Insurance Appeal Success Rates by Country: What the Data Shows

One of the first questions anyone asks after receiving an insurance denial is: "Is it worth fighting this?" The answer, across most regulated insurance markets, is almost always yes — and the data backs that up.

This guide compiles publicly available data on insurance appeal success rates across major markets, explains what the numbers actually mean, and identifies the factors that most reliably improve your chances of winning an appeal.

Understanding What "Success Rate" Means

Before diving into the numbers, it's important to understand how success rates are measured — because different bodies measure differently.

"Uphold rate" (FOS UK, AFCA): The percentage of complaints that are decided in the consumer's favour by the ombudsman. Does not include cases settled at the referral stage.

"Resolution rate" (FIDReC Singapore): The percentage of cases successfully resolved through the entire process (including mediation settlements), not just formal adjudications.

"Settlement rate" (AFCA referral stage): Separate from the formal uphold rate — the percentage of cases resolved (often in the consumer's favour) before formal proceedings.

These definitional differences mean that direct country-to-country comparison requires care.

Singapore: FIDReC

Overall resolution rate: 85%+

FIDReC's published data consistently shows that more than 85% of cases that proceed to mediation are successfully resolved at that stage. This is the highest reported resolution rate of any major insurance dispute body globally.

This impressive figure requires context:

• It reflects cases resolved at mediation, not just formal adjudication
• Many mediation resolutions involve some compromise — not necessarily the full amount claimed
• Cases that don't proceed to FIDReC (resolved internally) are not captured

At adjudication: Cases that fail mediation and proceed to adjudication are a small minority. The adjudication success rate for consumers is not separately published, but FIDReC's adjudicators are considered independent and their decisions are binding on financial institutions.

What this means for you: Filing a FIDReC complaint — even if you're unsure of your case — triggers a mediation process in which the great majority of disputes find resolution. The high rate suggests that many insurers settle at mediation rather than risk an adverse adjudication.

Factors that most improve FIDReC success: Clear policy interpretation in your favour, strong specialist medical letters for health claims, and well-documented claim chronologies.

United Kingdom: Financial Ombudsman Service (FOS)

Formal uphold rate: approximately 30-40% (varies by product)

The FOS publishes detailed quarterly and annual data on uphold rates by product category. Recent data (2023-24) shows:

Insurance Product	Approximate Uphold Rate
Travel insurance	35-40%
Buildings and contents	30-35%
Motor insurance	25-35%
Life and protection	25-35%
Private medical insurance	30-38%

However, the formal uphold rate does not capture the full picture. Many complaints are resolved before an ombudsman decision is issued — either at the adjudicator stage or by the insurer making an offer. The FOS's own data shows that approximately 50% of insurance complaints are resolved without a formal ombudsman decision, often in the consumer's favour.

Total effective success rate (including informal resolutions): Estimated 45-55% across all insurance complaint types.

What this means for you: Even a formal uphold rate of 35% means that more than 1 in 3 contested insurance denials are reversed by the FOS. This is not a long shot — it is a significant probability. And when you add informal resolutions, the odds are better still.

Factors that most improve FOS success: Specific evidence directly rebutting the insurer's stated denial grounds, Consumer Duty breaches documented during the handling process, and medical or expert reports that challenge the insurer's technical assessments.

Australia: AFCA

Registration and referral stage resolution: approximately 70%

AFCA's 2023-24 Annual Review shows that approximately 70% of insurance complaints are closed at the registration and referral stage — within 30 to 60 days of filing and before formal case management begins. These closures are often resolutions in the consumer's favour, as the referral process prompts many insurers to reconsider their position.

Formal determination uphold rate: For cases that proceed to determination, AFCA's published data shows a consumer-favourable outcome in approximately 35-45% of formal determinations. The remaining cases are resolved at earlier stages.

By product category (approximate):

• Home and contents: 38% uphold at determination
• Motor insurance: 32% uphold at determination
• Travel insurance: 40% uphold at determination
• Life insurance: 35% uphold at determination

Non-financial loss awards: In addition to claim payments, AFCA regularly awards non-financial loss compensation (up to $7,500) for distress and inconvenience. This is awarded in a significant proportion of insurance cases where the insurer's handling was poor.

What this means for you: The very high early resolution rate (70%) means that simply filing with AFCA often produces a result. Insurers know their files will be scrutinised and many resolve cases they were previously unwilling to budge on.

Factors that most improve AFCA success: Section 54 of the Insurance Contracts Act (for act/omission-based denials), independent expert reports challenging insurer assessments, and detailed documentation of insurer delays and misconduct.

Ireland: FSPO

Uphold or partially upheld rate: approximately 30-40%

The Financial Services and Pensions Ombudsman (FSPO) publishes annual reports showing that approximately 30-40% of investigated complaints are upheld or partially upheld in the consumer's favour. The FSPO also achieves a significant number of mediated resolutions before formal investigation.

Ireland's Consumer Insurance Contracts Act 2019 has strengthened the consumer's position, particularly for non-disclosure cases, which may drive uphold rates upward in coming years as the Act's full effect is felt.

Malaysia: Ombudsman for Financial Services (OFS)

Published resolution rates: The OFS does not publish detailed uphold statistics in the same format as FOS or AFCA, but industry observers estimate that a significant proportion of mediated cases (the majority of the OFS caseload) are resolved in the consumer's favour.

For life insurance disputes specifically — which make up a large share of OFS cases — the proportionality principle for non-disclosure cases has enabled many partially denied claims to be at least partially recovered.

Hong Kong: ICCB

Resolution rate: The Insurance Claims Complaints Bureau (ICCB) reports handle a significant volume of complaints, with resolution through mediation being the primary mechanism. The ICCB does not publish detailed uphold statistics, but practitioners report that mediation resolves the majority of complaints that reach the ICCB, often with the insurer making some concession.

What Factors Most Increase Your Success Rate?

Across all markets, the data and practitioner experience point to a consistent set of factors that improve appeal success:

1. Specific, Documented Evidence

The single biggest differentiator. Appeals with strong evidence — specialist medical letters, independent expert reports, clearly dated documentation — succeed at significantly higher rates than vague protests.

2. Referencing the Correct Legal Provisions

Knowing and citing the relevant consumer insurance law (CIDRA in UK, section 54 of the ICA in Australia, CICA in Ireland) transforms a general complaint into a legally specific challenge that the insurer must address.

3. Specialist Support for Medical Claims

For health, life, and disability claims, a detailed letter from the treating specialist — specifically addressing the insurer's stated denial grounds — is arguably the most powerful single piece of evidence.

4. Filing with the Ombudsman

Simply filing triggers a review process that prompts many insurers to settle. The 70% early resolution rate at AFCA and 85%+ FIDReC resolution rate are partly driven by the fact that formal complaint processes change the cost-benefit calculation for insurers.

5. Professional, Well-Structured Appeal Letters

Anecdotally and empirically, well-structured letters with clear headings, numbered evidence bundles, and specific legal references receive more serious responses than emotional, unstructured communications.

6. Acting Quickly

Evidence is fresher, medical records are more easily obtained, and deadlines are more easily met when you act quickly after a denial. Don't wait months.

What Reduces Your Chances

Accepting the denial: The single biggest waste of a potentially valid appeal. Many denied claims are simply accepted without challenge.

Filing without evidence: Ombudsman bodies cannot manufacture evidence for you. A complaint without supporting documentation is very difficult to uphold.

Providing inconsistent information: Inconsistencies between what you tell the insurer and what your medical records say are damaging to credibility.

Missing deadlines: FOS's 6-month rule, AFCA's 2-year rule, and FIDReC's 6-year rule are all real limits. Missing them forfeits your rights.

Getting Help to Improve Your Odds

Given that appeal success rates range from 30% to 85% depending on jurisdiction and approach, the quality of your appeal preparation is one of the most controllable factors.

ClaimBack (claimback.app) generates professional, evidence-referenced appeal letters tailored to your country, your insurer, and your specific denial reason. The tool is free and takes about five minutes. Using a structured, regulation-referenced letter rather than an ad hoc complaint significantly increases the probability of resolution at the internal stage — before you even need to go to the ombudsman.

Summary

• FIDReC Singapore: 85%+ overall resolution rate at mediation — the highest globally
• FOS UK: 30-40% formal uphold rate, estimated 45-55% including informal resolutions
• AFCA Australia: 70% of complaints resolved at referral stage; 35-45% uphold at formal determination
• FSPO Ireland: 30-40% uphold rate
• Strong evidence, specialist letters, and correct legal references are the top factors in success
• Simply filing a complaint — in any jurisdiction — dramatically improves outcomes vs. accepting the denial
• Quality of the appeal letter and evidence bundle is the most controllable factor in your success rate