Quick answer

An insurance claim is a formal request for payment, reimbursement, repair or another covered benefit after an event that may be insured under a policy. The insurer reviews the event, policy coverage, evidence, limits, exclusions and any applicable excess before deciding the claim. A claim is not automatically payable simply because a loss occurred; the loss must fall within the policy terms.

How does an insurance claim start?

The policyholder, insured person or eligible beneficiary notifies the insurer of an event that may give rise to a claim and provides the information required by the relevant policy and claims process. Depending on the type of insurance, that can involve a claim form, police or accident report, medical documents, invoices, photographs, proof of ownership or other supporting evidence.

CBUAE insurance rules require insurers to establish claims-processing mechanisms, define the documents required for examination and settlement, and make claim forms available free of charge to the insured or beneficiary.

What does the insurer assess?

The insurer considers whether the event falls within the policy period and coverage, whether any exclusion applies, whether policy conditions have been met, the amount of the covered loss, applicable policy limits and the deductible or excess that the customer must bear.

The outcome can be a payment, reimbursement, repair or another policy benefit, depending on the class of insurance and contract.

Claim acceptance, settlement and rejection

CBUAE claims rules require claims to be settled without undue delay in accordance with the law and policy terms. For the UAE unified motor insurance framework, accepted financial compensation claims are subject to specific settlement requirements after completed claim documents are received, and a rejected claim must be accompanied by written reasons and supporting documents.

Do not apply a motor-insurance deadline to every other insurance class. Health, property, travel, life and other products can have different claims procedures and service standards.

How does the excess affect a claim?

If a policy has a deductible or excess, the insured bears that amount or share of an eligible claim as set out in the policy. The insurer then applies the policy terms to the remaining covered amount.

For example, if a covered repair is AED 4,000 and a hypothetical AED 500 excess applies, the simple starting point for the insurer-funded portion would be AED 3,500 before any other policy conditions or limits.

What should you do after a loss?

Take reasonable steps required by the policy to limit further loss or damage.
Notify the relevant official authority where required, such as police for specified motor accidents or theft.
Notify the insurer within the timeframe and channel stated in the policy.
Keep claim reference numbers, forms, invoices, reports and correspondence.
Do not assume a repair, replacement or treatment is covered before checking pre-authorisation requirements where applicable.
Read any settlement offer or rejection reason carefully before accepting or escalating it.

What if you disagree with the insurer?

First use the insurer’s formal complaint process and keep a record of the complaint and response. Sanadak handles eligible complaints against insurance companies licensed by the Central Bank of the UAE. Its current eligibility process requires, among other conditions, that the consumer first file an official complaint with the insurer and that 15 calendar days have elapsed with no written response or the consumer is dissatisfied with the response.

Eligibility conditions can change, so consumers should check Sanadak’s current website rather than relying on an old checklist.

Frequently asked questions

Does filing a claim mean the insurer must pay it?

No. The insurer must assess the claim against the policy coverage, evidence, limits, exclusions and conditions.

What documents do I need for an insurance claim?

It depends on the policy and event. The insurer should specify the documents required for examination and settlement. Common examples include claim forms, invoices, medical records, photographs and official reports.

What is claim settlement?

Claim settlement is the insurer’s completion of an accepted claim through payment, reimbursement, repair or another covered benefit under the policy.

Can an insurer reject a claim?

Yes, where the policy terms or facts support rejection. For motor insurance under the unified policy framework, the company must provide written reasons for rejection along with supporting documents.

Who can I complain to about an unresolved insurance claim?

Start with the insurer’s formal complaint process. If you meet the current eligibility criteria, Sanadak can handle complaints against insurance companies licensed by the CBUAE.

Is every UAE insurance claim settled within 15 days?

No. The specific 15-day settlement rule cited in the unified motor insurance framework should not be applied to all insurance classes. Check the rules and policy relevant to your product.