My insurer refuses to pay my claim — who decides?
A refusal must be in writing, with the policy clause it relies on. Ask for exactly that first, then complain to the insurer's complaints department — they have a legal deadline to answer. When they uphold the refusal, Kancelář ombudsmana České asociace pojišťoven / ČOI (ADR) (246 090 090) — the insurance ombudsman for Czechia — reviews the file for free and insurers follow the outcome in the vast majority of cases. Česká národní banka — ochrana spotřebitele (224 411 111) supervises insurers and takes complaints about practices; Česká obchodní inspekce (ČOI) (222 703 404) helps with unfair small print.
🗣️ What to say
"I make a formal complaint about the refusal of claim [number] dated [date]. Please state the exact policy clause you rely on and the facts you base it on. In my view the loss is covered because [reason]. I ask for a decision within the legal deadline."
🪜 Step by step
- Get the reason in writingClause number and facts. Vague refusals ("not covered") do not survive an ombudsman.
- Read the clause yourselfExclusions must be clear and were shown to you before you signed; ambiguous terms are read in your favour.
- Complain to the insurerFormal, dated, with your evidence: photos, reports, receipts, the police report if any.
- Escalate to Kancelář ombudsmana České asociace pojišťoven / ČOI (ADR)Free, written, usually a few months. Attach the whole file. Binding or followed in nearly all cases.
- Unfair terms or practice: Česká národní banka — ochrana spotřebitele, Česká obchodní inspekce (ČOI)The regulator for systematic behaviour; the consumer body for unfair small print.
📇 All contacts
❓ Frequently asked
They say I was late reporting
Late notification only allows refusal if it actually prejudiced them and you were at fault. Explain the delay and ask them to show the prejudice.
Can they cancel my policy after a claim?
Only with notice and never retroactively for the claim you made. Cancellation for "risk" cannot be used to escape a valid claim.
The travel insurer refers me to the airline, the airline to the insurer
Claim from both in writing; the one whose refusal is unjustified goes to the ombudsman. Airline compensation under EU 261 is separate from insurance.
📎 Sources
- Kancelář ombudsmana České asociace pojišťoven / ČOI (ADR) →
- Česká národní banka — ochrana spotřebitele →
- Česká obchodní inspekce (ČOI) →
- Česká advokátní komora — bezplatná právní pomoc / Občanské poradny →
🔎 Common searches
Recognise your own search? The answer above covers all of these.
- “insurer refuses claim what to do Czechia”
- “insurance ombudsman Czechia”
- “insurance complaint procedure deadline”
- “insurer rejected claim exclusion”
- “travel insurance claim refused”
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