They said no to your health claim.
A refusal is not a second opinion.
Private medical claims are refused over pre-existing conditions, "not medically necessary" rulings, and disputes about approved hospitals and consultants. Your consultant’s evidence usually carries more weight than an insurer’s internal guideline.
Who's behind thisSteve Smart Helped people recover £25M+ from rejected claims
“Your claim relates to a pre-existing medical condition which was not declared when the policy was purchased.”“You failed to disclose a material fact. We have therefore avoided your policy from inception and returned your premium.”“You did not notify us of the incident within the timescale set out in your policy.”
Insurers refuse thousands of claims every week
Don't let this happen to you.
Which? confirm a number of leading insurers don’t follow the rules that are there to help you, and that their small print is unfair and lacks transparency. smarterclaims explains the arguments you need to overcome their excuse — and writes the letter you need to fight back.
Source: Which? consumer research, cited in its 2025 super-complaint to the FCA
The reasons they give
Refusals rest on a small number of standard arguments. Each one has a name, a meaning, and a known answer. Find yours.
Your claim relates to a pre-existing medical condition which was not declared when the policy was purchased.
Read the counter-argument →You failed to disclose a material fact. We have therefore avoided your policy from inception and returned your premium.
Read the counter-argument →You did not notify us of the incident within the timescale set out in your policy.
Read the counter-argument →How it works
Describe in plain English what happened and your current concern. Takes 60 seconds. We'll give you clear guidance on whether we can help and what to do next - completely free. You can start right now, even if you don't have your refusal letter with you.
Drop your refusal letter and insurance policy. Takes 2 minutes. No account needed.
Our system identifies the legal flaws in the refusal and writes a professional rebuttal with citations.
Send the letter to your insurer. Most reverse their decision. If not, escalate to the Ombudsman.
Start free. Pay only if we can help you win.
A small one-off fixed fee - not a lawyer's hourly bill.
Questions
The most common reasons are a pre-existing condition the insurer says was not covered, treatment declared "not medically necessary", non-disclosure when the policy was set up, and disputes over whether the hospital or consultant was approved.
Most of these turn on evidence and definitions rather than on a flat "no", which is exactly why they are worth challenging.
They can take that position, but it is an opinion — usually formed against an internal guideline — and it can be challenged with clinical evidence.
Your treating consultant’s reasoned view on why the treatment was necessary carries real weight, and it frequently contradicts a general guideline that never saw your case.
It depends on what you were actually asked and how the policy defines a pre-existing condition. A moratorium policy and a fully-underwritten one treat your history very differently.
If the condition was undiagnosed, unrelated to your claim, or never clearly asked about, there is something to argue. Our pre-existing condition page sets out how.
Usually not. Complaining to the insurer and then going to the Financial Ombudsman is free, and the Ombudsman handles medical-necessity and pre-existing-condition disputes routinely.
A well-argued letter with your consultant’s evidence attached is often what moves it. If your case genuinely needs representation, we will tell you.
No. smarterclaims publishes legal information and writes letters you can send yourself — like a digital version of a published legal guide. We are not a law firm and we do not give advice.
If your case needs professional representation, we will tell you, and we can introduce you to the right people if you ask us to.
Checking whether you have a case is free. You see the analysis and the arguments before you pay anything.
The rebuttal letter is £49.99. It comes with an explanation of where you stand and a step-by-step plan.
There is a no-questions-asked money-back guarantee. If the pack is not useful, tell us within 14 days and we refund you in full.
It should not, and firms are required to handle complaints fairly. Insurers deal with complaints as routine business — a well-argued letter tends to be taken more seriously than an angry phone call, not less.
Free tool | Before anything goes wrong
Still haven't filed a claim?
Completely free. Get ahead of a refusal before it ever happens — check your cover for the gaps insurers rely on, so you can avoid the pitfalls and traps. No charge, no account.
Policy check
See where your cover falls short — before you ever need to use it.
Meet Steve Who's behind this
Forty years inside the insurance industry, in both senior legal and commercial roles. Former UK General Counsel at AIG. Current Chairman of Lancashire Insurance UK. Regular voice on LBC radio. Steve has watched the same disputes come up again and again — and built the library of arguments that smarterclaims runs on, based on his decades of experience.
“I've spent forty years on the inside of insurance. The same excuses come up again and again, and most consumers don't know how to overcome them. This is the tool I wish my clients had before they called me.”Steve SmartMore about Steve
Real people, real results
“After being injured in action, my military insurer tried to argue that my injuries weren't permanent — so they'd pay me only a small percentage of the policy limit. Steve identified several arguments to challenge their refusal, and they ended up paying me virtually the full policy limit.”
“After a major house fire destroyed our contents, our insurer said we were under-insured — and that they'd only pay a fraction of our claim. Your know-how helped us overcome their excuse and get everything we were asking for.”
“Following a house fire, my insurer's loss adjuster argued that a lot of the damage was excluded. Steve identified the arguments to make, and they ended up paying our claim in full.”
“When my husband's physiotherapy practice was forced to close temporarily due to a virus, our insurer said it wasn't on their list of diseases and wouldn't pay anything towards our loss of earnings. The arguments you came up with convinced them to pay up.”
“After a car crash that wasn't my fault, the insurer tried to write off my car for far less than it was worth. You guided me through exactly what I had to do and say — everything was clear and easy to understand, and I got the full amount I was owed.”
Real clients we have helped, shared with their written permission.
Claim smarter.
Describe what happened. We'll do the reading. You'll have the rebuttal in minutes.
Keep reading on health insurance claims.
Free cheatsheetThe UK Consumer Insurance Claim Rejection CheatsheetOpen the cheatsheet →