Insurance claims can legitimately require investigation, but an open-ended investigation is not a substitute for handling the claim promptly and fairly. The insurer should be able to explain what it is waiting for, why it matters and what happens next.
Insurance disputes are rarely decided by one sentence in the policy. The wording, what the insurer asked, what happened, the evidence and the reason given for the decision all matter. Keep those questions separate so the complaint stays testable.
Key points
- ICOBS requires claims to be handled promptly and fairly and policyholders to receive appropriate information on progress.
- A reasonable evidence request should connect to a real coverage, causation, value or identity issue.
- Third-party adjusters, engineers and repair networks do not remove the insurer's responsibility for claim handling.
- Where delay causes additional direct loss, keep evidence of that impact and raise it expressly in the complaint.
Diagnosis
First: what exactly has happened?
Start by identifying the actual dispute. Similar-looking insurance complaints can turn on very different rules.
| What happened? | What to check first |
|---|---|
| The claim has been open for months | Ask for the outstanding investigation steps, owner, target dates and what is preventing a decision. |
| The insurer repeatedly asks for new documents | Ask why each item is material and whether it duplicates information already provided. |
| A loss adjuster is not responding | Complain to the insurer; outsourcing does not outsource regulatory responsibility. |
| The insurer wants an interview or statement | Ask the purpose and scope; cooperate reasonably but correct errors and keep a record. |
| Repairs are delayed after liability is accepted | Separate the coverage decision from repair-network performance and alternative accommodation / mitigation issues. |
Reasonable investigation versus drift
Complex claims can take time, especially where expert evidence, police information, medical evidence or several contractors are involved. The problem is not simply the number of days. The issue is whether the insurer is actively progressing the claim, explaining the investigation and avoiding unnecessary repetition or inactivity.
Ask for a claim status statement
Request a concise written position: what has been established, what remains disputed, what evidence is outstanding, who is responsible for obtaining it, and the next decision date. This often exposes whether the claim is genuinely under investigation or simply sitting in a queue.
Evidence requests should be proportionate
Insurers can ask for information needed to validate the claim, prove ownership/value, investigate causation or check policy conditions. If the request is burdensome, ask what issue it addresses and whether a narrower alternative would answer the same question.
Loss adjusters and outsourced suppliers
The adjuster may be the day-to-day contact, but the insurer remains responsible for the regulated claim. Where the adjuster is causing delay, copy the insurer into the complaint and ask it to take ownership rather than telling you simply to keep chasing the contractor.
Repeated expert inspections
If the insurer commissions another inspection after receiving an unfavourable report, ask why a further opinion is necessary. Multiple reports are not inherently unfair, but the consumer should know what conflict or evidential gap the additional inspection is meant to resolve.
Delay after settlement terms are agreed
ICOBS separately requires prompt settlement once settlement terms are agreed. If the amount or method has already been accepted, the insurer should not continue treating the claim as though basic liability is unresolved.
Consequential impact
Keep evidence of temporary accommodation, emergency repairs, storage costs, extra travel, lost use or other direct consequences. Whether those losses are recoverable depends on the policy and fairness of the claim handling, but undocumented impact is much harder to remedy later.
What to say next
Ask the insurer for a dated action plan and a final response on the complaint about delay. Separate the underlying claim from the service complaint: you can still want the claim determined while also complaining that the process has been unreasonable.
Who is responsible when third parties cause the delay?
Insurers often use loss adjusters, engineers, surveyors, solicitors, garages, builders and specialist investigators. The consumer may need to cooperate with those firms, but the regulated insurer remains responsible for the overall claim handling and cannot wash its hands of repeated inactivity by saying the delay belongs to a contractor.
If the delay arises because the consumer has not supplied reasonably requested information, that matters too. Keep a dated log showing what was requested, when it was provided and what the insurer said remained outstanding.
What remedy is realistic?
The immediate remedy is usually progress: a decision, inspection, report, payment, repair date or clear action plan. If delay has caused additional covered or foreseeable cost - for example prolonged alternative accommodation or storage - identify that separately and keep receipts.
Where poor handling has caused unnecessary distress, repeated chasing or serious practical disruption beyond the insured event, FOS can consider an award for distress and inconvenience as part of putting matters right.
Important exceptions and edge cases
Fraud investigations, police enquiries, complex liability questions and major-loss claims can reasonably take longer than routine claims. The right question is whether the work is necessary and progressing, not whether an arbitrary number of days has passed.
Do not refuse all further evidence requests simply because you are frustrated. Ask why the material is needed and propose a proportionate alternative if the request is excessive.
Common insurer responses - and what they do not necessarily prove
| The insurer says | What to test |
|---|---|
| "The claim is still under investigation." | Ask what investigation remains, who owns it and the target date for the next decision. |
| "We are waiting for our supplier." | The insurer remains responsible for its outsourced claim process. |
| "We need more information." | Ask what issue the information addresses and whether it has already been supplied. |
| "There is no fixed claims deadline." | True in general, but ICOBS still requires prompt and fair handling and appropriate progress information. |
Evidence worth keeping
Build the file around the issue the insurer actually has to decide. Preserve documents from the time of the claim rather than relying on memory later.
What to do
A practical next-step plan
- Ask for a written status and outstanding-action list.
- Map every evidence request to the issue it is supposed to answer.
- Escalate supplier/adjuster delay to the insurer.
- Document financial and practical impact of delay.
- Raise a formal complaint and use FOS if the firm does not resolve it.
What happens after you make a formal complaint?
The insurer or other regulated firm should acknowledge and investigate the complaint under the FCA complaint rules. For most ordinary insurance complaints it should send the required written response within eight weeks. Keep the complaint separate from day-to-day claim chasing: the claim can continue progressing while the complaint tests the decision or handling.
If you receive a final response and remain dissatisfied, check Financial Ombudsman eligibility immediately. FOS normally requires referral within six months of the date on a valid final response. Continuing to argue with the insurer does not safely stop that external clock, so diary it even if the firm says it is willing to look again.
Official sources
Check the current source material.
Insurance rules, policy wording and Financial Ombudsman approaches can change. Check the live source and the policy wording for the relevant policy year before relying on a formal deadline, exclusion or remedy.