Introduction: Why is Insurance Law the Subject of Millions of Complaints Every Year in Türkiye?

Almost everyone in Türkiye;

• Comprehensive car insurance

• Compulsory traffic insurance

• Home insurance

• Health insurance

• Life insurance

• Private pension systems

It has a relationship with insurance companies.

However, the most common problem in insurance claims processes is this:

➡ "Claim rejection decision"

Every year, hundreds of thousands of citizens apply to the Insurance Arbitration Commission due to insurance companies' failure to pay compensation, underpayments, or arbitrary refusals.

The most searched questions on Google:

• Why isn't the insurance company paying?

• How to appeal a damages rejection?

• How does the arbitration process work?

• In what situations will car insurance not pay?

• What constitutes gross negligence?

• Does insurance cover alcohol?

• Does home insurance cover flooding?

• How is the policy interpreted?

This article explains insurance law through its most critical topics.

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I. Legal Nature of the Insurance Contract

Insurance contracts are regulated in Articles 1401 and subsequent articles of the Turkish Commercial Code.

This agreement:

➡ It is a risk contract that includes the mutual debts and obligations of the parties.

The insurance company's most fundamental debt:

➡ The obligation is to pay compensation when the risk materializes.

However, the policy terms determine this process.

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II. Policy Review – The Most Critical Step

Whether a claim will be paid is assessed based on these three factors:

1. Scope of coverage

Which risks are covered?

2. Exceptions

In what situations will insurance companies not pay?

3. Limits

What is the maximum amount the insurance will pay?

A policy:

• If uncertain

• If it is open to interpretation

• If it contains vague expressions

➡ According to Article 1427 of the Turkish Commercial Code, it is interpreted in favor of the insured.

This is a fundamental principle of insurance law.

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III. The Most Common Reasons for Claim Rejection by Insurance Companies

1. Allegation of gross negligence

Examples:
Speeding, violating traffic rules, running a red light, driving under the influence of alcohol.

2. Exclusion from policy coverage

If your home insurance policy does not cover flooding, no payment will be made.

3. The risk never materializes

If your car insurance doesn't have theft coverage, theft won't be paid for.

4. Missing documents – late notification

5. Exceptions clause

6. Periods excluded from coverage

7. Allegation that the damage was intentional

The Supreme Court emphasizes that these allegations must be proven with concrete evidence.

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IV. The Most Common Claim Rejections in Motor Insurance

1. Failure to pay due to alcohol consumption

If the driver's blood alcohol level is above 0.50 per mille :

• Major damages are not covered

• However, the other party's damages are covered by their traffic insurance

However, the Supreme Court requires " conclusive proof that the accident occurred due to alcohol ."

2. Forgetting the key – having it stolen

Some policies include coverage, others do not.

3. Unauthorized repair shop

The insurance company may insist on a "contracted service" condition, but this;

➡ This could be considered an unfair term.

4. Exceptions for earthquakes, floods, and natural disasters

If the insurance policy has comprehensive coverage, payment will be made; if it has limited coverage, payment will not be made.

5. Allegation of false statement

Statements unrelated to the risk cannot be grounds for refusal.

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V. Grounds for Refusal in Compulsory Motor Insurance

Compulsory car insurance only covers damages to the other party.
Reasons for refusal:

• The fact that the fault lies entirely with the insured does not prevent payment

• However, no payment will be made if the behavior was intentional.

• Unlicensed driver

• Driver without a license

• License plate difference

These grounds must be proven in concrete terms.

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VI. Rejected Claims in Home Insurance

The most common problems with home insurance policies:

• Moisture/humidity (considered a cause of decay)

• flood

• Boiler malfunction

• Smoke damage after a fire

• Electrical damage

Insurance companies usually try to deny the claim by citing " lack of care ."

Supreme Court:
"Lack of care is only an exception if it is clearly proven."

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VII. Health Insurance – Additional Fees and Refusal Process

Problems encountered with private health insurance:

• Pre-existing medical claim

• Examinations not covered by the policy

• Exceeding the limit

• Participation fee disputes

• Invoice separation

• Incorrect coding

If hospitals inflate their bills, insurance companies may refuse to pay; patients can pursue legal avenues.

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VIII. Insurance Arbitration Commission – The Most Effective Way

The Insurance Arbitration Commission is the fastest and most effective solution for policyholders.

Advantages of arbitration:

• Results in 4-6 months

• Low application fee

• Expert witness

• Speedy trial

• Final decision

To initiate arbitration proceedings, an application must first be made to the insurance company.

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IX. How Does the Arbitration Process Work?

1. A written request is made to the insurance company

2. If no response is given or the request is rejected within 15 days

3. An application is made for arbitration

4. An expert is appointed

5. The file is reviewed

6. A decision will be made

The decision is final for disputes under 5,000 TL .

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X. Expert Report in Compensation Calculation

Expert witness in insurance cases:

• The market value of the vehicle

• The nature of the damage

• Policy coverage

• Limits

• Exclusions from coverage

• How the event occurred

takes into consideration.

It is possible to object to the expert report.

XI. The Most Common Mistakes Made by Policyholders

• Not reading the policy

• Not knowing the scope

• Submitting incomplete documents

• Late notification

• Accept the insurance company's initial response

• Not resorting to arbitration

These errors may lead to the rejection of compensation.

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Conclusion

Insurance law is a complex field affecting both individuals and companies.
Claims rejection, policy coverage, guarantees, exclusions, and compensation processes must be managed professionally.

Although insurance companies sometimes engage in arbitrary practices, it is possible to obtain deserved compensation with the right application and legal strategy.