How to file an insurance claim that gets paid
An insurance claim letter — formally a Notice of Loss or Proof of Loss — is the document that triggers your insurer's obligation to investigate, value, and pay your claim. Submit it late, leave information out, or misstate a material fact and the insurer can reduce, delay, or deny payment entirely. Done correctly, the same letter can mean the difference between a £25,000 cheque next month and a two-year coverage dispute.
Insurance is regulated very differently on each side of the Atlantic. In the US, insurance is primarily regulated at state level under the McCarran-Ferguson Act of 1945 — every state has its own insurance code and "unfair claims settlement practices" statute (typically modelled on the NAIC Model Act). In the UK, insurance contracts are governed by the Insurance Act 2015 for commercial policies and the Consumer Insurance (Disclosure and Representations) Act 2012 for consumer policies, with disputes ultimately referable to the Financial Ombudsman Service (FOS).
Statutory notice deadlines
Most policies require notice "as soon as reasonably practicable" or within a specific number of days. Common practical deadlines:
- Theft / burglary: notify the police within 24–48 hours and the insurer within the period stated in the policy (often 7 days). A police report (UK) or police case number (US) is usually a precondition to payment.
- Fire: notify the fire service immediately; notify the insurer within the period in the policy (often 14 days). Obtain the fire-service incident report.
- Water damage / escape of water: typically 30 days under most UK home policies; varies under US policies but "prompt notice" is the universal standard.
- Auto accident: notify the insurer immediately, especially where third parties are involved. Most US states have statutory deadlines for filing the proof of loss (e.g. New York: 90 days under N.Y. Ins. Law § 3420).
- Storm, flood, named natural catastrophe: follow any post-event notice published by the insurer; often 30–60 days.
UK Insurance Act 2015, section 13A (in force 4 May 2017) imposes an implied term that the insurer must pay sums due within a reasonable time, with damages available for late payment. Use this in correspondence if the insurer drags its feet.
The seven required pieces of information
- Policy number and your details — full name, address, telephone, email, policy number exactly as printed on your schedule.
- Insurer details — claims department address (often a PO Box different from the head office). Check the back of your schedule.
- Date and time of loss (or of discovery, if different).
- Place of loss — full address with unit, floor, or specific location.
- Description of what happened — chronological, factual, neutral. State what you saw, what you did, who else was present. Avoid speculation about cause.
- Itemised quantification of the loss — schedule of damaged items with description, age, original cost, replacement cost, and any documentary evidence.
- Supporting documents — a numbered list of enclosures (photos with timestamps, repair quotes, original purchase receipts, police report, fire-service report, third-party witness statements, medical reports for injury).
Documentation by claim type
- Water damage: dated photos of the damage and the source, plumber's invoice and report, dehumidification logs, replacement quotes, photos of original condition where available
- Theft: police case / crime reference number, list of stolen items with original receipts, photos pre-theft, evidence of forced entry
- Fire: fire-service incident report, photos before and after, list of damaged contents with replacement costs, structural-engineer's report for buildings claims
- Auto accident: police report, photos of all vehicles, third-party insurance details, witness statements, medical records (if injury), repair estimates
- Storm / flood: meteorological data confirming the event, photos, contractor reports establishing a single insured peril (not gradual damage)
Disclosure duties
UK consumers have a duty under the Consumer Insurance (Disclosure and Representations) Act 2012 to take "reasonable care" not to make a misrepresentation. The remedies for misrepresentation are graded by fault: deliberate or reckless misrepresentation entitles the insurer to avoid the policy and refuse all claims; careless misrepresentation gives a proportionate remedy.
UK commercial policyholders have a duty of "fair presentation" under section 3 of the Insurance Act 2015, including disclosure of every material circumstance the insured knows or ought to know. Breach gives the same graduated remedies (sections 8 and 14 plus Schedule 1).
US: the duty of utmost good faith (uberrimae fidei) applies in marine and some commercial lines; in consumer property and auto, the duty is one of honest answers to specific questions, but material misrepresentation can still void the policy. Several states (e.g. California Ins. Code § 332) codify the disclosure obligation.
Bad faith and unfair claims practices
If the insurer unreasonably delays, denies, or under-pays your claim, you have escalation routes that often produce far better outcomes than the original offer.
US bad faith. Most states recognise a tort of insurance bad faith for first-party claims. Key cases: Gruenberg v Aetna, 9 Cal. 3d 566 (1973) (California); Anderson v Continental Ins. Co., 271 NW 2d 368 (Wis. 1978). Damages can include consequential losses, emotional distress, attorney's fees, and (in egregious cases) punitive damages exceeding the policy limits. State unfair-claims-practices statutes (e.g. Cal. Ins. Code § 790.03(h); Tex. Ins. Code § 541.060) supplement common-law bad faith.
UK Financial Ombudsman Service. If your insurer is FCA-regulated, after 8 weeks (or earlier if you receive a final response) you can refer the dispute free of charge to the Financial Ombudsman Service. The FOS can award up to £430,000 (claims referred from 1 April 2024) plus interest and an inconvenience award. Decisions are binding on the insurer if you accept.
Time limits to bring suit
- UK: 6 years from breach of contract (Limitation Act 1980, s. 5); 3 years for personal injury (s. 11)
- US: varies by state — 2 to 6 years for breach of insurance contract, with shorter contractual periods sometimes valid (often 1 to 2 years from date of loss). Check your policy for any contractual limitation period
Common mistakes
- Late notice — even a few days late can be fatal under "as soon as practicable" wording
- Repairing or disposing of damaged property before the loss adjuster's inspection — except for emergency safety repairs, preserve everything
- Under-stating the loss — extremely difficult to amend upward later
- Over-stating the loss — risks total denial under the fraud exception (UK: Insurance Act 2015, s. 12; US: most states recognise the fraud forfeiture rule)
- Skipping the police report for theft or vandalism — claim refused
- Sending notice by ordinary email or unrecorded post — date of receipt becomes contestable
What Lettrio generates for you in 30 seconds
Our AI drafts a complete Notice of Loss with your policy details, a clear chronological description of the incident, an itemised list of damages with claimed amount, references to the Insurance Act 2015 / Consumer Insurance Act 2012 (UK) or the relevant state insurance code (US), a numbered enclosure list, and a request for prompt acknowledgement and the loss-adjuster's contact details. PDF ready to send by Royal Mail Signed For or USPS Certified Mail. First letter free, no account required.