Insurance Claims in the UAE: What to Check When an Insurer Rejects or Reduces a Claim

Insurance disputes often turn on policy wording, exclusions, evidence and claim procedure, making early legal review important before a rejection is accepted or challenged.

Insurance disputes are often decided long before a formal complaint is filed. The policy wording, information given when cover was arranged, the documents submitted with the claim and the insurer's written reasons for rejection can all shape the outcome. A claim that appears straightforward commercially may still turn on an exclusion, a notification requirement, a limit of cover or disagreement over whether the insured event actually falls within the policy.

The current federal framework is Federal Decree-Law No. 6 of 2025 regarding the Central Bank, Regulation of Financial Institutions and Activities, and Insurance Business. It has been in force since 16 September 2025 and replaced the separate 2023 insurance law. The Central Bank now regulates insurance companies and insurance-related professions within this consolidated framework.

Start With the Policy, Not the Claim Amount

The first legal question is what the policy actually covers. Insurance contracts usually contain the insured risks, exclusions, limits, deductibles, notification duties and conditions that apply when a loss occurs. The description of the insured property, activity or person also matters because a dispute can arise where the risk described when insurance was arranged differs from the risk that later produced the claim.

An insurance lawyer in Dubai should therefore review the complete policy and its endorsements before assessing whether a rejection is justified. Policy schedules, proposal forms, renewal documents and broker correspondence can be as important as the main wording. The legal issue is not simply whether a loss occurred, but whether that loss falls within the cover purchased and whether any exclusion or condition is being applied correctly.

Test the Rejection Against the Insurer's Written Reasons

Under Article 148 of Federal Decree-Law No. 6 of 2025, insurance companies must process customer complaints and claims according to their contractual terms and applicable legislation. If a claim or complaint is rejected in whole or in part, the insurer must state the reasons for its decision in writing.

That explanation should be compared carefully with the policy, claim documents and surrounding facts. A reference to an exclusion does not by itself settle the dispute. An insurance dispute lawyer in Dubai may need to examine whether the exclusion actually applies, whether the policy wording has been interpreted correctly and whether the facts relied upon by the insurer are supported by the available evidence.

Evidence Can Decide Property, Motor and Business Claims

Insurance claims can involve substantial documentation. Property damage may require photographs, repair estimates, invoices, expert reports and evidence of ownership. Business interruption claims may depend on accounts, turnover records and proof of the period of disruption. Motor or liability matters can involve police records, repair reports, medical material and evidence about responsibility for the incident.

A well-organised claim file is therefore important from the beginning. Businesses should preserve correspondence, damaged-property records, financial documents and relevant reports rather than trying to reconstruct the evidence months later. Lawyers in Dubai handling an insurance dispute should also identify any notification deadlines, information requests or cooperation requirements contained in the policy.

The Broker's Role May Need Separate Review

Where insurance was arranged through a broker, the broker's conduct may also become relevant. The Central Bank's Insurance Brokers' Regulation, effective from 15 February 2025, requires brokers to act honestly, fairly and transparently. Brokers must act in the client's best interests when comparing products and explain the conditions, benefits and exclusions of the policies they recommend.

This does not mean every rejected claim creates liability for the broker. The facts need to show what information the client provided, what advice was given and whether the coverage problem arose from the insurer's decision, the broker's conduct or an obligation of the insured. Advocates and legal consultants in Dubai should separate these issues before deciding which party's conduct needs to be challenged.

Know the Complaint Route Before Starting Court Proceedings

Insurance disputes have a specialised escalation process. Article 148 of the current law provides for an independent complaints unit and committees dealing with disputes involving banks and insurance companies. It also states that claims arising from insurance contracts, insurance business and services will not be accepted unless the dispute has first been presented to the relevant committees.

Sanadak currently operates this complaints framework. For eligible natural persons, sole proprietors and SMEs, an official complaint generally needs to be submitted to the insurance company first. Sanadak's current eligibility process generally requires 15 calendar days to have elapsed after the complaint, with either no written response or an unsatisfactory response, and the matter must not already be before a court. Insurance disputes can then proceed through the applicable Sanadak and Insurance Dispute Resolution Committee process.

Health Insurance Claims Require the Same Careful Review

Health insurance disputes can involve rejected treatment, exclusions, medical necessity, network restrictions, pre-authorisation requirements or disagreement about the scope of cover. A health insurance dispute lawyer in Dubai should begin with the policy, medical records, approvals, claim correspondence and the insurer's precise reason for refusing or reducing the claim.

A treatment being medically required does not, by itself, answer every insurance coverage question. The policy terms, regulatory requirements and circumstances of the treatment still need to be considered. Likewise, a rejection should not automatically be assumed correct simply because the insurer has referred to an exclusion.

A Claim Should Be Assessed Before It Becomes a Dispute

The strongest time to review an insurance problem is often immediately after a reservation, request for further information or rejection is received. At that stage, missing evidence can still be gathered and the insurer's reasoning can be addressed before positions become fixed.

Conclusion

The best legal companies approach insurance cases by identifying the precise coverage issue, relevant evidence and proper dispute route first. Clients comparing top law firms in Dubai for insurance matters should expect the same discipline. The aim is not merely to challenge a rejection, but to determine whether the claim has a proper contractual and legal basis and then pursue the appropriate remedy.

AY Advocates advises policyholders and businesses on insurance claims, coverage disputes, rejected claims and related proceedings in the UAE. The firm can assist with reviewing policy wording, assessing an insurer's reasons for rejection, organising evidence and determining the appropriate route for challenging a disputed claim.

If an insurance claim has been rejected, reduced or delayed, contact AY Advocates for a legal assessment of the policy and available options before taking further action.

Frequently Asked Questions

1. Must an insurer explain why it rejected an insurance claim?

Yes. Under the current federal framework, an insurance company rejecting a complaint or claim in whole or in part must state the reasons for its decision in writing.

2. Does an insurer's reference to a policy exclusion automatically mean the claim is not covered?

No. The wording of the exclusion, the circumstances of the loss and the rest of the policy should be reviewed before determining whether the exclusion actually applies.

3. Can an insurance dispute be taken directly to court?

Not necessarily. The current federal law requires disputes arising from insurance contracts, insurance business and services to be presented through the relevant specialised committee mechanism before the claim is accepted through the ordinary court route.

4. Does a policyholder need to complain to the insurer before approaching Sanadak?

Yes, where the Sanadak process applies. The complainant should first submit an official complaint to the insurance company. Current eligibility requirements generally require 15 calendar days to have passed with no satisfactory resolution before escalation.

5. Can an insurance broker be responsible for problems with insurance coverage?

Potentially, depending on the facts. The broker's advice, the information provided by the client and the regulatory duties owed by the broker should be examined separately from the insurer's handling of the claim.

6. Can a health insurance claim be challenged after treatment is refused?

Yes. Whether the challenge has merit depends on the policy terms, medical evidence, approvals, exclusions, regulatory requirements and the reason given for refusing the treatment or claim.