This section has information to help you if you need to make an insurance claim.
The first thing you need to do is check your full policy (not just the summary) to see whether you are covered. Remember, you may be covered for the same loss under more than one policy. For example, if your money is stolen while you are on holiday, this may be covered by your all-risks household policy and also by your travel insurance. You cannot claim under more than one policy for any loss, so carefully consider which policy to claim against, bearing in mind the excess on each policy.
For larger claims, such as a buildings claim on your home, you may want to hire an assessor. An assessor works on your behalf and will negotiate with your insurance company to settle your claim. Assessor’s fees are not covered by your policy, so you will have to pay for this service yourself. An assessor is not the same as a loss adjuster, who is employed by the insurance company and works on their behalf.
Things to consider before making a claim
- Before making a claim, check the excess you have to pay yourself on your policy. The amount varies but is generally between €100 and €300. You will not be able to claim for amounts less than the excess.
- If the amount of a claim is small, consider whether it is worth making a claim. If you make a claim, you may lose your no-claims discount with certain insurers and you may find it difficult to shop around for certain types of cover the next time you renew your policy.
How an insurer must deal with your claim
Although there is some paperwork involved in making a claim, you should remember that under the Central Bank’s Consumer Protection Code regulated companies are required to:
- Have a written procedure in place for dealing with claims.
- Help you if you need to make a claim and let you know about new developments which affect the outcome of your claim within 10 business days of knowing about them.
- Let you know their decision on your claim within 10 business days of making the decision. When a claim is not settled in your favour, they should explain the reasons why in writing, and provide you with details of how you can appeal the decision.
When the consumer makes a genuine mistake and gives inaccurate or incomplete information in the application process, the insurance company cannot use this to avoid paying a claim.
Where the consumer gives fraudulent information in the application process the insurance company can cancel the policy and avoid paying a claim.
An insurance company cannot automatically refuse a claim on the basis that the claim was not notified to them within the timeframes set out in the policy document if it does not negatively impact them.
In personal injuries cases your insurer must give you details of the Injuries Board. You can contact them directly, without an agent such as a solicitor, when making a personal injury claim.
Your insurance company will consider your claim and decide whether your policy covers you for the costs or damage. It is your choice to accept their settlement. You can negotiate with your insurance company or broker if you are unhappy with their offer.
Insurers normally settle claims by cheque, payable to you. If you have arranged home insurance through your mortgage lender, the insurance company may pay the money to your lender who will then pass it on to you.
How long should it take to settle a claim?
There is no definite length of time to settle an insurance claim and it will depend on the type of claim. Some claims may need expert opinions or the input of several people before the claim can be agreed.
Personal injury claims – what to do if you have an accident
In cases that involve another party, such as a traffic accident, you should:
- report the matter to the Gardaí immediately
- advise your insurance company straight away
- contact the Injuries Board (an independent statutory body set up by the Government) and/or get legal advice.
In the case of a claim for personal injury, you don’t have to accept the amount an insurance company offers. You can decide to reject their offer and refer your claim to the Injuries Board, to decide the amount of compensation you should get for personal injuries. This helps to make the claims process less expensive, as you are under no obligation to use a solicitor.
The Injuries Board website will let you see how much you could receive for certain injuries. You can take a claim and apply directly on piab.ie or use the Injuries Board Smartphone app.
However, if you decide to reject the Injuries Board assessment, you may take your claim to court. In these circumstances, you may prefer to get legal advice as soon as possible.
Some policies contain a ‘legal expenses clause’, where you would be offered the use of legal services if you were making a claim. Check if you have this cover on your policy so that you do not pay for any services you are already covered for.
If someone is claiming against you
Insurance companies do not have an obligation to inform you of the outcome of a claim made against you and can agree a settlement without your knowledge or consent. Keep in contact with your insurance company, in particular the claims manager appointed to the claim.
If you disagree with the finding, you can make your feelings known to the claims manager and the customer complaints department at the insurance company. If you need to make a complaint, follow our complaints procedures.
If you have an accident with an uninsured driver
Follow the above procedures, but you may also wish to contact the Motor Insurance Bureau of Ireland (MIBI). The MIBI was set up to compensate victims of uninsured and untraced drivers in Ireland.
It also makes sure claims against foreign registered vehicles in Ireland, or Irish motorists abroad, are properly handled and settled.
If you are getting repairs made to your car, you might want to make a claim on your policy to cover the cost. You can choose to use a business from your insurance company’s panel of ‘approved repairers’ or you can use a repairer that is not on that list, for example, a local mechanic you have used before.
Before you decide who repairs your car, always check the terms and conditions of your insurance policy, or contact your insurance provider, to see if the work needed to repair the damage is covered by your policy and if there are any limits on the amount you can claim.
Could I get less money then I claimed for?
In some cases, your claim may be reduced. For example, if you have underestimated the cost of rebuilding your home and replacing your belongings when taking out home insurance, you could get less money than you claimed for. This is due to an ‘average clause‘, which is included in some policies.
For example, if the contents of your home are worth €40,000 but you insure them for just €20,000 and they get completely destroyed by fire, the most you will get from your insurance company is €20,000.
Even if you claim €10,000, the insurance company will look at the overall amount you insured your contents for and will consider that you are only half insured. So they may pay out only €5,000 or half of the total damage.
Making a health insurance claim
If you have a health insurance policy and wish to make a claim, there are a number of basic steps you should follow when making a claim:
- Check the excess and allowable expense: if the excess that you are required to pay is more than the medical cost, then you will be unable to make a claim. You may only be able to claim back a portion of an expense paid, this is the ‘allowable expense’.
- Make the claim as quickly as possible: the terms of the policy will set out the amount of time you have to submit a claim on your health insurance policy. But an insurance company cannot automatically refuse a claim on the basis that the claim was not made to them within the timeframes set out in the policy document, if it does not negatively impact the insurance company.
- Get your paperwork in order: depending on whether you are claiming for everyday expenses such as doctor visits and out-patient treatment or for a hospital visit, the required documentation may be different. Be sure to contact your insurer or broker to find out what documentation is required.
Making a Life Insurance Claim
Making a life insurance claim involves some paperwork. There are a number of basic steps you should follow:
- Contact the deceased person’s insurer or broker first: (or their employer if it is an employee benefits package) to find out what paperwork is required.
- Find out what you are entitled to: You may not always know what sort of life insurance policies a spouse or family member had, particularly if they were members of a group scheme. Review credit card and bank statements and contact lenders and the deceased person’s employer to learn about any additional cover he or she may have had.
- Get your paperwork in order: You will need the policy documents as proof of your right to claim. If you are claiming following the death of the insured person, you will need a copy of the death certificate.
Making a serious illness cover claim
If you are diagnosed with a serious illness and have a serious illness policy in place, there are a number of basic steps you should follow when making a claim:
- Check your policy: check your policy document to see whether the illness and its severity is covered under the policy. If you are unsure whether you are covered, contact the insurer or broker.
- Complete a claims form: you will need to submit a claims form to your insurer when making a claim. Remember to complete the forms as accurately as possible to avoid delays or refusal of your claim. Depending on the severity of the illness, you may need to contact the insurer or broker directly before completing a claims form. You may be required to submit medical evidence of the diagnosed illness as part of the claims form.
- Get your paperwork in order: your insurer may ask for original documentation such as the original policy document, birth certificate to ensure the person claiming is the policyholder etc. If you are unable to provide original documentation, contact the insurer or broker to find out if any alternative documentation can be used.
Making an income protection claim
If you are out of work due to illness or injury and have an income protection policy in place, there are a number of basic steps you should follow when making a claim:
- Check your deferred period: when taking out an income protection policy, you will have set out your ‘deferred period’. The deferred period is the length of time between you being unable to work and the policy benefit being payable. Deferred periods tend to range from 13 to 52 weeks. If you are still within your deferred period, you will be unable to make a claim.
- Complete a claim form: you will need to submit a claim form to your insurer when making a claim. Remember to complete the forms as accurately as possible to avoid delays or refusal of your claim. If you are unsure of any information requested on the form then contact the insurer or broker.
- Get your paperwork in order: when making a claim on an income protection policy, you will be required to submit documentation to support your claim. Examples include medical certificates, proof of earnings, medical assessments etc. Your insurer or broker will advise what is required.
Making a mortgage protection claim
Making a mortgage protection claim involves some paperwork. There are a number of basic steps you should follow:
- Contact your insurer or broker: you will need to notify your insurer or broker that the policyholder or one of the policyholders, in the case of a joint life policy, is deceased. As a mortgage protection policy is assigned to your lender, usually your bank, the balance on the policy will be paid directly to the lender.
- Complete a claims form: you will need to submit a claims form to your insurer when making a claim. Remember to complete the forms as accurately as possible to avoid delays or refusal of your claim. If you are unsure of any information requested on the form then contact the insurer or broker.
- Get your paperwork in order: your insurer may ask for documentation such as the original policy document, certified copies of the death certificate and will if available. The insurer or broker will advise what documentation is required during the initial contact.