Dispute against Insurance Rejection: How to Successfully Enforce Your Claims
30 Apr 2025
9
Minutes
Katrin Straub
CEO at nextsure
Has your insurance denied a benefit? That's frustrating, but often not the final word. Discover how you can enforce your legitimate claims with a well-founded appeal, and which deadlines are crucial in this process.
The topic in brief and concise terms
An objection to an insurance rejection must usually be made within one month and be well justified.
Carefully examining the reasons for rejection and your own policy is crucial for success.
In complex cases or in the event of a further rejection, the insurance ombudsman or a specialised lawyer can help.
Rejection received: The first steps to a successful appeal
Receiving a claim denial from your insurer can initially be disheartening. Stay calm and review the letter carefully; often, the solution is in the details. The most common deadline for an appeal is one month from the receipt of the decision.
Analyse the insurer's exact reasons for the denial; these must be listed in detail. Compare the explanation with your insurance terms to assess its validity. This first step is crucial for your future success in filing an appeal against the insurance denial.
Understanding and meeting deadlines: Timeframe for your appeal
Timeliness is of utmost importance when appealing against an insurance rejection. Generally, you have one month to file an appeal, often starting on the third day after the notice is posted. Some sources mention deadlines ranging from one to three months.
If the rejection notice lacks or has incorrect legal instructions, the deadline can be extended up to a year. If the deadline is missed, an application for review under § 44 SGB X may be an option to reopen the proceedings. Also, inform yourself about correctly writing letters to insurance companies. Careful examination of your notice is essential here.
Formulating the objection: Content and important documents
An informal written objection is usually sufficient; a special form is rarely needed. Your letter should include your personal details, the insurance number, and the date of the rejection letter. A detailed explanation of why you disagree with the rejection significantly increases your chances of success.
Attach all relevant documents to support your case. These include, for example:
Medical certificates or expert opinions (especially for disability insurance)
Photos of the damage
Estimates or invoices
Witness statements (if available)
A copy of the rejection letter
Relevant excerpts from your insurance contract
Ideally, send your objection by registered post with acknowledgment of receipt to have proof. A clear and factual presentation is your advantage here.
Common reasons for rejection of insurance claims
Insurance claims are rejected for a variety of reasons, often more than five. A common reason is the breach of the pre-contractual duty to disclose, such as when pre-existing conditions are not accurately reported. A delayed claim notification can also cause issues; there are often contractually stipulated deadlines of just a few days for notification.
Other reasons may include:
The damage is not covered due to an exclusion clause in the contract (e.g., intent).
The damage exceeds the agreed coverage limit.
There is gross negligence, in which case the payout is often only reduced, not completely denied.
Insurance premiums were not paid on time.
There is suspicion of insurance fraud or false information regarding the circumstances of the damage.
Always check carefully whether the stated reason actually applies to your case and is regulated in the contract as such. This is an important step before you formulate an objection to the insurance rejection.
Seeking support: When a lawyer or ombudsman makes sense
If your objection is unsuccessful or the case is complex, external help may be advisable. The Versicherungsombudsmann e.V. is a recognised arbitration board that operates free of charge for consumers. In 2023, around 18,000 complaints were received there, with more than half being successful from the consumer's perspective.
The Ombudsman's decision is binding for the insurer for complaints up to a value of 10,000 euros. There is a separate ombuds office for private health and care insurance. A lawyer specialising in insurance law can also represent your interests, particularly in cases involving higher amounts in dispute or complex legal questions. Our expert tip: Clarify in advance whether your legal expenses insurance covers the cost of a lawyer.
Expert knowledge: Legal foundations and current judgments
The Insurance Contract Act (VVG) forms the legal basis for your insurance contract and thus also for objection in the case of rejection. § 8 VVG, for example, regulates the policyholder's right of withdrawal, which can be exercised within 14 days of receiving all documents. For contracts concluded between 1994 and 2007 under the so-called policy model, objection rights may still exist today if the information provided was faulty.
Current court rulings continuously shape insurance law. For instance, the Federal Court of Justice (BGH) has repeatedly specified the requirements for a temporary recognition in disability insurance (e.g. BGH, judgment of 09.10.2019 – IV ZR 235/18). It is important to know that, following an unjustified denial of coverage by the insurer, the policyholder generally no longer has any obligations. Knowledge of such details can be crucial in the event of a dispute.
After the objection: Possible reactions from the insurance company and next steps
After you have submitted your objection to the insurance rejection, the insurance company will review the case again. The processing time can vary; for example, health insurance funds often have to respond within three to five weeks. There are essentially three possible outcomes: the insurance company fully recognises your claim, they offer a settlement, or they reject the objection again.
If your objection is rejected, further options remain open to you. You can, as already mentioned, involve the insurance ombudsman or take legal action. An action for failure to act in the social court is possible if a benefit provider does not decide on the objection within three months. Weigh up the chances of success and the cost risk carefully before taking further steps.
nextsure by your side: Support in the insurance jungle
More useful links
Versicherungsombudsmann: The official website of the Versicherungsombudsmann offers comprehensive information about the arbitration body for insurance disputes in Germany.
Wikipedia: A Wikipedia article provides a detailed overview of the role and function of the Versicherungsombudsmann.
Stiftung Warentest: Stiftung Warentest highlights in an article why filing a complaint with the Versicherungsombudsmann can be worthwhile.
Finanztip: Finanztip offers an informative article about the tasks and benefits of the Versicherungsombudsmann.
Verbraucherzentrale NRW: Verbraucherzentrale NRW provides information about legal advice on insurance and rights in the event of a claim.
Verbraucherzentrale: Verbraucherzentrale offers general information about which insurances are sensible.
Verbraucherzentrale: On the Verbraucherzentrale website, you can find general information about advisory services.
FAQ
What should I do if my insurance denies the payment?
First, check the reason for the rejection and your insurance policy. Then, submit a written and well-justified objection within the deadline (usually one month). Send this by registered mail.
What documents do I need for an appeal?
Important documents include the letter of rejection, your insurance number, a detailed explanation, evidence such as photos, invoices, medical certificates, and relevant excerpts from your insurance contract.
What happens if I miss the deadline to object?
If you miss the objection deadline, the insurance company's decision usually becomes final. Sometimes, a review application (e.g., under § 44 SGB X in social law) is still possible.
Does my legal protection insurance help me with an objection?
Whether your legal protection insurance covers the costs for legal assistance in the event of an appeal depends on your contract. Check your policy or ask your legal protection insurer directly for a confirmation of coverage.
When should I hire a lawyer?
A lawyer is advisable when the case is complex, involves large amounts, your appeal has been rejected again, or you are uncertain. A specialist lawyer in insurance law can assess your chances of success and represent you.
What does the insurance ombudsman do?
The Insurance Ombudsman is a free arbitration service for consumers. It neutrally examines disputes with insurance companies. Its decisions are binding for the insurance company up to a dispute value of 10,000 euros.
