Insurance Claim Denied in Ireland: FSPO Appeals Process Guide 2026

Ireland has a strong consumer protection framework for insurance disputes. If your insurer has denied your claim, you have access to the Financial Services and Pensions Ombudsman (FSPO) — a statutory body that resolves disputes between consumers and financial service providers, including insurers, for free.

Whether your claim involves health insurance, motor insurance, home insurance, travel, or life and protection policies, this guide explains your rights, how the FSPO works, and how to build the strongest possible case.

Ireland's Insurance Regulatory Framework

Insurance companies operating in Ireland are regulated by the Central Bank of Ireland under the Insurance Act 1936 (and subsequent amendments) and European insurance directives (particularly Solvency II). The Consumer Protection Code (CPC) issued by the Central Bank sets out standards for how insurers must treat customers, handle claims, and respond to complaints.

From July 2023, the enhanced Consumer Insurance Contracts Act 2019 also applies, which significantly strengthened Irish consumers' rights in insurance contracts — particularly around non-disclosure and proportionality.

The FSPO is established under the Financial Services and Pensions Ombudsman Act 2017 and has statutory powers to investigate, mediate, and adjudicate insurance disputes.

What the FSPO Can Do

The FSPO can:

• Investigate your complaint against your insurer
• Require the insurer to provide documents and explanations
• Mediate a resolution between you and the insurer
• Issue a legally binding decision directing the insurer to pay a claim, change a decision, rectify conduct, or pay compensation
• Award compensation of up to €500,000 for financial loss and additional amounts for non-financial loss (inconvenience, distress)

The FSPO service is completely free for consumers.

Decisions of the FSPO are legally binding on the insurer. You retain the right to appeal an FSPO decision to the High Court if you wish, but the insurer cannot appeal unless the complainant also appeals.

Who Can Use the FSPO?

The FSPO handles complaints from:

• Individual consumers
• Small businesses with an annual turnover of up to €3 million

You can complain about any regulated financial service provider operating in Ireland, including all major Irish insurers (Aviva, Allianz, AXA, FBD, Liberty, Zurich, etc.) and Irish subsidiaries of international insurers.

The 6-Year Complaint Window

This is one of the most important features of the Irish system: the FSPO accepts complaints about conduct that occurred within the previous 6 years (extended from 3 years in 2017). This is a generous window compared to many other jurisdictions.

However, long-running disputes are better resolved sooner rather than later — evidence and witnesses become less reliable over time.

Common Denial Grounds Seen in Irish Insurance

Motor insurance:

• Driver not named on the policy
• Use of vehicle for commercial purposes not covered
• Failure to report accident promptly
• Disputed liability for at-fault accidents

Home insurance:

• Wear and tear exclusion (one of the most contested in Irish homeowner disputes)
• Flood damage disputes (particularly regarding "Storm" vs. "Flood" classification)
• Subsidence claims
• Contents claims for stolen items without adequate proof

Health insurance (VHI, Laya, Irish Life Health):

• Day surgery vs. inpatient classification disputes
• Pre-existing condition exclusions
• Consultants not on approved list
• Waiting period disputes for new members

Life and income protection:

• Non-disclosure of medical conditions
• Contested disability definitions
• Terminal illness claims during contestability period

Travel insurance:

• Pre-existing condition (most common)
• Cancellation for reasons not listed as covered events
• Medical expenses exceeding benefit limits

Step-by-Step: How to Appeal a Denied Insurance Claim in Ireland

Step 1: Read the Denial Letter Carefully

Note the specific clause, exclusion, or reason given for the denial. This is the foundation of your appeal — every subsequent step should directly address this stated reason.

If the denial letter is vague, write to your insurer immediately requesting:

• The precise policy clause being applied
• The factual basis for their decision
• Any reports or assessments they relied upon

Step 2: Gather Your Supporting Evidence

Build an evidence file tailored to the denial reason:

• Medical records or doctor's letters for health-related claims
• Receipts, valuations, purchase evidence for property claims
• Police reports or crime reference numbers for theft claims
• Engineering or surveyor reports for property damage claims
• Travel documentation for travel claims (tickets, hotel bookings, cancellation notices)

For health and life insurance denials based on non-disclosure, your GP and specialist records are critical — particularly records showing when conditions were first diagnosed.

Step 3: File a Formal Complaint with the Insurer

Under the Consumer Protection Code, your insurer must have a formal complaints procedure. You must exhaust this before going to the FSPO.

Write a formal complaint letter to your insurer's complaints department. Under Central Bank of Ireland regulations, the insurer must:

• Acknowledge your complaint within 5 business days
• Provide a final response within 40 business days of receiving the complaint

If the insurer upholds the denial or fails to respond within 40 business days, you can take your complaint to the FSPO.

Step 4: Request a Final Response Letter

Even if you think the insurer is unlikely to reverse their decision, wait for (or request) a formal final response letter. This letter:

• Confirms the insurer has completed their internal review
• Sets out the basis for their decision
• Must inform you of your right to go to the FSPO

You need this letter to proceed to the FSPO.

Step 5: File Your FSPO Complaint

Go to fspo.ie and file your complaint online. You will need to provide:

• Your personal details and the insurer's details
• Your policy number and claim reference
• A description of the complaint
• The outcome you are seeking
• Copies of all relevant documents (policy, denial letter, your internal complaint, the insurer's response, evidence bundle)

Filing is free and can be done entirely online.

Step 6: The FSPO Process

After filing:

1. Acknowledgement: FSPO acknowledges receipt and assigns a reference number.
2. Assessment: FSPO checks the complaint is within its jurisdiction and mandate.
3. Early resolution attempt: FSPO may contact the insurer to attempt early resolution before a full investigation.
4. Investigation: If early resolution fails, FSPO investigates — requesting documents from both parties, potentially conducting interviews.
5. Preliminary decision: FSPO may issue a preliminary decision for comment before finalising.
6. Final decision: FSPO issues a legally binding decision.

The process typically takes between 12 and 18 months for cases that go to full investigation. Simpler cases resolved at the early resolution stage may conclude within a few months.

The Consumer Insurance Contracts Act 2019 — Your New Rights

The Consumer Insurance Contracts Act 2019 (CICA) came into full effect in 2023 and significantly strengthened Irish consumer insurance rights. Key protections relevant to claim denials:

Proportionate remedies for non-disclosure: Under the old law, any non-disclosure could void a policy. Under CICA, the insurer's remedy is proportionate to the seriousness of the non-disclosure:

• Innocent non-disclosure: The insurer must pay the claim with at most a proportional reduction
• Negligent non-disclosure: The insurer may reduce the payout proportionally
• Fraudulent non-disclosure: Only then can the insurer void the policy and retain all premiums

This is a major protection for policyholders facing non-disclosure allegations.

Duty of good faith: CICA imposes a mutual duty of good faith — the insurer must act in good faith in all dealings with the consumer, including claims handling.

Clearer disclosure obligations: Insurers must be proactive in asking for information at application — they cannot rely on vague general questions to later claim material information was undisclosed.

Common Mistakes to Avoid

Not using the insurer's internal complaints process first: The FSPO will refer you back to the insurer if you haven't completed the 40-business-day internal process.

Not requesting the full claims file: Under data protection law, you can request all information the insurer holds about you and your claim. This may reveal internal assessor notes, medical reports, or other evidence that supports your case.

Accepting wear and tear as an absolute: In home insurance disputes, insurers frequently apply wear and tear to reduce or deny claims. The FSPO has been willing to scrutinise whether wear and tear was the proximate cause of damage or merely a contributing factor.

Not understanding the storm vs. flood distinction: Irish home insurance policies typically cover storm damage but often limit or exclude flood damage. If your claim was reclassified from storm to flood (or vice versa), the classification can be contested with meteorological evidence.

Missing the 6-year window: While generous, this deadline is real. If you have an older denied claim you never pursued, now is the time.

Getting Help with Your Appeal

The key to a successful FSPO complaint is a well-structured, evidence-backed case that clearly addresses the insurer's specific denial grounds and references the relevant legal protections under CICA and the Consumer Protection Code.

ClaimBack (claimback.app) generates professional insurance appeal letters tailored to Irish insurance law and the FSPO process. The tool is free, incorporates the correct regulatory references including the Consumer Insurance Contracts Act 2019, and produces a letter you can send immediately to your insurer or use as the foundation of your FSPO submission.

Summary

1. Read the denial letter and identify the exact stated ground for denial
2. Build an evidence file that directly addresses this ground
3. File a formal internal complaint and wait up to 40 business days
4. If unresolved, file with FSPO at fspo.ie — it's free and legally binding
5. Reference the Consumer Insurance Contracts Act 2019 for proportionate non-disclosure remedies
6. Use data protection rights to request the full claims file from your insurer
7. The FSPO 6-year complaint window means past denied claims may still be challengeable