A claim can be handled exactly according to the written policy and still produce a valid complaint if the policy was sold or described wrongly. Separate a sales complaint from the later claim decision.
The key questions are who sold or advised on the insurance, what you told them you needed, what they said the policy would do, what important exclusions or limits were disclosed, and what you would reasonably have done with correct information.
Key points
- An insurer, broker, bank, retailer or other intermediary can have different responsibilities in the sale.
- A non-advised sale is not the same as an advised recommendation, but information still needs to be clear, fair and not misleading.
- A failed claim does not automatically prove the policy was mis-sold; compare what was promised with what was actually provided.
- Keep the sales journey, demands/needs statement, product information, call recordings and comparison-site wording.
Diagnosis
First: what exactly went wrong?
| What happened? | What to check first |
|---|---|
| You were told a risk was covered but the claim was rejected | Preserve the sales representation and compare it with the exclusion/limit now relied on. |
| A broker recommended a policy that does not meet your stated needs | Check whether the sale was advised and the recorded demands and needs. |
| A comparison site description differed from the policy | Identify which business supplied the description and what the full journey showed before purchase. |
| An optional add-on or insurance product was added unexpectedly | Check consent, price disclosure and whether the product was presented as optional. |
| You bought the cheapest policy but assumed broader cover | Mis-selling is not established by disappointment alone; identify the inaccurate or missing information. |
Who is responsible?
The underwriting insurer is responsible for the policy and claim. A broker or intermediary can separately be responsible for its advice, recommendation, demands-and-needs assessment or misleading description. Banks, retailers and comparison sites can also have regulated responsibilities depending on the role they actually performed.
Ask for the legal entity and role of each firm. This prevents a common loop where the insurer says the broker sold it, while the broker says only the insurer controls the wording.
Advised and non-advised sales
Where a firm actually recommends a policy, the suitability/advice issues can be more significant. In a non-advised sale, the consumer chooses, but the product information and demands-and-needs process still matter. Do not describe every sale as "advice" if no recommendation was made.
What did you tell the seller you needed?
Preserve emails, chat transcripts, call recordings and application answers showing the risks you described. If you expressly asked for cover for a particular situation and were told the policy provided it, that evidence can be central when the written policy later excludes it.
Significant exclusions and limitations
A sales complaint is stronger where a material limitation was inconsistent with how the product was presented or where the seller failed to explain a significant restriction relevant to the consumer's stated needs. The complaint should identify the specific limitation and why it mattered to the purchase decision.
Comparison sites
Comparison sites simplify complex products into filters and summaries. Treat the comparison result as part of the evidence, not the entire contract. Save screenshots showing the filter used and the feature represented, then compare the final insurer documentation. If the summary was wrong, identify which firm generated it and how it affected the purchase.
Optional add-ons and bundled insurance
Breakdown cover, legal expenses, gadget cover, excess protection and other add-ons can be sold alongside a main policy. Check whether the price and optional nature were clear and whether consent was obtained. A complaint can be about the add-on sale even where the main policy is fine.
What remedy is realistic?
The aim is usually to put you in the position you would have been in if the sale had been handled correctly. Depending on the facts, that can mean refunding premiums, paying the difference between the unsuitable and suitable position, honouring a represented benefit, or compensating a direct loss caused by relying on the misrepresentation.
The remedy is fact-sensitive. It is not automatically a full refund simply because one claim was declined.
Common business responses - and what they do not necessarily prove
| The business says | What to test |
|---|---|
| "You should have read the policy." | Reading duties do not automatically cure misleading advice or a material representation made during the sale. |
| "We did not advise you." | Then focus on whether the factual information, demands/needs process and product presentation were accurate and clear. |
| "The insurer wrote the policy, not us." | The broker can still be responsible for its own recommendation or description. |
| "The comparison site was only a guide." | Check what feature was represented and whether that representation materially influenced the purchase. |
Evidence worth keeping
What to do
A practical next-step plan
- Identify who sold/advised on the policy and what role they performed.
- Write down the need you expressed and the representation/recommendation you relied on.
- Compare that with the actual exclusion or limitation that caused the loss.
- State what you would have done with correct information and quantify the resulting loss.
- Complain to the responsible regulated firm and then FOS if unresolved and eligible.
What happens after you make a formal complaint?
The insurer or other regulated firm should acknowledge and investigate the complaint under the FCA complaint rules. For most ordinary insurance complaints it should send the required written response within eight weeks. Keep the complaint separate from day-to-day claim chasing: the claim can continue progressing while the complaint tests the decision or handling.
If you receive a final response and remain dissatisfied, check Financial Ombudsman eligibility immediately. FOS normally requires referral within six months of the date on a valid final response. Continuing to argue with the insurer does not safely stop that external clock, so diary it even if the firm says it is willing to look again.
Official sources
Check the current source material.
The exact sales rules depend on the product, distributor, date and whether advice was given. Check the live source and the documents from the actual sale.