6 Reasons for insurance claims rejection in Saudi Arabia

Insurance is considered one of the preventive measures individuals and institutions resort to in Saudi Arabia to mitigate the burdens resulting from unexpected accidents or losses. However, some insurance claims are rejected by insurance companies, prompting many to question the reasons for insurance claims rejection in Saudi Arabia that stand as a barrier between the insured and their rightful compensation.

From violating policy conditions, or failing to provide the necessary documents, to delays in reporting the incident—this article sheds light on the reasons for insurance claims rejection in Saudi Arabia, what the insured should do in such cases, and the steps for filing an official complaint against a car insurance company.

The article also addresses the reasons behind clients’ trust in Sarah Al-Mutairi Law Firm in such disputes, and how to contact the office to obtain legal advice and necessary support in insurance conflicts.

Reasons for insurance claims rejection in Saudi Arabia

The following points clarify the reasons for insurance claims rejection in Saudi Arabia:

1. Failure to provide the required documents
   The insurance company reserves the right to reject any claim if all required and accurate documents are not submitted.
2. Delays in premium payments
   In case of failure to pay premiums on time, the company has the right to suspend or reject insurance coverage for any claims arising during the delay period.
3. Damages excluded from insurance coverage
   The insurance policy does not cover damages that are explicitly excluded, such as damages resulting from wars or natural disasters.
4. Violation of the essential conditions of the policy
   These are cases where the policyholder commits explicit violations of the policy’s terms, such as driving without a valid license or using the vehicle for purposes not covered.
5. Filing the claim after the legal deadline
   The insured is required to file the claim within the time period specified in the insurance policy. The company has the right to reject any claim submitted after this deadline.
6. Delay in reporting the accident or claim
   The insured must notify the insurer of the accident or claim within the period specified in the policy. The company may reject the claim if the delay harms its interests, unless there is a valid excuse for the delay.

Policyholder rights when the claim is rejected

According to the provisions of the Cooperative Insurance Companies Control Law and the insurance regulations issued by the Saudi Central Bank (SAMA), the policyholder has the following rights in the event of a claim rejection:

Right to a written and reasoned notification

The insurance company is obligated to issue an official written notice detailing the reasons for insurance claims rejection in Saudi Arabia.

Right to view the documents supporting the rejection

The insured has the right to view all documents, technical reports, and evaluations used by the insurance company to reject the claim and to obtain a copy of them.

Right to appeal the rejection decision

The insured has the right to file a formal appeal, starting with the insurance company’s internal complaint channels or escalating the complaint to the “SAMA Care” platform of the Saudi Central Bank.

Right to resort to the judiciary

If no satisfactory solution is reached with the insurance company or the Saudi Central Bank, the insured has the right to file a lawsuit before the Committee for Insurance Disputes and Violations, or refer the matter to the general court.

What to do after an insurance claim is rejected?

After understanding the reasons for insurance claims rejection in Saudi Arabia, the insured may take the following steps:

• Review the rejection letter carefully and compare it with the policy terms to ensure:
  • The rejection aligns with the policy’s actual terms.
  • All required documents were submitted.
  • The claim was submitted within the specified time frame.
• Contact the claims officer at the insurance company and request a detailed written explanation of the rejection reasons. Document all communications and dates.
• File an appeal to the insurance company if the rejection is unjustified, including the following:
  • Policy number and date.
  • Detailed description of the rejected claim.
  • Reasons for the policyholder’s objection to the rejection decision.
  • All documents supporting the policyholder’s position.
• Contact the Insurance Authority
  If the insurance company does not respond to the policyholder’s appeal within 30 days, a complaint should be submitted to the Insurance Authority via its website, mobile app, or by visiting its headquarters in Riyadh.
• File a lawsuit
  If all other options fail, the insured may resort to the competent court within one year from the date of rejection, ensuring:
  • Submission of all evidence and correspondence with the insurance company and the Insurance Authority.
  • Preparation of a detailed legal claim.
  • Seeking assistance from a lawyer specialized in insurance disputes.

Filing a complaint against a car insurance company

After learning the reasons for insurance claims rejection in Saudi Arabia, one can file a complaint against a car insurance company by:

1. Visiting the official website of the Insurance Authority.
2. Clicking on the (E-Services) section.
3. Selecting (Individuals) services.
4. Choosing the (Complaints) service.
5. Clicking (New Complaint or Follow Up on a Complaint Against an Insurance Company).
6. Logging in via the National Unified Access platform.
7. Filling in the complaint form.
8. Uploading all required documents.
9. Confirming and submitting the complaint.
10. Saving the complaint number for follow-up.

Delay in insurance compensation

According to Article (46) of the Executive Regulations of the Cooperative Insurance Companies Control Law, insurance companies must pay the claim within:

• 15 working days for individuals
• 45 days for institutions
  from the date all required documents and information are received, unless there is a valid legal justification for the delay.

Insurance companies are also obligated to respond to any inquiries from the policyholder within one week of submission.

In cases of unjustified delays in disbursement, the following actions must be taken:

• Contact the insurance company for a written explanation of the delay.
• File a complaint via the “SAMA Care” platform, the official portal of the Saudi Central Bank for customer complaints against insurance companies.
• File a lawsuit before the competent judicial authorities.

The Saudi Insurance Authority

The Saudi Insurance Authority is the body responsible for regulating the insurance sector in Saudi Arabia. It was established by Cabinet Resolution No. (85) dated 18/02/1445H (corresponding to 03/09/2023), taking over supervisory functions from the Saudi Central Bank (SAMA).

It is tasked with receiving all reports and complaints related to insurance companies and was created to ensure consumer protection and effective dispute resolution.

Insurance Authority Contact Details

You can contact the Saudi Insurance Authority via:

• Phone: 8001240551
• Email: Info@ia.gov.sa
• Contact Form: (Contact Us) service on their website

Why do clients trust Sarah Al-Mutairi Law Firm in insurance disputes?

Our expertise in insurance disputes combines deep legal knowledge with practical professionalism in client representation. Client trust stems from:

• Specialized legal experience in insurance systems.
• Comprehensive services in preparing and auditing insurance documents for individuals and companies.
• A track record of successful insurance cases.
• Professional legal representation before regulatory and judicial bodies.
• Commitment to protecting client rights and securing their compensation.
• Full adherence to transparency and clarity in litigation procedures and expected outcomes.

How to contact Sarah Al-Mutairi Law Firm?

If you are suffering from delays, stalling, or unjustified reasons for insurance claims rejection in Saudi Arabia, or if you need precise legal advice on your policy, our team at Sarah Al-Mutairi Law Firm is ready to provide you with full support. Just contact us through the following channels:

• Mobile Number: 966503696000⁩ / 966133446000
• Email: info@sarah-lawfirm.sa
• Website: https://sarah-lawfirm.sa/

You can also reach us through our official page on Instagram and on the X platform

Conclusion

Understanding the reasons for insurance claims rejection in Saudi Arabia is the gateway to resolving many insurance disputes in the Kingdom. It is essential to review your policy carefully, be aware of the regulatory reasons for rejection or delay, and take the appropriate action on time, whether through complaint, appeal, or litigation.

At Sarah Al-Mutairi Law Firm, we believe that awareness of rights and adherence to legal procedures are key to resolving insurance disputes fairly and justly according to Saudi regulations. So always strive to know your rights—and defend them through the legal means available to you.

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