i need to know if an insurance companies' claim denial can be overturned

Question

Seeking legal counsel to challenge a wrongful insurance denial by General Accident for our stolen vehicle. The insurer denied the claim, asserting the policyholder—my mother—lacks "insurable interest." This decision, upheld by the FSC, is based on a decontextualized phrase from my statement: "the vehicle was really mine." This ignores the full context. The car was purchased with my funds but was legally titled, registered, and insured in my mother’s name for administrative convenience, a common family arrangement. It served as a bona fide shared family asset, not a personal vehicle. My mother used it extensively for her professional work as a NERHA Traveling Officer, my father used it for his farm, and my use was for commuting. Most critically, when the policy was initiated, my mother explicitly disclosed to the agent that she would not be the primary driver. The agent assured her that coverage was valid for any driver with her permission. The insurer collected premiums for years based on this disclosed usage, and is now acting in bad faith by re-interpreting a single phrase to avoid a legitimate claim. This constitutes a clear breach of contract. We have exhausted the FSC process and require legal assistance to pursue this matter.

Archer, Cummings &amp; Co., Attorneys-at-Law · Accepted Answer

You did the right thing by taking the matter to the Financial Services Commission (FSC), as that is the regulator responsible for reviewing complaints against insurers.

Now that the FSC has completed its investigation and issued its position, you should know that the FSC’s role is mainly regulatory and supervisory. They cannot force the insurance company to pay you; their function is to ensure the insurer followed proper procedures. Once the FSC has finished its review, your remaining option is usually to take the matter outside of the FSC process.

In most insurance policies, disputes like this must be resolved through arbitration first. This is a formal process where an independent arbitrator reviews the claim and makes a binding decision. You should check your policy wording , many Jamaican insurance policies contain a clause stating that disputes must go to arbitration before you can consider any other legal action. If legal action is commenced without first attempting arbitration, the claim can be struck out upon an appication from the insurer.

At this stage, since the regulator has already dealt with the complaint, your next and only real avenue is to proceed to arbitration, provided your policy has an arbitration clause (which most do). An attorney can help you review the policy language and guide you through filing the arbitration request and law suit, if necessary.

i need to know if an insurance companies' claim denial can be overturned

คำตอบจากทนายความ

Archer, Cummings & Co., Attorneys-at-Law

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