What are the reasons for a refusal of compensation from home insurance?
Many home insurance contracts contain clauses of exclusions, nullity, or forfeiture of guarantees. With these clauses, the insurer may refuse to compensate you for a declared claim.
To be legally valid, they must be written in “distinct and extremely legible” characters, in the general conditions of the contract.
- Exclusions from home insurance guarantees: these represent situations in which the guarantees provided for in the contract could not operate. For example, for the application of the Civil Liability cover, compensation cannot be paid in the event of damage caused voluntarily by the insured to a third party.
Some warranty exclusions are legal, such as an adult deliberately setting fire to their apartment. Others are defined by each insurer, such as the exclusion which consists of not compensating for the burglary of the home of an insured person who has been absent for too long, leaving the accommodation vulnerable (clause inhabitation).
- The forfeiture of guarantees: it allows the insurer to notify his client of the impossibility of claiming compensation. It must be written legibly in the contract and can only apply following a claim.
It can intervene in the following cases: claim declared too late causing financial damage to the insurer; the insurer has not been notified of a change in the situation (personal or professional) of the insured; the amount of the damage suffered was exaggerated by the insured; late payment of insurance contributions.
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Natural disaster: can we refuse to compensate you?
You will be compensated for damage caused by a natural disaster only if an interministerial decree published in the Official Journal recognizes this state of natural disaster. Damage caused to unharvested crops, crops, soils, and live livestock excluding buildings, that fall under the agricultural calamities regime, will not be compensated. Nor are they compensated for damage to boats, planes, transported goods, and marine renewable energy installations located at sea beyond the shore.
The home insurer can also refuse compensation for property or activities located in unbuildable areas after the publication of a Natural Risk Prevention Plan (PPRN).
For constructions before the PPRN, you will have to bring your goods and activities into compliance, within 5 years and at your expense. In which case, the insurer may again refuse natural disaster compensation.
How soon should a home claim be reported?
After a claim, you must notify your insurer within the time limits provided for in your contract (by registered mail with AR). These deadlines may vary depending on the type of claim:
Nature of the claim Reporting deadline to be respected
Theft, burglary, the act of vandalism 2 working days
Any other claim 5 working days
Natural disaster recognized at the OJ 10 working days
In the event of a delay in reporting a home insurance claim, it will be much more difficult for you to assert your rights.
Your declaration of loss must include as many elements as possible to help your insurer properly determine your liability and thus the amount of compensation. Your declaration must include the following elements in particular:
- date of loss;
- circumstances of the loss and assessment of the damage suffered;
- supporting documents that can facilitate/accelerate compensation (photographs, testimonials from neighbors, purchase invoices, copy of the complaint filed in the event of theft, statement from the company managing the security and surveillance system for your accommodation).
How to challenge the refusal of compensation out of court?
If your insurer refuses to compensate you for a claim, there are several ways to claim adequate reimbursement. Before taking any action, make sure that this refusal is not legitimate. Otherwise, your dispute will be useless. If it is indeed illegitimate, first send a letter contesting the refusal of compensation to your insurer (registered mail with AR). Here is an example:
- Call on an expert: you can first add your expert to carry out a second opinion. The work of this counter-expert then consists in demonstrating that the damage suffered indeed exceeds the compensation threshold and that you can thus be compensated.
If the disagreement with your insurer persists despite this counter-expertise, you can request a final assessment: third-party expertise. You will choose this 3rd expert jointly with your insurer and will have to share the cost of the service.
The appended expert reports are at no time based on the work of the 1st expert. In addition, your expert’s fees may be covered by your insurance if you have expert’s fees cover.
- Call on a mediator: you can also send a complete file to the mediator of your insurer, your mutual insurance company, or your bank; then to that of the French Federation of Insurance Companies (FFSA), the Grouping of Mutual Insurance Companies (GEMA) or the French Banking Federation (FBF).
If your file is solid and well-argued, they will be able to offer you fair and adequate solutions. Please note that only Gema’s opinions are mandatory for mutual insurance companies. Those of the FFSA are not approved by insurance companies, although its opinion if it is favorable to you, makes your insurer’s position in court difficult. If mediation fails, you can notify your insurer of your intention to contact a consumer association or request its intervention by sending a file to the Prudential Control and Resolution Authority (ACPR).
How to contest the refusal of compensation via legal remedies?
The law prohibits insurers from inventing dilatory means to delay the settlement of a claim. Thus, the appraisal of a claim must be completed within 3 months of the submission of the statement of losses caused by the claim. Failing this, you can send your insurer a formal notice of payment (by registered mail with AR). If this expertise is not completed within 6 months, you are then entitled to take legal action.
Article 1153 of the Civil Code provides that, failing to settle a claim within the prescribed period, the insurer must pay the insured party the legal damages and interest fixed by law and additional interest if his bad faith has caused to his insured another loss.
Moreover, if the disagreement with your insurer is not settled by the insurance mediator, you can also initiate legal proceedings. It is then imperative to seize the competent court within a maximum of 2 years following the start of the dispute. Depending on the amount of compensation requested by the customer, the competent court will be as follows:
- less than €4,000: local judge.
- between €4,000 and €10,000: district court.
- more than €10,000: high court.
Recourse to a lawyer for the defense of your interests is only compulsory in the last case (loss > €10,000), knowing that the legal protection guarantee may make it possible to cover the costs incurred in court.
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9 tips to make the home insurance claim process easier
Tip #1: before the visit of the insurer’s expert, ask several craftsmen to obtain repair estimates after water damage, fire, accidental explosion, storm, etc.
Tip n°2: if the insurer’s expert offers you a derisory compensation compared to the quotes, tell him that you will ask for another one.
Tip n°3: your contract turns out to be too light at the time of the claim? Threaten to hold the seller – employee, agent, or broker – liable for failure to provide advice.
Tip #4: if the price of your multi-risk home contract has increased regularly while the value of your property has fallen, the fact that you are charged high dilapidation at the time of the claim may be considered abusive.
Tip #5: Are you suffering from water damage caused by the upstairs neighbor or common areas? Your insurer does not have to apply the slightest obsolescence to you.
Tip n°6: keep all proof of the claim, even after the visit of the expert. He can photograph them but has no right to take them away.
Tip 7: the expert does not have the right to go around your home if only the kitchen and the living room have been damaged and the cause identified.
Tip #8:the agreements between insurers, which are often invoked, are not enforceable against the insured if they affect his interests.
Tip n°9: any recognized consumer association can ask the judge to order a professional to terminate or delete a contract, a simple clause, or to stop illegal acts.
Refusal of compensation: cancel in favor of better home insurance?
After a dispute between you and your insurer about your compensation after a disaster, perhaps you want to change home insurance. And that is perfectly understandable. You must then terminate your contract.
You can cancel your home insurance from the first expiry date of your contract (after one year) without having to justify yourself. Just send a registered letter with acknowledgment of receipt 2 months before this date. Normally, your insurance company is under a legal obligation to notify you, at least 15 days before, of the deadline by which you can make this cancellation request. From this date, you then have a period of 20 days to send your cancellation letter.
After 1 year of the contract, you can terminate your contract at any time and without having to justify yourself (Hamon law). Again, the request must be made by registered letter AR. To help you in your efforts, here is a standard termination letter to download:
