Aviva Insurance Claim Denied: How to Appeal Aviva UK Decisions

Aviva Insurance Claim Denied: How to Appeal Aviva UK Decisions

Aviva is the UK's largest insurance company by market share, offering life, health, motor, home, travel, and commercial insurance products. With millions of active policies, Aviva generates a significant volume of claim disputes each year. If Aviva has denied your insurance claim, this guide explains exactly how to appeal the decision, what evidence you need, and how to escalate to the Financial Ombudsman Service (FOS) if necessary.

About Aviva in the UK

Aviva plc is a FTSE 100-listed company headquartered in London. For insurance purposes, Aviva's UK operations are regulated by both the Prudential Regulation Authority (PRA) and the Financial Conduct Authority (FCA). Aviva's complaint handling obligations are governed by the FCA's DISP (Dispute Resolution: Complaints) sourcebook.

Aviva's main UK insurance products include:

• Life insurance (term life, critical illness, income protection)
• Private medical insurance (PMI)
• Home insurance (buildings and contents)
• Motor insurance
• Travel insurance
• Business insurance
• Aviva DigiCare+ (digital health products)

Common Aviva Denial Patterns by Product Type

Life Insurance (Term Life and Critical Illness)

Non-disclosure at application: Aviva's underwriting team reviews applications carefully. If a claim is made and Aviva discovers that a material health condition, lifestyle factor (such as smoking), or activity was not disclosed at application, it will deny or reduce the claim. The most commonly contested non-disclosures involve mental health history, prior surgeries, alcohol consumption, and hazardous hobbies.

Critical illness definition disputes: Aviva's critical illness products use ABI+ (Association of British Insurers enhanced) definitions for most conditions, but disputes still arise about whether a specific cancer, heart attack, or stroke meets the clinical threshold. Aviva may deny a critical illness claim if the diagnosis does not meet the degree of severity specified in the policy.

Income protection — occupation and incapacity tests: Income protection denials often involve disputes about whether the insured cannot perform their own occupation or any suited occupation, and disputes about the deferral period and actual incapacity level.

Private Medical Insurance (PMI)

Pre-existing conditions: Aviva PMI products often use "moratorium" underwriting, which excludes any condition for which symptoms were present or treatment was received in the five years before cover started. Claims relating to conditions that Aviva classifies as pre-existing under this definition are routinely denied.

Treatment not recognised or approved: Aviva maintains a list of recognised specialists and approved treatment facilities. Using a non-approved provider or treatment method can result in claim denial.

Limits exhausted: Aviva PMI policies have annual and per-treatment benefit limits. Exceeding these limits generates denial of the excess amount.

Psychiatric and mental health treatment: Mental health treatment limits are lower than physical health limits in many Aviva PMI policies, and denials for mental health treatment are common.

Home Insurance

Storm, flood, and subsidence disputes: Aviva frequently disputes whether damage was caused by a covered peril (storm, flood) or by pre-existing defects, gradual deterioration, or a non-covered event. Expert evidence — a surveyor or structural engineer's report — is often necessary to resolve these disputes.

Undisclosed property changes: If you carried out alterations to your property (such as converting a loft, adding an extension, or changing the property's use) without notifying Aviva, it may deny claims arising after the undisclosed change.

Valuation disputes in contents claims: Aviva may dispute the value of lost or damaged contents, particularly high-value items without documented proof of purchase or valuation.

Motor Insurance

Fraudulent or exaggerated claims: Aviva has a dedicated counter-fraud unit. Claims involving whiplash, low-speed collision injuries, or unexplained vehicle damage are subject to heightened scrutiny.

Policy condition breaches: Aviva may deny motor claims if the vehicle was being driven by an unlisted driver, used for a purpose not covered by the policy (for example, commercial use under a private policy), or if the driver was under the influence of alcohol or drugs.

Uninsured periods: If you previously had an uninsured period and it was not declared at application, Aviva may deny claims on non-disclosure grounds.

Step-by-Step: Appealing an Aviva Denial

Step 1: Request Aviva's Full Denial Reasons

If you have not received a detailed written explanation of the denial grounds, contact Aviva's claims department and request one. Under FCA ICOBS rules, Aviva must provide a clear explanation of any claim decision.

Step 2: Read Your Policy Documents

Identify the specific policy clause Aviva is relying on for the denial. Check whether the exclusion or condition cited is clearly worded and unambiguously applicable to your situation. Ambiguous policy wording is interpreted against Aviva under the contra proferentem principle.

Step 3: Gather Supporting Evidence

Compile evidence that directly addresses the denial grounds:

• Medical records and specialist reports (for life, PMI, and income protection disputes)
• Surveyor or engineer reports (for home insurance disputes)
• Photographs and estimates (for property and motor claims)
• Independent valuations (for high-value contents claims)
• Accident reconstruction or witness statements (for motor claims)

Step 4: Submit a Formal Complaint to Aviva

Aviva Complaints Contact:

• Online form: Available at aviva.co.uk/complaints
• Phone: 0800 051 6902 (general complaints line)
• Post: Customer Relations, Aviva, 2 Rougier Street, York, YO90 1UU

Under FCA DISP rules, Aviva must:

• Acknowledge your complaint within 5 business days
• Issue a Final Response within 8 weeks

Your complaint letter should reference the specific denial ground, cite the policy clause you believe entitles you to coverage, provide supporting evidence, and request an independent review.

ClaimBack at claimback.app generates professional, FCA-compliant appeal letters for Aviva UK disputes. The tool ensures your complaint is structured correctly and references the right regulatory framework for your specific Aviva product.

Step 5: Escalate to the Financial Ombudsman Service (FOS)

If Aviva's Final Response does not resolve your dispute:

FOS Contact:

• Website: financial-ombudsman.org.uk
• Phone: 0800 023 4567
• Award limit: Up to £430,000 (verify current limit on FOS website)
• Free for consumers
• File within 6 months of Aviva's Final Response

FOS data shows that Aviva is one of the most complained-about insurers in the UK, and FOS upholds a significant proportion of those complaints. FOS regularly overturns Aviva denials involving ambiguous pre-existing condition exclusions, unfair non-disclosure decisions, and disputed storm or flood damage claims.

Key Tips for Aviva Appeals

For moratorium PMI disputes: Obtain your full medical records for the 5-year pre-cover period and compare them carefully against the condition Aviva claims was pre-existing. Many moratorium disputes involve conditions that are not the same as, or causally connected to, the pre-cover history Aviva is relying on.

For non-disclosure disputes (life/CI): Check whether the non-disclosure is genuinely material to the risk Aviva agreed to insure. If a smoker failed to disclose occasional recreational drug use 10 years ago that has no connection to the current claim, the materiality argument is weak.

For storm/flood disputes: Independent surveyor reports from an RICS-qualified surveyor are almost essential for disputed property claims. Aviva's own loss adjuster is not neutral.

Conclusion

Aviva insurance denials are common but frequently overturned on appeal or at FOS. The key is a structured, evidence-based complaint that directly addresses Aviva's stated denial grounds. Use ClaimBack at claimback.app to generate a professionally formatted appeal letter, escalate to FOS if needed, and pursue your claim persistently until you achieve a fair outcome.