Appealing an Insurance Claim Rejection: How to Successfully Enforce Your Claims
30.04.25
12
Minutes
Katrin Straub
Managing Director at nextsure
Has your insurer rejected a claim? That’s frustrating, but often not the final word. Find out how, with a well-founded appeal, you can still enforce your legitimate claims and which deadlines are crucial.
The topic in brief and concise terms
An appeal against an insurance rejection must usually be lodged within one month and be well justified.
Careful review of the reasons for rejection and your own policy is crucial for success.
In complex cases or if it is rejected again, the insurance ombudsman or a specialist lawyer can help.
Received a rejection: The first steps to a successful appeal
Receiving a denial of benefits from your insurer is initially disheartening. Stay calm and review the letter carefully; often the solution lies in the details. The most common deadline for an appeal is one month after receipt of the notice.
Analyse the insurer’s exact reasons for rejecting the claim; these must be listed in detail. Compare the explanation with your insurance terms and conditions to check whether it is justified. This first step is crucial to your дальнейший success in lodging an appeal against the insurance rejection.
Understanding and meeting deadlines: Timeframes for your objection
Meeting deadlines is of the utmost importance when lodging an objection to an insurance refusal. As a rule, you have one month to file an objection, often starting on the third day after the decision was posted. Some sources mention time limits of one to three months.
If the refusal notice is missing a statement of legal remedies, or if it is incorrect, the deadline can be extended to up to one year. If you miss the deadline, a review request under § 44 SGB X may be an option to reopen the proceedings. Also find out about the correct drafting of letters to insurance companies. A careful review of your notice is essential here.
Formulating the objection: content and important documents
A simple written objection is usually sufficient; a special form is rarely required. Your letter should include your personal details, the insurance policy number and the date of the rejection letter. A detailed explanation of why you do not agree with the rejection significantly increases your chances of success.
Enclose all relevant documents to support your argument. These include, for example:
Medical certificates or reports (especially for income protection insurance)
Photos of the damage
Quotes or invoices
Witness statements (if available)
A copy of the rejection letter
Relevant excerpts from your insurance policy
Ideally, send your objection by recorded delivery with acknowledgement of receipt, so you have proof. A clear and factual presentation is to your advantage here.
Common reasons for a denial of insurance benefits
Insurers reject benefits for various reasons, often there are more than five causes. A common reason is a breach of the pre-contractual duty of disclosure, for example if pre-existing conditions were not stated correctly. A late claim notification can also lead to problems; here, there are often contractually stipulated notification deadlines of just a few days.
Other reasons may include:
The loss is not covered by an exclusion clause in the contract (e.g. deliberate intent).
The loss falls outside the agreed sum insured.
Gross negligence is involved, although in such cases the benefit may often only be reduced, not refused altogether.
The insurance premiums were not paid on time.
There is a suspicion of insurance fraud or false statements about how the loss occurred.
Always check carefully whether the reason given actually applies to your case and is regulated in the contract in this way. This is an important step before drafting an objection to the insurance refusal.
Seeking support: When a solicitor or ombudsman makes sense
If your objection is unsuccessful or the case is complex, external assistance can be worthwhile. The Insurance Ombudsman e.V. is a recognised dispute resolution body that operates free of charge for consumers. In 2023, it received around 18,000 complaints, more than half of which were successful from the consumer’s perspective.
The ombudsman’s decision is binding on the insurer up to a complaint value of EUR 10,000. There is a separate ombudsman office for private health and long-term care insurance. An insurance law solicitor can also represent your interests, especially in cases involving higher amounts in dispute or complex legal issues. Our expert tip: Check in advance whether your legal expenses insurance will cover the cost of a solicitor.
Expert knowledge: legal foundations and current rulings
The Insurance Contract Act (VVG) forms the legal basis for your insurance contract and thus also for objecting to a rejection. Section 8 VVG, for example, governs the policyholder’s right of revocation, which can be exercised within 14 days of receipt of all documents. For contracts concluded between 1994 and 2007 under the so-called policy model, objection rights may still exist today in certain circumstances if the instruction was defective.
Current court rulings continuously shape insurance law. For example, the Federal Court of Justice (BGH) has repeatedly clarified the requirements for a time-limited acknowledgement in disability insurance (e.g. BGH, judgment of 09/10/2019 – IV ZR 235/18). It is important to know that, following an unjustified refusal of cover by the insurer, the policyholder is generally no longer subject to any obligations. Knowledge of such details can be decisive in the event of a dispute.
After you have submitted your appeal against the insurance refusal, the insurer will review the case again. The processing time can vary; for example, health insurers often have to respond within three to five weeks. There are essentially three possible outcomes: the insurer fully accepts your claim, offers a settlement, or rejects the appeal again.
If your appeal is rejected, other options remain open to you. As mentioned above, you can involve the insurance ombudsman or take legal action. A claim for failure to act before the Social Court is possible if a benefits provider does not decide on the appeal within three months. Carefully weigh up the chances of success and the cost risk before taking any further steps.
nextsure by your side: support in the insurance jungle
Dealing with an insurance rejection can be complex and stressful. With over ten years of experience in the digital insurance market, we at nextsure understand the challenges faced by policyholders. Our mission is to provide you with tailored and easy-to-understand insurance solutions.
Although we are not permitted to provide legal advice on individual cases, we are happy to support you in analysing your insurance situation and identifying areas for improvement. Benefit from our expertise in niche insurance and our fully digitalised processes. A well-structured objection is often the first step towards successfully asserting your claims.
Request your individual risk analysis now: Have your insurance situation reviewed free of charge and receive specific recommendations for improvement.
More useful links
Insurance Ombudsman: The official website of the Insurance Ombudsman provides comprehensive information about the ombudsman office for insurance disputes in Germany.
Wikipedia: A Wikipedia article provides a detailed overview of the role and function of the Insurance Ombudsman.
Stiftung Warentest: Stiftung Warentest explains in an article why making a complaint to the Insurance Ombudsman can be worthwhile.
Finanztip: Finanztip offers an informative article about the tasks and benefits of the Insurance Ombudsman.
Verbraucherzentrale NRW: Verbraucherzentrale NRW provides information on legal advice on insurance and your rights in the event of a claim.
Verbraucherzentrale: Verbraucherzentrale offers general information on which insurance policies are useful.
Verbraucherzentrale: On the Verbraucherzentrale website, you will find general information about advisory services.
FAQ
What should I do if my insurance company declines payment?
First, check the reason given for the rejection and your insurance policy. Then, within the deadline (usually one month), lodge a written, reasoned objection. Send it by registered post.
What documents do I need for an objection?
Important documents include the letter of rejection, your policy number, a detailed explanation, evidence such as photos, invoices, medical certificates and relevant excerpts from your insurance policy.
What happens if I miss the deadline for filing an objection?
If you miss the deadline for lodging an objection, the insurer’s decision will generally become final. In some cases, an application for review (e.g. under Section 44 of Book X of the Social Code in social law) may still be possible.
Does my legal expenses insurance help me with the appeal?
Whether your legal expenses insurance covers the cost of legal assistance in the event of an objection depends on your policy. Check your policy wording or ask your legal expenses insurer directly for confirmation of cover.
When should I involve a lawyer?
A lawyer is advisable when the case is complex, large sums are at stake, your objection has been rejected again, or you are unsure. 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 body for consumers. He reviews disputes with insurance companies impartially. His decisions are binding on the insurer for amounts in dispute of up to EUR 10,000.
