How to win insurance claims

The very first thing to do when disaster strikes is to check that the loss caused by this particular mishap falls within the scope of your policy. So dig out your latest insurance documents and look through them carefully. Alas, you'll find that all insurance policies are riddled with loopholes and get-out clauses. Thus, to save frustration later, be sure to establish what isn't covered as well as what is.

To win at the claim game, you must play by the rules. If your insurer requires you to call its helpline to submit a claim, follow its orders. If you're instructed to submit a claim form by a certain deadline, be sure to do so. If you can't get these basics right, then you're in for a tough old time.

There's nothing that an insurance company hates more than fraud, alias "attempting to obtain pecuniary advantage by deception". In my time in the insurance world, I gave evidence that sent fraudulent claimants to prison – including a serving police officer! So, don't be tempted to exaggerate your claim by adding on a few bogus items or bumping up the value of your loss. If even a small part of your claim is shown to be false, then an insurer can reject your entire claim. Why risk losing thousands in order to claim a few extra quid?

Insurers like to gather as much information as they can before making a decision on your claim. One reason for this is that they are looking for grounds on which to reject payment. So be precise, thorough and comprehensive if you want to get paid. It's up to you to prove your claim is valid.

Insurance companies always make you jump through hoops before they pay up, because delaying payments significantly boosts their profits. Thus, given half a chance, an insurance company will let your claim drag on and on. So be sure to chase your insurer for payment at every suitable opportunity!

If your claim is sufficiently large (for example, your home has suffered severe flooding), then an insurance company may appoint a loss adjuster. This person is responsible for assessing the validity and size of claims and, in theory, is supposed to be impartial. However, as the saying goes, "he who pays the piper calls the tune", so don't expect a loss adjuster to be on your side. Indeed, if it's a large claim, it can pay dividends to appoint your own (expensive) loss adjuster.

The whole point of insurance is to return you to the same position that you were in before disaster struck. So, in a perfect world, you'd neither gain nor lose a single penny after a claim has been settled. However, thanks to policy excesses (agreed deductions from your claim), you normally end up worse off after the event. On the other hand, many home insurance policies offer 'new for old' cover – where older items are replaced with new substitutes – which is a bonus.

In my days in insurance, I learnt the saying "the squeakiest hinge gets the grease". In other words, the most persistent complainants usually get decent settlements. However, there is an art to protesting. For instance, a twelve-page letter with large sections in bold, underlined or brightly coloured type is sure to relegate your claim to the bottom of the pile!

Seriously, if you're unhappy with the service provided by your insurance company, then ask for a copy of its complaints procedure and then follow this to the letter. If you're still dissatisfied, then ask for a 'deadlock' letter and warn the firm that you intend to escalate your complaint to the Financial Ombudsman Service (FOS). A complaint to the FOS costs firms several hundred pounds but costs you nothing, so this may speed up resolution of your claim – as will a knowing mention of "TCF" (the Treating Customers Fairly rule enforced by the Financial Conduct Authority).

Finally, don't stay with an insurer that has treated you badly.