A rejection is bad news arriving at the worst time – yet it is rarely arbitrary: most causes are well known, predictable and, most importantly, largely preventable. Below I take the five most frequent causes one by one, each with the way to prevent it.
- The five most common causes: an event within the waiting period, a situation under an exclusion, incomplete documentation, late filing, inaccurate job-role or headcount data.
- Prevention rests on two pillars: knowing the conditions and a tidy internal process.
- There is a route after a rejection too: written reasoning, a review request, the insurer's official complaints channel, and then, as a consumer, the Financial Arbitration Board or the courts (the MNB's consumer-protection procedure only examines breaches of the consumer-protection rules – complaint handling, for example – and does not decide on the claim itself) – in a disputed case, I help liaise with the insurer as broker, based on the policy terms.
An event within the waiting period
Several covers – typically the illness elements, critical illness cover for example – carry a waiting period after the contract starts: for events occurring within it, the insurer typically does not pay. Whoever does not know this will experience even a justified rejection as unfair. Accident covers, by contrast, are typically live immediately, without a waiting period – the difference varies by cover. The prevention: communicate the waiting periods to the team clearly at rollout, cover by cover. The details are laid out in the waiting periods article.
A situation under an exclusion
Every set of conditions contains exclusions – typically certain dangerous activities, extreme sports, events under the influence of alcohol. Prevention here is good timing: review the exclusion list not at signing but already when comparing offers – and if, say, a hobby sport is common in the team, flag it in the quote request so the cover is fitted to it. A plain-language overview is in the exclusions article.
Incomplete documentation and late filing
The conditions typically set a filing deadline, and with a very late filing the circumstances are also harder to establish – which can weigh on the assessment unfavourably. An incomplete package, in turn, breeds document-request rounds and a longer timeline. Prevention is twofold: report the event as soon as possible on the insurer's claims channel, and know the document list in advance, so the package is complete first time. The internal one-pager and the employee guide are worth a lot here: whoever knows where and with what to turn typically files on time and with a full package.
Inaccurate job-role or headcount data
The group contract lives on the insured list: if a colleague appears on the list with an office job role while actually doing physical work, that can breed a dispute at assessment – premium calculation, after all, tracks the risk. The prevention: regular refreshing of the joiner–leaver lists and the data reconciliation at the anniversary. How that process runs with us is pictured on the How it works page.
What is the route after a rejection?
The first step is always the written reasoning: exactly which point of the conditions does the decision rest on? On that basis a review can be requested from the insurer – especially when a new document supports the claim – and the insurer's official complaints channel stands open as well. If the case remains disputed after these, I help the client, as broker: I go through the conditions and help with the correspondence with the insurer, where I can – I described the details in the when the broker steps in article. Results no one can promise, but a structured, documented dispute in experience brings a cleaner closure.
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