Overview
Insurance policies typically contain exclusion clauses defining cases coverage doesn't extend to, and these clauses may not be read carefully at the time of contracting, only becoming relevant when the insurer denies a claim based on them.
We review the policy before contracting to confirm the coverage actually suits the risks the company faces, not a generic policy that may not cover its specific risks.
Regulatory Basis
Insurance activity falls under Saudi Central Bank regulations overseeing the insurance sector, which govern insurance company operations and policyholder rights.
How We Handle Insurance Claims
We begin by carefully reviewing the policy and its terms to determine the extent coverage applies to the claimed incident.
If the insurer denies or reduces the claim, we review the reasons for denial and assess the company's position before negotiating or escalating to a formal process.
Who Needs This Service
A company contracting for a new insurance policy that needs it reviewed to confirm adequate coverage for its actual risks.
A company filing an insurance claim that's denied or reduced by the insurer and needs their regulatory position assessed regarding this denial.
Insurance policies for industrial facilities in the Eastern Province specifically need a careful review of exclusion clauses related to operational incidents, since these clauses differ from general commercial insurance policies and may exclude certain types of incidents that the insurer considers ordinary operational risk not covered under the base policy.
Additional Considerations
When insurance is tied to a real estate asset or factory, this connects with our real estate and property law service to confirm coverage matches the asset's actual value and risk.
If a claim denial escalates into a formal dispute, we coordinate with our litigation and advocacy team to assess chances of success before any full escalation.
Common Questions
Why do insurance companies deny some claims?
Often based on an exclusion clause in the policy that wasn't read carefully at contracting, and we review these clauses to assess the validity of denial grounds.
Can we negotiate with the insurer after a claim denial?
Yes, we handle this negotiation on the company's behalf, while assessing the possibility of escalating to a formal process if direct negotiation doesn't succeed.