Disputes and complaints between policyholders and insurance companies are common in Nigeria’s evolving insurance landscape. These conflicts often arise from misunderstandings, unmet expectations, or misinterpretation of policy terms.

It is crucial for policyholders to understand the proper steps to resolve these issues effectively. This guide outlines strategies to handle insurance disputes and complaints, ensuring a smoother process toward resolution.

Common Causes of Insurance Disputes

Insurance disputes can occur for several reasons, including:

• Claim Denials: When an insurance company denies a claim, citing reasons such as non-disclosure, policy exclusions, or missed deadlines, it can cause significant frustration.
• Delayed Settlements: Delays in processing claims or payouts can be a source of complaints, especially when policyholders depend on timely settlements for emergencies.
• Disagreements Over Coverage: Differences in interpretation of policy language may lead to disputes over what is covered and what is not.
• Policy Cancellations: In some cases, an insurer may cancel or refuse to renew a policy, triggering a complaint from the policyholder.
• Premium Increases: Unexpected or unexplained increases in insurance premiums can also lead to disputes.

Also read:
Understanding the Difference between Insurance Brokers and Agents
Legal Aspects of Insurance Claims: A Guide for Policyholders
Comparative Analysis of Insurance Products in Nigeria
Evaluating Insurance Providers: What to Look for in an Insurer

Steps to Effectively Handle Insurance Disputes and Complaints

1. Review Your Policy
Before raising a complaint, it is essential to thoroughly review the terms and conditions of your insurance policy. Understanding what is covered, what exclusions apply, and the insurer’s responsibilities will help you assess the validity of your complaint. Pay close attention to policy clauses regarding claim processes, coverage limits, and applicable deadlines.

2. Gather Relevant Documentation
Organize all necessary documentation related to your claim or dispute. This includes:

• The insurance policy itself
• Copies of any correspondence with the insurer
• Claim forms and any receipts or estimates submitted
• Medical reports, repair quotes, or any other documents supporting your claim

Having this information on hand will be crucial when discussing the issue with your insurer and if the dispute escalates to higher authorities.

3. Contact Your Insurer
Begin by reaching out to your insurance provider’s customer service or claims department. Clearly state your issue, referencing your policy number and any claim documentation. It’s important to remain calm, concise, and professional during this communication. Insurers often have dedicated channels for resolving disputes and may resolve the issue at this stage.

4. Escalate to a Supervisor or Manager
If the initial contact does not yield a satisfactory resolution, escalate the complaint to a supervisor or a more senior member of staff. This step may involve submitting a formal written complaint through the insurer’s designated process. Ensure your complaint includes:

• A clear description of the dispute
• Any evidence or documentation supporting your case
• What outcome you expect from the insurer

Insurers typically have a specific time frame within which they must respond to formal complaints.

5. Involve an Independent Expert
If there is a disagreement over the technical aspects of your claim, such as medical assessments or repair costs, you may wish to seek a second opinion from an independent expert. Their report can be used to support your case when dealing with the insurer.

6. Approach the National Insurance Commission (NAICOM)
In Nigeria, if your dispute remains unresolved after following the insurer’s internal processes, you can escalate the issue to the National Insurance Commission (NAICOM). NAICOM serves as the industry regulator and has a dedicated unit for handling complaints and disputes between policyholders and insurers.

To file a complaint with NAICOM, you’ll need to:

• Submit a formal complaint in writing
• Attach all relevant documentation, including the insurer’s response to your complaint
• Be clear about the resolution you are seeking

NAICOM will investigate the matter and mediate between you and the insurer to resolve the issue.

7. Consider Arbitration or Legal Action
In cases where NAICOM is unable to resolve the dispute, you may consider arbitration or legal action. Arbitration is a more cost-effective and quicker alternative to litigation, where a neutral third party makes a binding decision. If arbitration is not an option or fails to bring about a satisfactory resolution, you may proceed with legal action through the courts. However, this should be considered a last resort due to the costs and time involved.

8. Preventing Future Disputes

• Read and Understand Your Policy
• Maintain Proper Documentation
• Promptly Report Claims
• Disclose All Relevant Information

9. Tips for Effective Dispute Resolution

• – Stay calm and objective
• Be clear and concise in communication
• Provide supporting documentation
• Be open to negotiation
• Seek professional advice (if necessary)

Handling insurance disputes and complaints effectively requires a structured approach. By following these steps and considering alternative dispute resolution methods, policyholders can resolve disputes efficiently and maintain trust in the insurance industry.

Transparent Protection Ltd encourages policyholders to stay informed about their policies and leverage additional resources, as provided below.

Additional Resources

For further guidance, contact:

• National Insurance Commission (NAICOM)
• Nigerian Insurers Association (NIA)
• Transparent Protection Ltd (TPL)