevent the occurrence of the loss.
  • Do not aggravate or extend the insured risks.
  • Pay the insurance premium, in the form and term agreed with the insurance company. Failure to comply with this obligation may release the company from its obligation to pay the claim, in accordance with the conditions of the respective policy.
  • Keep damaged objects and take the necessary measures to save or recover the insured object or preserve its remains.
  • Report or report the claim immediately, indicating its causes, consequences and other facts that allow the Insurance Company to properly impose itself once the event has occurred.
  • Make the claim of the claim in the insurer online or in person and within the term provided in the policy.
  • Provide timely information to the insurance company or the claims adjuster.

Breach of the insured’s obligations that generates rejections of payment

These are the most common reasons that can lead to the rejection of the loss of the insurance offered and demanded in the market:

1. In the case of motor vehicle insurance: all vehicle insurance companies have certain exclusions when it comes to indemnifying in case of accidents. The main reasons why an insurance could be automatically invalidated are the following:

to. The driver has an accident and does not carry his driving documents with him.

b. Drive under the influence of alcohol or drugs.

c. It does not leave a record in Carabineros when suffering a crash with the injured or total or partial theft.

d. It does not provide assistance to the injured. In the event of a collision or similar accident, the fact of not assisting the pedestrian who suffers a collision, or runs away, for the insurer constitutes a crime.

2. Life or health insurance companies: insurers that provide compensation in the event of death or medical expenses incurred due to accidents or illness, require certain procedures or compulsory procedures , which, when not executed by the client, could lead to the rejection of the compensation payment.

to. Do not deliver budgets or quotes, vouchers, receipts, bonuses, etc. to request reimbursement of medical expenses.

b. Failure to submit a report from the treating physician in cases of health or life insurance, etc.

c. In the event of a claim, it is advisable to review the conditions of the insurance policy in advance and make all pertinent inquiries to the insurance company or broker, as appropriate.

d. To omit or not to declare pre-existing diseases.

There are also specific cases in which an insurer can deny the payment of compensation:

3. Expiration of the policy: if the insured stops paying the installments, in the case of monthly payment insurance, the contract will lose its validity.

Regardless of the reason for not paying the insurance premiums, if it is not canceled within the established term, the policy will expire and the beneficiaries will not have coverage.

4. Fraud cases: if the company considers or verifies that there is an inconsistency in the veracity of the documentation and / or data provided by the insured, the payment of the compensation will be denied.

5. Documentation that presents errors: all the documents presented must be official and accredited before a notary (in the case of certificates, for example). Therefore, providing false medical documentation may lead to the rejection of the claim payment by the insurer.

6. Armed conflicts: if the insured dies in the course of a war or similar conflict, the insurance company will not pay the insured capital.

7. Indiscriminate intake of medications or other substances: the insurer will not respond in the event that complications or secondary effects are generated by the ingestion of drugs for the treatment of psychological illnesses, the use of narcotics, or in cases of alcoholism or drug addiction.

8. Extreme risk sports practices: it is important that the beneficiary informs the company in advance if he participates in extreme sports competitions, such as: motorcycling or motorsports, aerobatics, skydiving, diving, mountaineering at more than 3,000 meters, between others.

9. Self-inflicted injuries or suicide attempts: the company will not respond in the event of consequences for suicide attempt or self-inflicted injuries that occur when the beneficiary is in a conscious state or not.

In summary

Before contracting insurance, try to read each part of your policy in detail, in order to have complete clarity on the corresponding coverage and exclusions.

It is also very important to find out about the reputation of the company and the insurance that is being contracted to suit your needs.

In addition, analyze what is the most suitable coverage, what deductible it offers, be aware of the restrictions it has and the insured’s obligations.


Please enter your comment!
Please enter your name here