Insurance claims in Pakistan are declined for a narrower set of reasons than policyholders expect, and most of those reasons are arguable.

The mistake is accepting the rejection letter as final. There is a defined complaints structure, it costs little to use, and insurers settle a meaningful proportion of matters once a claim is properly pursued.

Start with the actual reason

Ask for the repudiation in writing, stating the specific policy clause or ground relied on. A verbal "it is not covered" is not a decision you can challenge.

The grounds that recur:

Non-disclosure or misstatement. The dominant reason for life and health declines — that something material was not disclosed when the policy was taken out. Frequently the alleged non-disclosure is a condition the proposer did not know about, did not consider material, or was never actually asked about in the form.

Pre-existing condition. In health cover, a claim attributed to a condition said to predate the policy.

Waiting period not expired.

Policy lapsed for non-payment of premium, sometimes where the insurer failed to give the notice the policy required, or where a grace period applied.

Exclusion relied on — and exclusions must be construed against the insurer where they are ambiguous.

Late notification, where the policy required prompt notice.

Breach of condition — in motor claims, commonly that the driver was unlicensed, the vehicle was used outside the permitted purpose, or the accident was not reported to the police.

Non-disclosure is more arguable than insurers suggest

Insurance is a contract of utmost good faith and material facts must be disclosed. But three points frequently help the policyholder:

Was it material? Not every omission is. The test concerns facts that would influence a prudent insurer's judgement, not everything a person's medical history contains.

Was it asked? Where the proposal form did not ask about the matter, an argument that it should have been volunteered is weaker.

Who filled in the form? In a great many Pakistani policies the proposal was completed by an agent, at speed, with the proposer signing. Where the agent recorded answers inaccurately, or never asked the questions, that is relevant — and the insurer's own agent's conduct is not simply the proposer's problem.

The routes available

Internal complaint to the insurer, in writing, addressing the stated ground directly and annexing evidence. A surprising number resolve here.

The Insurance Ombudsman, which handles complaints against insurers from policyholders. Accessible, does not require you to fund litigation, and designed for exactly this.

The SECP, which regulates insurers and can act on conduct, including handling of claims.

The tribunal or court route provided under the Insurance Ordinance 2000 for insurance disputes, including small dispute mechanisms for lower-value claims.

Civil suit, for larger claims, with the ordinary cost and time that involves.

Note the deadlines applicable to each route, and note that pursuing one does not always preserve time for another. Take advice on sequencing before you commit.

The evidence that decides it

Assemble, and keep:

  • The policy document and schedule — the full wording, not the brochure
  • The proposal form you signed. Request a copy; what it actually asked matters
  • Premium payment records, proving the policy was in force
  • The claim form and everything submitted
  • The repudiation letter
  • Medical records in life and health claims — and the insurer's basis for saying a condition pre-existed
  • The FIR, survey report and estimates in motor claims. See after a road accident in Pakistan
  • All correspondence, including WhatsApp exchanges with the agent

Motor and marine claims

Motor. Comply with the notification period, do not begin repairs before the survey, and do not admit liability at the scene. Where the insurer relies on a breach of condition, examine whether the breach actually caused the loss.

Marine cargo. Different regime and much shorter practical timescales — the survey at discharge is decisive, and there is a separate time bar against the carrier running in parallel. See cargo claims for importers.

For businesses

Two things worth doing before a claim ever arises.

Read the policy when you buy it, not when you claim. Check the exclusions, the notification period, and any condition precedent to liability.

Disclose properly at inception and at renewal. Non-disclosure at renewal is a common and avoidable route to a declined claim.

Practical advice

Get the ground of rejection in writing. Do not sign a discharge voucher or accept a part payment "in full and final settlement" without advice — that is frequently what ends an otherwise good claim. Complain in writing, addressing the stated ground specifically. Keep every deadline.

And do not assume the first answer is the final one. It very often is not.

How the firm can help

We review policies and repudiations, advise candidly on whether a decline is defensible, and pursue claims through internal complaint, the Insurance Ombudsman, the SECP and the courts.

We also advise businesses on policy wordings before purchase and on disclosure at inception and renewal — which is where most declined claims are actually caused.

If a claim has been rejected, contact the firm with the policy, the proposal form and the rejection letter. Those three documents usually settle whether there is a case.