How Long Does an Insurance Appeal Take? Country-by-Country Guide

You've filed your appeal. Now you're waiting. How long will this take? The answer depends on your country, insurer, and whether your case is urgent.

This guide gives you exact timelines by country and appeal level. You'll know what to expect and when to escalate if the insurer is dragging their feet.

General Timeline Rules

Before diving into countries, here are universal principles:

Internal Appeal: 20-30 days (most countries). Can be longer for complex cases.

External Review: 30-90 days (most countries). Urgent cases: 24-72 hours.

Total: 2-6 months in most cases.

If Insurer Misses Deadline: You can usually escalate immediately without waiting.

United States

Internal Appeal (Employer Plans)

• Standard request: 30 days
• Urgent request (affects health within 72 hours): 72 hours
• Complex case extension: Can extend up to 40 business days if additional information needed

Internal Appeal (ACA Plans)

• Standard: 30 days
• Urgent: 72 hours (expedited review)

External Review

• Urgent external review: 72 hours total
• Standard external review: 30 days
• Complex external review: Up to 72 days if additional evidence needed

Total timeline:

• Urgent: 4-5 days (72 hours internal + 72 hours external)
• Standard: 3-4 months

United Kingdom

Internal Complaint

• Standard: 8 weeks (56 calendar days)
• FCA requirement: Cannot exceed this without good reason

Financial Ombudsman Service (FOS)

• Most cases: 4-8 weeks from submission
• Complex cases: Up to 6 months
• Aim: 80% resolved within 6 months

Total timeline: 3-7 months

Key rule: 8-week deadline is strict. If the insurer misses it, escalate to FOS immediately without waiting for Final Response.

Australia

Internal Dispute Resolution (IDR)

• Standard claim: 30 calendar days
• Financial hardship claim: 21 calendar days

AFCA (External Dispute Resolution)

• Standard case: 2-6 months
• Complex case: Longer
• Streamlined case: Up to 2 months

Total timeline: 3-8 months

If insurer misses IDR deadline: You can escalate to AFCA immediately.

Canada

Internal Appeal

• Ontario, BC, Alberta: 30 calendar days
• Other provinces: Usually 30 days (check provincial Insurance Act)

OLHI (Life and Health Insurance)

• Standard case: 6-12 months
• Complex case: Longer

Total timeline: 3-13 months

Provincial variation: Timelines vary slightly by province. Check your provincial regulator.

Singapore

Internal Appeal

• Standard: 4 weeks (28 calendar days)

FIDReC

• Most cases: 6 months from lodging
• Simple cases: Can be faster

Total timeline: 3-6 months

European Countries

Ireland (FSPO)

• Internal complaint: 15 business days or 30 calendar days (whichever is sooner)
• FSPO escalation: 6-12 months

Total timeline: 2-8 months

UK (FOS)

See USA section above (8 weeks internal + 4-8 weeks FOS = 3-7 months)

Germany, France, Netherlands, etc.

• Internal appeal: 30 days (varies by country)
• Ombudsman/regulator: 2-6 months

Total timeline: 2-6 months

Asia-Pacific

New Zealand

• IDR: 20 working days (1 month for complex cases)
• FSCL: 4-6 months for most cases

Total timeline: 2-6 months

Malaysia

• Internal appeal: 14 days
• BNMLINK or OmbudsFin: 30-60 days for BNMLINK, 2-6 months for OFS

Total timeline: 2-7 months

Hong Kong

• Internal complaint: 30 calendar days
• IARB: 6-12 months

Total timeline: 4-13 months

UAE

• Internal complaint: 30 days
• Insurance Authority: 60-90 days

Total timeline: 3-4 months

What If the Insurer Misses the Deadline?

Missing their deadline is actually good news for you.

In most jurisdictions:

• Missing the deadline is itself a regulatory violation
• You can escalate to external review immediately
• The insurer's missed deadline strengthens your position

Example: USA: Insurer has 30 days to respond to internal appeal. If Day 31 passes with no response, you can immediately file external review. You don't have to wait the full 30 days.

What to do:

1. Document when you submitted your appeal
2. Count the days (calendar or business, depending on jurisdiction)
3. On Day 1 after the deadline, contact the insurer: "Your internal appeal deadline was [date]. The deadline has passed. I am now escalating to [external review body]."
4. File with the external review body immediately
5. Reference the missed deadline in your external review submission

The regulator takes missed deadlines seriously.

Urgent vs. Standard: How to Get Faster Review

Urgent Cases

What qualifies as urgent:

• Delaying treatment could cause serious harm
• Delaying could result in hospitalization or death
• Delaying could cause permanent damage
• Medical condition is worsening rapidly

If your case is urgent:

• Explicitly request expedited/urgent review in your appeal
• Write "URGENT REVIEW REQUESTED" on the envelope and in your letter
• Provide medical evidence of urgency from your doctor
• Call the insurer's appeals department directly and state urgency

Timeline advantage:

• 72 hours instead of 30 days (USA)
• 24-48 hours instead of weeks (many countries)

Standard Cases

These get normal timelines. Don't claim urgency if it's not. Claiming false urgency weakens your credibility.

Strategies to Speed Up Your Appeal

1. Submit Complete Documentation

Incomplete submissions cause delays. The insurer asks for more, which resets the clock.

Submit everything upfront:

• Complete medical records
• Doctor's letter
• Clinical guidelines
• Policy documentation
• Your appeal letter

Complete submissions often resolve within the minimum timeline.

2. Use Email with Read Receipts

Email is faster than mail. Include read receipt request so you know they received it.

Example: Subject: "Insurance Appeal - Claim [number] - Urgent Review Requested"

They can't claim they didn't receive it.

3. Request Peer-to-Peer Review Immediately

For medical decisions, request peer-to-peer review in your initial appeal. Many insurers flip decisions within 48 hours after a doctor-to-doctor conversation.

4. Call the Appeals Department

After submitting, call the appeals department: "I submitted appeal [number] on [date]. Can you confirm receipt? When should I expect a decision?"

Sometimes a phone call moves things along.

5. Don't Accept Extensions Without Pushing Back

If the insurer says they need more time:

• Ask why specifically
• Provide what they need immediately
• Ask for a specific decision date
• Note that extensions should be rare

Some insurers use extension requests to stall. Don't let them.

6. Escalate to External Review Early (If Applicable)

In some jurisdictions, you can escalate after the internal deadline passes without waiting for the insurer's response.

Examples:

• UK: After 8 weeks with no Final Response, go to FOS
• Australia: After 30 days with no IDR response, go to AFCA
• USA: After 30 days with no internal appeal response, go to external review

Don't wait for the full internal timeline if it's not moving.

Difference Between Urgent and Standard Medical Necessity

This matters for your timeline.

Urgent: Your doctor says you need treatment within days. Request 24-72 hour review.

Standard: Your doctor says you need treatment but there's some time. Request 30-day review.

Not urgent: Your condition is stable, treatment is elective, no deadline. Accept standard timeline.

Be honest about urgency. Inflating urgency can backfire.

Checklist: What You Can Do While Waiting

While the insurer reviews your appeal:

• Keep your doctor updated on the appeal status
• Document any health deterioration due to delayed treatment
• Research similar cases (may help if you escalate further)
• Gather any additional evidence that might strengthen your case
• Follow up with the insurer at 50% of the timeline (e.g., after 15 days if 30-day deadline)
• If escalating, research the external review body's process
• Don't pay disputed medical bills if you can avoid it
• Keep insurance company communications organized

Red Flags: When to Escalate Immediately

Even if the insurer hasn't missed a deadline, escalate if:

• Insurer requests the same information twice: Sign they're stalling
• Insurer gives contradictory reasons: Sign they don't have a solid position
• Appeals department is unresponsive to phone calls: Regulatory violation
• Insurer suggests appeal is unlikely to succeed: Bad faith
• Insurer misses multiple requested deadlines for peer-to-peer review: Intentional delay

These are reasons to escalate to external review even if the deadline hasn't formally passed.

Timeline by Claim Value

Higher-value claims sometimes get longer timelines because they warrant more careful review.

Typical pattern:

• Under $10,000: Faster (1-2 months)
• $10,000-$50,000: Standard (2-4 months)
• Over $50,000: Slower (3-6+ months)

This isn't official, but it's what you often see. Don't let a high-value claim justify indefinite delays.

Final Timeline Expectations

• Minimum: 4-6 weeks (if everything goes smoothly)
• Typical: 2-4 months (internal + external review)
• Slow: 4-8 months (complex cases, multiple escalations)
• Worst-case: 8-12+ months (if you escalate to full legal process)

Plan your finances and medical care around 2-4 months. If it resolves faster, that's a bonus.

Tracking Your Timeline

Create a simple tracker:

Appeal submitted: [date]
Insurer deadline: [date]
Internal decision: [date]
External review submitted: [date]
External review deadline: [date]
Decision: [date]

Update as things progress. If the insurer misses a deadline, you'll immediately know it.

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Disclaimer: ClaimBack provides AI-generated appeal assistance for informational purposes only. ClaimBack is not a law firm and does not provide legal advice. Always review your appeal letter before sending and consider professional advice for complex or high-value claims. Regulatory processes vary — always verify current procedures with your insurer or regulator.

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