My insurance claim was denied — what can I do?
Last updated: 2026-07-11 · Educational content; not legal advice.
Short answer
A denial is not the final word — you can contest it. First get the denial in writing and the specific reason for it, because RA 10607 (the Amended Insurance Code) Section 247 prohibits insurers from denying or refusing to settle claims 'without just cause' and from unfair claim settlement practices. Reply in writing demanding the exact policy provision and facts the insurer relied on, and submit any missing proof of loss. If the insurer will not reconsider, you can bring the dispute to the Insurance Commission, which under RA 10607 Section 439 can adjudicate a single claim of up to ₱5,000,000. If the denial was unreasonable, the insurer can also be made to pay interest on the amount due (see Section 250).
Denials commonly cite concealment or misrepresentation, a policy exclusion, a lapsed premium, or 'insufficient proof.' Each has a legal answer. Concealment and misrepresentation only defeat a claim if the withheld or misstated fact was material (RA 10607 Sections 26–27 and 45) — and for a life policy in force two years, the incontestability clause (Section 48) bars most such defenses. Exclusions must be read against the whole policy, and ambiguities are construed against the insurer that drafted it. A 'proof' denial is often cured by resubmitting documents. Keep every letter, and note the dates: the clock for the insurer's duty to pay runs from your proof of loss.
Primary sources
Frequently asked
The insurer denied me verbally — is that enough?
Ask for the denial in writing, stating the exact policy provision and the facts relied on. A written denial pins down the ground so it cannot shift later, and you will need it if you escalate to the Insurance Commission. RA 10607 Section 247 treats a failure to promptly and reasonably explain the basis of a denial as an unfair claim settlement practice.
They say I concealed something on my application — can they deny me?
Only if the concealed or misstated fact was material. Under RA 10607 Sections 26–27, concealment entitles the insurer to rescind, and under Section 45 a representation that is false in a material point does too — but the fact must actually matter to the risk. And for a life policy that has been in force for two years, the incontestability clause (Section 48) generally bars the insurer from voiding the policy for fraudulent concealment or misrepresentation at all.
How much can the Insurance Commission decide?
Under RA 10607 Section 439, the Insurance Commissioner has authority to adjudicate a claim for any loss, damage, or liability under an insurance policy where the single claim does not exceed ₱5,000,000 (excluding interest, costs, and attorney's fees). Larger claims go to the regular courts, but the Commission's Public Assistance route can still mediate.
Can I get interest for the delay and denial?
Yes, if the refusal was unreasonable. RA 10607 Section 250 provides that an insurer's refusal or failure to pay a claim within the time prescribed makes it liable for interest on the proceeds at twice the ceiling prescribed by the Monetary Board for the duration of the delay, unless the refusal is based on the claim being fraudulent.
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Your rights as a policyholder or HMO member — what to do when an insurance claim is denied or delayed, how long an insurer has to pay a valid claim and the interest it owes for unreasonable delay (RA 10607, the Amended Insurance Code), the 2-year incontestability clause on life policies, HMO coverage and pre-existing-condition denials (now regulated by the Insurance Commission under EO 192 s.2015), what CTPL motor insurance covers and the no-fault indemnity, premium grace periods and lapsed policies, cash surrender value when you cancel, and how to file a complaint with the Insurance Commission.