CLAIM EXCUSES; Reasons insurers give to wriggle out of paying.

Byline: SIMON READ

THOUSANDS of policy holders every year are shocked when their insurance claims are turned down.

Often the reason given by the insurer is a complete surprise. For example, did you know that you can't claim for a stolen car if you left the keys in the ignition?

Or that leaving a window open - even on a hot day - may lead to your burglary claim being rejected? It makes sense to find out what excuses your insurer can use to wriggle out of paying.

Below we give the main reasons why insurance companies reject claims, compiled with the help of Richard Hanson-James at insurance claims experts ClaimEx. And here are some other examples where claimants took on the insurer and won their case.

AFTER a storm damaged his roof, Mr W claimed on his buildings insurance. The insurer agreed to repair the roof, but refused to pay for a damaged TV aerial.

The company said that aerials were only covered under contents insurance, which Mr W did not have. But the Ombudsman ruled that most people would regard a fixed aerial as part of the building and the insurer had to pay out.

WHEN her father was unexpectedly admitted to hospital, Mrs D cut short her holiday.

But her insurer refused to pay for her return flight and cost of unused accommodation because her father was suffering from liver disease, caused by alcohol abuse. Mrs D received her money after the Ombudsman said the insurer had been unfair.

MR K drove a woman home after she spent the night with him.

They stopped at a petrol station and he popped in to buy some chocolate. When he returned, the car and the woman were gone.

The insurer rejected his claim, saying he failed to take reasonable care.

But the Ombudsman made it pay up because there was no evidence to back up the allegation.

SILENT TREATMENT

INSURERS may reject your claim if you haven't told them about past accidents, convictions, or previous claims.

If you haven't done so it may not be your fault.

"If you buy insurance over the phone you're often not expecting a barrage of questions, so check the paperwork when it comes through," warns Richard Hanson-James.

However, if relevant information comes to light after you've claimed, companies can refuse pay-outs for non-disclosure or misrepresentation.

TAMPER PROOF

BEWARE of making modifications to your motor - firms can refuse a claim on the grounds of misrepresentation.

That may be fair if you've tweaked your engine to get more power. But insurers have been known to throw claims out over the fitting of a rear spoiler.

UNCOVERED

MOST contents policies are on a new-for-old basis. However, if you have not insured your contents for a high enough figure insurers can cut your claim.

If your 10-year old TV is stolen, you'd expect to get it replaced with a new one. But if you're under-insured you may only get enough to buy another 10-year-old set.

THE KEY ISSUE

SICK NOTE

CAR insurers will not pay out if your motor is stolen when you've left the keys in the ignition or near the car.

So jumping out to buy a paper or post a letter and leaving the car unattended - even for a few seconds - will invalidate your insurance.

As will popping back indoors while the engine is warming up or because you've forgotten something.

IF you have a medical condition like angina, stroke or cancer and haven't told your medical or travel insurer, they will turn the claim down.

They may try to do this even if you weren't aware of the significance of the earlier event. "The pre-existing condition is a trap in most medical insurances and the medical bits of travel insurance," warns Hanson-James.

CAR TROUBLE

YOUR motor must be in a roadworthy condition. If it's not, your claim can be turned down.

That makes sense if the accident is due to a defect in the car or because it hasn't been maintained properly.

But your insurer might try to avoid paying if the engineer spots, say, a tear in a tyre wall which has nothing to do with the accident.

Keep a close eye on the condition of your car, and get it fixed if needs be, to avoid giving the issuer a get-out clause.

WINDOW SHOPPING 

MOST policies require window and door locks to conform to certain minimum standards. If they don't and you're burgled, you may not get paid.

Ensure you know what your locks are and whether they are suitable under the terms of your policy.

LYING LOW

IF you lie you could make yourself uninsurable, warns Richard Hanson-James.

He says: "There's a clause in most policies that says if anything you do in connection with the claim is fraudulent you won't get a penny."

Worse still, you could go to jail like I'm A Celebrity's Lord Brocket. He got five years for faking the theft of his pounds 4.5million vintage car collection.

SLIP UP

SLIPPING on a wet surface and hurting yourself or leaning out of a boat to take a photo and soaking the camera is reckless behaviour in an insurer's eyes.

In both instances, such behaviour will get short shrift if you make a claim. But Richard Hanson-James believes this is worth contesting. He argues: "That's nonsense. It ignores the point of insurance, which is to compensate us for some of the daft things we do."

TO DIY FOR

BLUNDERING builders are not covered on your insurance policy for any damage they do.

Homeowners spent more than pounds 40million on DIY and building work last year.

But most standard home contents policies don't cover accidental damage caused by builders or other contractors.

Martin Nugent, at insurance broker UK & Ireland Insurance Services warned: "People forget domestic buildings policies usually only cover damage done by the homeowner and their family - not builders.

"The first step is to ensure that reputable builders are used and references are checked.

"Thousands of people will be undertaking ambitious projects to improve their houses in 2005.

"New kitchens, loft conversions and extensions are expensive and it's worth checking how good your insurance policy is before the work starts."

TIPSY TURVY

IF you claim on your travel insurance for an incident that happened when you had had a drink, you could be turned down.

All travel policies say that no claim will be paid if your misfortune occurs because you have drunk excess alcohol.

"What is excessive isn't usually defined," says Richard Hanson-James.

"Even falling down steps when you're unsteady after a drink might mean that your medical costs won't be paid."