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Start by obtaining the rejection and the exact policy clause in writing. Then check the activity, exclusions, add-ons and claim conditions against the documents you actually bought, assemble evidence in date order, and submit a formal complaint to the insurer. If the insurer has not issued a final response within eight weeks, or you disagree with its final response, an eligible UK consumer can take the dispute to the Financial Ombudsman Service (FOS). Whether the claim should be paid depends on the precise wording, facts, evidence and jurisdiction.
1. Preserve the denial and every deadline
Save the refusal letter or email in its original form, including the date received, claim reference, sender and attachments. Keep the policy schedule, full wording, certificate, endorsements, add-on confirmation, statement of insurance and any sales material that described the cover. A telephone explanation is not a substitute for a written decision.
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Write to the insurer asking it to identify:
- the exact clause or definition it relied on;
- the facts it says trigger that clause;
- the documents or statements it considered;
- any evidence it says is missing or contradictory; and
- the process and deadline for making a formal complaint.
Ask for relevant claim notes or documents where appropriate. Keep a dated log of calls, names, reference numbers, promises and submissions. Send important material by a method that gives you proof of delivery and retain a complete copy of everything you submit.
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2. Test the activity against the cover you bought
“Adventure holiday” is a description, not a guarantee of insurance. GOV.UK warns that sports and adventure tourism may need specialist insurance or an add-on. It gives bungee jumping, jet skiing, winter sports and skydiving as examples of activities not usually covered by standard policies; quad bikes and mopeds are also commonly outside standard cover. Those are general warnings, not a decision on your claim.
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Read the policy’s activity wording rather than relying on the name used by a tour operator or booking website. Check each of these details:
- the exact activity and equipment used;
- difficulty, grading or level of participation;
- location, altitude, depth or terrain;
- whether it was guided, supervised or unguided;
- whether racing, competition, training or a professional element was involved;
- the age, qualification or safety requirements stated by the policy; and
- whether the activity was booked as part of an organised excursion or undertaken independently.
Look for a sports or adventure list, definitions, general exclusions, dangerous-activity exclusions and conditions that apply only to medical, baggage, cancellation or liability sections. An exclusion in one section may not remove cover elsewhere, and a general exclusion may be modified by an endorsement.
Check add-ons and endorsements
Find the transaction or schedule showing whether you purchased winter-sports, water-sports, activity, gadget, medical or other optional cover. Confirm the insured dates, destination and named travellers. Read what the add-on adds and what it leaves excluded; an add-on may cover one activity while retaining restrictions on altitude, depth, competition or safety equipment.
Compare the wording in force on the date of booking and the date of the incident. If documents conflict, preserve both versions and ask the insurer to explain which term it says governs and why. Financial Ombudsman Service guidance stresses that policy terms should be clear; disputes can arise when exclusions or optional cover appear inconsistent with the rest of the policy.
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3. Match the insurer’s reason to the evidence
Prepare a short chronology. Start with the booking and the activity description, then list the incident, treatment or cancellation, notifications, expenses and the insurer’s decisions. Give each event a date, source and document reference. This lets the complaint reviewer test facts instead of reconstructing them from a long narrative.
Evidence commonly relevant to an activity claim
- booking confirmations, invoices and the operator’s description of the activity;
- receipts, proof of payment and cancellation or refund records;
- permits, tickets, guide or instructor statements and safety briefings;
- incident, rescue, police, transport or weather reports where relevant;
- photographs, messages, location data or other contemporaneous records;
- communications with the insurer, broker, emergency assistance service and activity provider; and
- witness statements identifying what the witness saw and when.
Do not send a large undifferentiated file. Label documents and explain which point each one proves. Ask the insurer what specific missing or contradictory evidence would change its assessment. The FOS says it reaches a decision using evidence from the consumer, the financial business and relevant third parties.
Medical treatment and repatriation
Medical claims can involve separate questions from the activity exclusion. Check whether the treatment was medically necessary, whether the policy required you to contact the emergency assistance service before treatment or travel, whether repatriation was authorised and whether the refusal relies on a pre-existing-condition term.
Preserve clinical notes, invoices, prescriptions, discharge records, referrals and fit-to-fly or repatriation advice. If you could not call the assistance line first because of an emergency, incapacity or lack of access, record the reason and provide supporting evidence. Keep proof of when you notified the insurer and follow-up instructions it gave.
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4. Make a formal complaint to the insurer
Use the complaint address and method in the insurer’s complaints procedure. Address the complaint to the financial business named there, which may differ from the brand shown on a booking page. State that you are making a formal complaint about the claim decision.
A focused complaint should contain:
- The decision challenged. Give the claim number, date of refusal, amount claimed and sections of cover involved.
- The relevant wording. Quote the definition, exclusion, condition or endorsement and identify the page or section.
- The material facts. Describe the activity, supervision, location, circumstances and notification history accurately.
- The evidence. Refer to the attached documents by name and explain what each establishes.
- Why the decision is disputed. Explain whether the activity is covered, the exclusion is inapplicable or unclear, a condition was met, or the investigation omitted material evidence.
- The remedy requested. Ask for reconsideration, payment of an eligible amount, correction of an inaccurate record or a reasoned explanation. Do not promise that any particular remedy must follow.
Ask the insurer to respond to each issue and to identify any further information required. Keep the delivery receipt and the complete complaint pack. If the insurer sends a final response, note the date immediately because it affects the ombudsman deadline.
5. Escalate to the Financial Ombudsman Service when eligible
In the UK, the insurer’s formal complaint is the required first stage for an FOS case. The FOS says you can approach it if the firm has not sent a final response within eight weeks or if you disagree with the final response. The Financial Conduct Authority (FCA) advises contacting the FOS within six months of the final response; after that, the service may not be able to help.
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|---|---|---|---|
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Check current FOS eligibility and filing instructions before submitting. Eligibility depends on the firm, the complainant and the type of dispute. Include the refusal, policy documents, complaint, final response (if any), chronology and the evidence that answers the insurer’s stated reason. Explain the outcome you seek without overstating what the policy guarantees.
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The FCA says consumers can complain themselves. A claims management company is optional and may charge a fee; it is not a required stage and a paid intermediary does not guarantee a better result.
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Organise the submission so the issue can be decided from the documents:
- Give a one-paragraph summary of what happened and the amount in dispute.
- List the policy terms in issue and quote the key wording accurately.
- Set out the chronology with dates and document references.
- Answer each reason in the final response separately.
- Identify any ambiguity or conflict between the schedule, wording, endorsement and sales description.
- Explain financial loss and provide proof, while separating insured loss from expenses the policy does not cover.
Be candid about adverse facts, such as an unguided element, missed notification or pre-existing condition. A clear explanation of why a requirement could not be met is more useful than omitting it. The ombudsman weighs material from all sides and relevant third parties, so unsupported assertions are unlikely to resolve a factual dispute.
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7. Common reasons an adventure claim is rejected—and the right response
“The activity is excluded”
Ask whether the exact activity and circumstances fall within the exclusion’s definition, whether an add-on changes it and whether the insurer has applied the correct policy version. Supply the operator’s description, guide statement and proof of supervision or qualification where those facts matter.
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“You did not disclose a medical condition”
Request the precise question allegedly answered incorrectly, the answer recorded at purchase or renewal and the policy test the insurer applied. Provide medical records relevant to what was known, when it was known and whether it caused the loss. Do not speculate about diagnosis or causation.
“You failed to notify us before treatment or repatriation”
Show when you notified the assistance service, what instructions it gave and why advance contact was impossible if there was an emergency. Ask the insurer to identify the contractual consequence of non-notification and whether it has assessed actual prejudice or necessary treatment under the wording.
“There is insufficient proof of loss”
Request a precise list of missing items. Replace estimates with invoices, receipts, provider confirmations, medical records or independent reports where available. Explain any item that cannot be obtained and provide alternative corroboration.
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Provide the event rules, entry category, sponsorship or employment information and the operator’s description. Distinguish casual participation from racing, training or paid work only if the documents support that distinction.
8. Timing and record-keeping checklist
- Record the date the refusal arrived.
- Request the clause, facts and evidence behind the decision.
- Secure the schedule, wording, endorsements and sales documents in force.
- Build a dated chronology and indexed evidence bundle.
- Submit a formal complaint and retain proof of delivery.
- Record the date of the final response or the date eight weeks elapsed.
- If eligible, submit to the FOS within six months of the final response.
- Keep copies of every message sent to the insurer, assistance service and ombudsman.
9. What the wider regulatory context does—and does not—show
In 2025, the FCA said its review covered 15 home-insurance providers and eight travel-insurance providers and identified areas for improvement in claims handling. That is sector context, not evidence that a particular insurer mishandled your claim. There is no established published statistic here showing how many adventure-holiday denials are overturned or how often activity exclusions are successfully challenged, so do not rely on an assumed success rate.
10. If you live outside the UK
The steps of preserving the decision, matching the wording to the facts and building an evidence-led complaint are broadly useful, but UK deadlines and the FOS route do not automatically apply elsewhere. Use the insurer’s local complaints process and your country’s recognised financial-ombudsman, consumer-protection or dispute-resolution scheme. Confirm jurisdiction, eligibility and time limits before allowing a deadline to pass.
11. When professional legal advice may be sensible
Consider independent legal advice where the loss is substantial, the facts are disputed, limitation is close, an injury has serious consequences or the policy involves multiple jurisdictions. A solicitor is not required for an insurer complaint or an eligible FOS case. If you use a paid claims representative, check its fees, authority and cancellation terms before signing; the FCA notes that claims-management companies may charge.
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