There’s little more frustrating than paying your insurance on time for years… and then, just when you need it, the insurance company refuses to pay. At Legal Allies, we receive many queries from people who’ve had accidents, thefts, or medical issues, only to be faced with a denial, unexpected fine print, or months of silence.
In this situation? Take a deep breath. Here’s a step-by-step guide on what to do if your insurance company won’t pay what you’re legally entitled to.
Why Would an Insurance Company Refuse to Pay?
The most common reasons are:
- Lack of Coverage
They claim the damage isn’t covered by the policy. Sometimes that’s true… sometimes it’s debatable. - Failure to Meet Policy Conditions
Example: You reported the incident too late, or didn’t submit proper documentation. - Blaming the Insured
They say you caused the damage or acted negligently. - Poorly Written or Ambiguous Policy
That sneaky fine print you didn’t fully understand when you signed. - Delay Tactics
Yes, some insurers delay payments on purpose, hoping you’ll give up.
What to Do If the Insurance Company Refuses to Pay
1. Review Your Policy
Before going into battle, know what weapons you’ve got. Read carefully:
- What’s covered.
- What’s excluded.
- Deadlines for reporting incidents.
- Requirements for compensation.
If legal language makes your head spin (understandable!), Legal Allies can help you interpret it.
2. Gather All Evidence
- Photos of the damage or incident.
- Medical reports, invoices, accident reports.
- Written communications with the insurer.
- Witnesses, if any.
Key rule: document everything.
3. Submit a Formal Complaint to the Company
Write a polite but clear letter stating:
- Date of the incident.
- Policy number.
- Exact compensation you’re claiming.
- Attach documents and request a written response.
Send it via registered mail or email with read receipt. Avoid casual phone calls.
4. Contact the Insurance advocate
All insurance companies must have a customer service and ombudsman.
You can file a complaint there if you haven’t received a reply in 30 days or disagree with their response.
5. File a Complaint with the General Directorate of Insurance
If the insurer still doesn’t resolve the issue, you can escalate it to this official body under the Ministry of Economy.
They can’t sanction the company, but their reports carry weight—many insurers prefer to settle rather than face scrutiny.
6. Take Legal Action (as a Last Resort)
If all else fails, you can file a civil lawsuit against the insurer.
- If the amount is under €2,000, you can do it yourself.
- If it’s more, you’ll need a lawyer and legal representative.
Legal Allies can assess whether it’s worth going to court, if you have enough evidence, and how to claim interest and legal costs.
How Much Time Do I Have to File a Claim?
You have 2 years from the date of the incident to claim from your insurer. In some cases (like life insurance), it can be 5 years.
Don’t wait—sooner is always better.
Real Cases from Legal Allies
Irene, a French student, was hit by a car and her health insurance refused to cover her rehab. We drafted a formal complaint and submitted medical reports. They paid the full treatment.
Carlos, a self-employed worker, had a fire in his shop. The insurer denied coverage due to “faulty wiring.” We presented an independent expert report and won a court settlement over €9,000.
Tips If Your Insurance Company Refuses to Pay
- Keep all communications in writing.
- Never sign a waiver without legal advice.
- Get independent expert reports if you disagree with the insurer’s assessment.
- Be firm, polite, and legally precise.
When an insurance company refuses to pay, it doesn’t mean they’re right. It means you need to defend yourself—with evidence, legal knowledge, and if necessary, formal complaints or a lawsuit.
At Legal Allies, we review your policy, draft complaints, negotiate with insurers, and if needed, go to court with you to ensure you receive what you’re entitled to.
Because when the insurer won’t answer… we will.
