Insurance Claim Appeal Timelines: How Long Does It Take to Win?
How long does it take to win an insurance claim appeal? This guide covers internal and external appeal timelines for the UK, USA, Singapore, Australia, and Malaysia — plus practical tips to speed up your case.
Insurance Claim Appeal Timelines: How Long Does It Take to Win?
One of the most common questions from policyholders challenging a claim denial is: how long is this going to take? The answer depends heavily on which country you are in, which appeal stage you are at, and the complexity of your case. This guide provides a comprehensive, country-by-country breakdown of insurance claim appeal timelines — and practical strategies to move your case forward as efficiently as possible.
Why Timelines Matter
Understanding appeal timelines is critical for several reasons:
Legal deadlines exist. In every jurisdiction covered in this guide, there are strict time limits for filing appeals. Miss them, and you may lose your right to dispute the denial entirely.
Cash flow pressure. If you are waiting for a medical claim to be paid while facing hospital bills, or a property claim while living in temporary accommodation, knowing the timeline helps you plan financially.
Negotiating leverage. Knowing the expected timeline helps you make strategic decisions — for example, whether to settle for a partial payment at mediation or hold out for full payment through adjudication.
Managing stress. Uncertainty about "how long this will take" is itself a significant source of stress. A clear roadmap makes the process more manageable.
United Kingdom: Insurance Appeal Timelines
Internal Complaint: Up to 8 Weeks
Under the FCA's DISP (Dispute Resolution) rules, UK insurers must:
- Send an acknowledgement within a reasonable time (typically 5 business days)
- Issue a Final Response within 8 weeks of receiving your complaint
For straightforward claims, many insurers resolve complaints within 2 to 4 weeks. For complex cases (medical disputes, large property claims, non-disclosure arguments), the full 8 weeks is commonly used.
If the insurer does not send a Final Response within 8 weeks, you can escalate to FOS immediately — you do not need to wait further.
Practical tip: Contact the insurer in writing on day 55 or 56 (approximately 8 weeks minus 2-3 business days) if you have not received a Final Response. This creates a record of the deadline being approached and sometimes triggers faster action.
Financial Ombudsman Service (FOS): 6 to 24 Months
The FOS has faced significant backlogs. Realistic timelines as of 2025-2026:
- Case assessment: 3 to 6 months from filing
- Adjudicator's provisional decision: 9 to 18 months from filing
- Final ombudsman decision (if challenged): Up to 24 months from filing
Expedited process: FOS offers priority handling for cases involving:
- Serious financial hardship
- Terminal illness
- Irreversible harm if delayed
If your situation qualifies, request priority status when filing your FOS complaint.
Your 6-month filing window: You must file with FOS within 6 months of the insurer's Final Response. Missing this deadline is usually fatal to your FOS complaint.
United States: Insurance Appeal Timelines
Internal Appeal: 30 to 60 Days
Under the ACA (Affordable Care Act) and ERISA:
| Appeal Type | Insurer's Decision Deadline |
|---|---|
| Urgent/expedited care appeal | 72 hours |
| Pre-service (before treatment) appeal | 30 days |
| Post-service (after treatment) appeal | 60 days |
Most employer-sponsored plans comply with the ACA's 60-day standard for post-service appeals. Individual and Marketplace plans are subject to state-specific timelines which may vary slightly.
Practical tip: Request an expedited internal appeal if waiting for the standard decision would endanger your health. This shortens the insurer's response obligation to 72 hours.
External Review by IRO: 45 to 60 Days
After exhausting internal appeals, you can request external review:
- Standard external review: Decision within 45 calendar days
- Expedited external review: Decision within 72 hours for urgent cases
You typically have 4 months from the insurer's final internal appeal decision to request external review. Some states impose shorter deadlines.
Total timeline (standard): From initial denial to external review decision, expect 3 to 6 months for most cases.
Singapore: Insurance Appeal Timelines
Internal Complaint: 21 Working Days
Under MAS guidelines, Singapore insurers must:
- Acknowledge your complaint within 5 business days
- Issue a final response within 21 working days
For complex disputes, some insurers extend this to 30 or 45 working days with notification. If no response is received within 21 working days, you can escalate to FIDReC.
Practical tip: Submit your internal appeal letter with all supporting documentation on day one. Incomplete submissions often cause the insurer to extend the timeline while requesting more information.
FIDReC: 3 to 12 Months
| FIDReC Stage | Typical Duration |
|---|---|
| Preliminary assessment | 4 to 6 weeks from filing |
| Mediation hearing | 2 to 4 months from filing |
| Adjudication (if mediation fails) | 6 to 12 months total from filing |
FIDReC resolves approximately half of cases through mediation before adjudication is required. Cases with strong documentation and a clear legal basis typically resolve faster.
Your 6-month filing window: File with FIDReC within 6 months of the insurer's final response.
Total timeline: Internal complaint (21 working days) + FIDReC mediation (2 to 4 months) = approximately 3 to 5 months for mediated resolution.
Australia: Insurance Appeal Timelines
Internal Dispute Resolution: 45 Calendar Days
Under AFCA's complaint resolution standards, Australian insurers must:
- Acknowledge your complaint within 10 business days
- Issue a final response (Internal Dispute Resolution, or IDR, response) within 45 calendar days of receiving your complaint
For some complaint types, a shorter 5-business-day "straightforward" resolution is expected.
If the insurer does not resolve the complaint within 45 calendar days, you can escalate to AFCA.
AFCA: 60 Days to 18 Months
AFCA handles insurance complaints in stages:
| AFCA Stage | Typical Duration |
|---|---|
| Registration and referral to insurer | 2 to 4 weeks from filing |
| Insurer's response period | 21 days from AFCA referral |
| AFCA case management (negotiation/assessment) | 2 to 4 months |
| Preliminary assessment/recommendation | 3 to 6 months |
| Determination (binding decision) | 6 to 18 months for complex cases |
AFCA prioritises cases involving vulnerable consumers or serious financial hardship. Most insurance disputes resolve within 6 months.
Total timeline: Internal IDR (45 days) + AFCA resolution (3 to 6 months) = approximately 4 to 8 months for most cases.
Private Health Insurance: PHIO
For private health insurance disputes specifically, the Private Health Insurance Ombudsman (PHIO) processes complaints within 30 to 90 days for most cases — faster than AFCA for straightforward PHI disputes.
Malaysia: Insurance Appeal Timelines
Internal Complaint: 14 to 30 Working Days
Under BNM guidelines, Malaysian insurers must:
- Acknowledge complaints within 5 working days
- Issue a substantive response within 14 working days
- For complex cases, this may be extended to 30 working days with notification
Ombudsman for Financial Services (OFS): 3 to 12 Months
| OFS Stage | Typical Duration |
|---|---|
| Registration and preliminary review | 4 to 6 weeks from filing |
| Mediation | 2 to 4 months from filing |
| Adjudication (if mediation fails) | 6 to 12 months total |
Total timeline: Internal complaint (14 to 30 working days) + OFS mediation (2 to 4 months) = approximately 3 to 5 months for mediated resolution.
Factors That Affect Appeal Timeline
Completeness of your submission: Cases with complete, well-organised documentation move significantly faster than cases where the ombudsman or regulator needs to chase you for additional information. Submit everything upfront.
Complexity of the dispute: Medical necessity disputes requiring clinical review take longer than straightforward coverage interpretation disputes.
Volume of cases at the ombudsman: FOS (UK) in particular has experienced significant backlogs. AFCA and FIDReC generally have shorter wait times.
Cooperation of the insurer: Some insurers respond faster to internal appeals and ombudsman investigations than others.
Whether mediation succeeds: If your case resolves at mediation, total timeline is typically 3 to 6 months regardless of country. If you need adjudication, add 6 to 12 more months.
How to Expedite Your Appeal
Submit all documents upfront. Do not wait to be asked for additional information.
Write a clear, structured appeal letter. Use ClaimBack at claimback.app to generate a professionally structured letter that presents your case clearly and efficiently. A well-structured letter is processed faster than a disorganised complaint.
Reference specific policy clauses. Vague complaints take longer to investigate. Specific references enable faster case assessment.
Request expedited handling where applicable. If you face serious financial hardship, terminal illness, or urgent medical need, say so explicitly and request priority handling.
Respond to information requests promptly. Every delay in providing requested information extends your timeline.
Escalate promptly when you reach a dead end. Do not send multiple rounds of correspondence with an insurer who has clearly made its final decision. Move to the ombudsman as soon as the internal process is genuinely exhausted.
Complete Timeline Summary
| Country | Internal Appeal | Ombudsman/External Review | Total (Typical) |
|---|---|---|---|
| UK | 8 weeks | 6 to 24 months (FOS) | 7 to 25 months |
| USA | 30 to 60 days | 45 to 60 days (IRO) | 3 to 6 months |
| Singapore | 21 working days | 3 to 12 months (FIDReC) | 3 to 5 months (mediation) |
| Australia | 45 calendar days | 3 to 18 months (AFCA) | 4 to 8 months |
| Malaysia | 14 to 30 working days | 3 to 12 months (OFS) | 3 to 5 months (mediation) |
| Germany | 4 to 8 weeks | 3 to 6 months (Versicherungsombudsmann) | 4 to 8 months |
| New Zealand | 40 working days | 3 to 6 months (IFSO) | 4 to 8 months |
Conclusion
Insurance claim appeals take time — there is no way around that. But the process is time-limited by clear legal deadlines at every stage, and ombudsman services in every major market are designed to produce a fair, independent resolution within months rather than years. The most important thing you can do is start the process correctly: a professional, structured appeal letter using ClaimBack at claimback.app moves your case forward faster, reduces unnecessary back-and-forth, and puts you in the strongest possible position at mediation or adjudication.
Know your deadlines, submit everything upfront, and escalate promptly when the internal process is exhausted.
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