What To Do When An Insurance Company in Nigeria Denies Your Claim

What’s more frustrating than paying your insurance premiums religiously year after year, only to have the company deny your claim when you truly need them?

It’s a situation no one wants to find themselves in, but it does happen more often than it should in Nigeria. When an insurance provider refuses to pay out a legitimate claim that you’ve paid your premiums for, it can feel like a slap in the face and leave you wondering why you even bothered having coverage in the first place. If this has happened to you, don’t just accept the denial and give up.

There are steps you can take to fight back and hopefully overturn that unfair decision.

WHEN YOU’VE PAID YOUR PREMIUMS BUT YOUR INSURANCE CLAIM IS DENIED – WHAT NEXT?

For most people in Nigeria, having an insurance policy provides peace of mind and a sense of security for themselves and their loved ones. You dutifully pay those premiums year after year, hoping you’ll never need to make a claim but reassured that if something bad does happen, you’re covered.

So it can be a rude awakening when you do make a legitimate claim only for the insurance company to turn around and deny it. After paying all those premiums, how can they just refuse to pay out? Doesn’t that defeat the entire purpose of having insurance?

Unfortunately, claim denials by insurance companies do happen in Nigeria, sometimes for legitimate reasons and sometimes not. When it happens to you, it’s devastating, frustrating, and can leave you feeling powerless.

However, you are not entirely without recourse when your insurance claim is unfairly denied. There are steps you can take to fight back and hopefully overturn the denial. It just requires some persistence and grit on your part.

UNDERSTAND WHY YOUR CLAIM WAS DENIED

The first step is to find out exactly why your claim was denied by the insurance company. They are legally required to provide a reason, which will be stated in the denial letter they send you.

Common reasons insurance claims get denied in Nigeria include:

• The claim was for something not covered by your policy
• You failed to notify the insurance company about the event soon enough
• There were errors or lack of documentation in your claim filing
• The insurance company suspects fraud on your part

Go over the reason given very carefully to see if it is valid or not. Perhaps there was just a misunderstanding or mistake. If you think the denial is unjustified based on a wrong interpretation of your policy, for example, you may be able to get it overturned simply by clarifying the facts to them.

However, if the insurance company seems to be denying your claim in bad faith or treating you unfairly, that’s when you need to get more assertive in your appeal efforts.

FILE A FORMAL APPEAL

Most insurance companies have an internal process for appealing a denied claim. The denial letter should outline what this process is and what supporting documentation you need to provide for your appeal.

Some key tips for an effective insurance claim appeal:

• Request a copy of your full claim file from the insurance company. This file may reveal additional insights into why your claim was denied.
• Gather all documentation related to your claim – medical records, repair estimates, police reports, receipts, witness statements, etc. Make copies.
• In your appeal letter, refer directly to the policy language that you believe entitles you to have the claim paid out.
• If the amount the insurance company approved is less than you expected, get cost estimates from third parties to back up your requested claim amount.
• Be very clear, detailed and firm in disputing the denial reason. But avoid getting emotional or angry in your letter.
• Send the appeal letter promptly by a trackable mail service and keep copies.

You may have to go through more than one appeal level, such as appealing to a claims reviewer and then to a claims manager. Be persistent and follow all instructions they provide carefully.

HIRE A CLAIM DENIAL ATTORNEY

If your insurance company still won’t budge after one or more appeals, your next recourse is to hire a claims denial attorney who specializes in insurance bad faith cases.

A good claims denial lawyer will be able to:

• Review your policy and all documentation to look for any violations by the insurance company
• Determine if the denial is in breach of your policy contract
• Represent you aggressively in further appeals and negotiations
• File an official complaint or lawsuit against the insurance company if warranted

In Nigeria, insurance companies are required to handle and settle claims promptly and fairly under the Insurance Act. If the evidence shows yours is a legitimate claim that was unfairly denied in bad faith, you may be able to sue not just for the original claim amount but also for additional damages. This gives the insurance company more incentive to settle properly.

While hiring a lawyer involves some upfront costs, it’s worth considering if the insurance company continues to stonewall you. Lawyers are experts in insurance policies and claims, so they are often able to recover money that individuals could not on their own.

OTHER THINGS YOU SHOULD DO

There are other avenues worth exploring if your claim was unfairly denied. These should come along with a formal appeal and legal representation:

FILE A COMPLAINT WITH NAICOM

NAICOM (National Insurance Commission) is the government regulator that oversees insurance companies operating in Nigeria. You can file an official consumer complaint with NAICOM regarding any allegedly unethical or illegal claims practices by your insurer. NAICOM may investigate and try to resolve the issue.

FILE A COMPLAINT WITH CONSUMER PROTECTION GROUPS

Organizations like the F.C.C.P.C. (Federal Competition and Consumer Protection Commission) exist to protect consumer rights in Nigeria. You can file a formal complaint with these groups as well regarding claims denial issues.

POST ON SOCIAL MEDIA

In today’s environment, insurance companies are often concerned about negative publicity and their online reputation. Posting details about your claim denial story and experience on social media sites may get their attention and motivate them to resolve the issue more quickly.

CONCLUSION

Having an insurance claim wrongfully denied is an incredibly frustrating experience that can make anyone want to just cash out their policy and be done with it all.

However, if you’ve paid your premiums and made a legitimate claim, you deserve to have it paid out fairly per your policy contract. Don’t just roll over and accept a denial, especially if you suspect the insurance company is acting in bad faith or treating you unfairly.

By persisting through appeals, considering legal action, filing complaints, and applying pressure through social media, you can push back and hopefully get your rightful claim resolved. It may take some effort on your part, but fighting for what you are rightly owed is well worth it in the end.