Insurance Claim Denied in Ireland: How to Use the FSPO

An insurance claim denied Ireland doesn't mean you're stuck. Ireland's regulatory system is strong, and the Financial Services and Pensions Ombudsman (FSPO) exists specifically to help people like you. This guide walks you through every step from internal appeal to independent resolution.

The Central Bank of Ireland (CBI) oversees all insurers. They've set strict standards for fair claims handling. If your insurer denies your claim without proper justification, they're likely in breach of CBI rules.

Here's how to win.

Your Rights in Ireland's Insurance System

Ireland has clear protections for insurance consumers:

Central Bank of Ireland (CBI): Regulates all insurance companies, brokers, and intermediaries. Sets binding standards for conduct and consumer protection.

FSPO (Financial Services and Pensions Ombudsman): Independent dispute resolver for financial services complaints. Free, impartial, can award compensation up to EUR 500,000.

Insurance Distribution Directive (IDD): EU law requiring fair treatment and clear disclosure.

Consumer Rights Act: Protects you against unfair contract terms.

Irish Insurance Act: Requires transparency, fair dealing, and proper claims handling.

6-Year Rule: You have up to 6 years from the denial to pursue a claim in court (if needed).

The system gives you multiple paths. Use them.

Step 1: Get a Full Written Explanation

Your insurer must provide a detailed written reason for any denial. If you don't have one, request it now.

The explanation must:

• Quote the specific policy clause being cited
• Explain how your claim doesn't meet that clause
• Reference the evidence reviewed
• Show they considered your circumstances
• Include information about how to escalate

If vague, that's a red flag. Push for clarity.

Keep this letter. It's your appeal foundation.

Step 2: File Your Internal Complaint

Every insurer in Ireland must have a documented complaints procedure. Use it formally.

Timeline: The insurer must respond to your complaint within 15 business days or 30 calendar days (whichever is sooner) in most cases. For complex complaints, they have up to 40 business days.

How to Complain:

1. Write to the insurer's Complaints Department
2. State: "I am lodging a formal complaint about the denial dated [date]"
3. Include: policy number, claim number, date of denial, why you believe it's wrong
4. Attach new evidence: medical reports, doctor's letters, policy analysis
5. Send by registered mail or email with read receipt

What to Include:

• Clear statement you're formally complaining
• Reference to the denial letter and date
• Specific policy clauses you believe support your claim
• Medical evidence or documentation
• Factual, professional tone
• Request for written response

What Happens:

• The insurer acknowledges receipt
• They review your new evidence and original claim file
• Within 15-40 business days, they respond with a decision
• They provide a detailed explanation if upholding the denial
• They inform you about FSPO escalation rights

Possible Outcomes:

• Claim approved (success!)
• Denial upheld with explanation
• Partial settlement or compromise offer

If they uphold the denial, keep their response letter. You'll need it for FSPO.

Step 3: Escalate to the FSPO (Financial Services and Pensions Ombudsman)

If the insurer rejects your complaint (or doesn't respond within the required timeframe), you can escalate to the FSPO for free.

What is FSPO? The Financial Services and Pensions Ombudsman is Ireland's independent dispute resolver for all financial services complaints, including insurance. They're impartial, funded by the industry but operate independently, and have real authority over insurers.

FSPO's Power:

• Can award compensation up to EUR 500,000
• Can overturn insurer decisions
• Decisions are binding on the insurer
• You don't have to accept FSPO's decision (though 99% of complainants do)

How to Complain to FSPO:

1. Visit fspo.ie
2. Complete the complaint form online or request a paper form
3. Provide: your details, insurer name, policy number, claim number, what happened, why you disagree, supporting documents
4. Attach: denial letter, internal complaint outcome, medical evidence, policy document
5. Submit

What FSPO Will Do:

• Acknowledge receipt
• Contact the insurer for their response
• Review both sides independently
• Issue a decision with detailed reasons
• If in your favour, order the insurer to pay the claim plus compensation

Timeline: Most complaints are resolved within 6-12 months. Straightforward cases can be faster. FSPO aims to resolve cases reasonably quickly but gives proper time for investigation.

Cost: Completely free.

Step 4: Understand the CBI's Consumer Codes

The CBI publishes codes of conduct for fair claims handling. Your insurer must:

• Handle claims promptly
• Make decisions based on the policy and facts
• Give clear reasons for denials
• Allow formal complaints
• Treat you fairly throughout the process

If your insurer breached any CBI requirement, that's a breach that strengthens your position at FSPO.

Reference these codes in your complaint: "The insurer breached CBI Consumer Code on Insurance Distribution [specific section]."

Common Denial Reasons in Ireland—And How to Challenge Them

"Pre-existing condition": The insurer says your condition existed before the policy. Counter with: doctor's letter with dates, medical records showing timeline, evidence you disclosed what was required, policy definition of "pre-existing."

"Not medically necessary": The insurer claims the treatment wasn't clinically justified. Fight back with: doctor's letter explaining medical necessity, Irish or international clinical guidelines, evidence similar patients receive the same treatment.

"Exclusion applies": The insurer says a policy exclusion covers your situation. Counter with: policy wording that contradicts this, medical evidence showing treatment for a covered condition, industry standards interpretation.

"Insufficient documentation": Ask exactly what's missing. Then provide it. If vague, that weakens their position.

"Non-disclosure": The insurer says you failed to disclose information at point of sale. Counter with: evidence you disclosed what was asked, policy language about what disclosure was required, evidence the information wouldn't have changed the premium or acceptance.

Evidence That Wins FSPO Cases

Build a strong evidence pack:

Medical Evidence:

• Doctor's letter addressing the denial reason
• All medical records and test results
• Specialist opinion (if applicable)
• Clinical guidelines (Irish, UK, or international) supporting treatment
• Evidence the condition was diagnosed when you say it was

Policy Analysis:

• Full policy document with relevant clauses highlighted
• Schedule of benefits
• Comparison showing similar claims approved by the same insurer
• Communications from the insurer about what's covered

Documentation:

• Your complaint letter to the insurer
• The insurer's response
• Email correspondence
• Timeline of events
• Proof of how you submitted the claim

Expert Opinion:

• Doctor's detailed letter supporting necessity
• Specialist opinion
• References to treatment guidelines
• Evidence of standard medical practice in Ireland

Writing Your FSPO Complaint

Your complaint must be clear, specific, and well-organized.

Structure:

1. What happened (brief chronology)
2. Why you believe the denial is wrong (specific policy references, medical evidence)
3. What CBI codes the insurer may have breached
4. What outcome you're seeking
5. All supporting documents attached

Keep it professional. Facts only. Let evidence speak.

ClaimBack can analyse your case and write your complaint letter in minutes — Start Free →

We'll analyze your denial, your policy, your medical records, and Irish insurance law, then generate a professional letter that FSPO reviewers take seriously.

The 6-Year Rule

In Ireland, you have up to 6 years from the date of the denial to pursue a claim in court. This means even if FSPO doesn't resolve it, you could eventually pursue legal action. However, FSPO is much faster and cheaper.

Use FSPO first. Legal action is a last resort.

Timeline for Appeal in Ireland

• Internal complaint: 15-40 business days
• FSPO investigation: 6-12 months
• Total: 6-14 months in most cases

During this time, try to avoid paying disputed medical bills if possible.

If You Used a Broker or Agent

If you purchased through a broker or agent:

• They also have responsibilities for fair dealing
• They can be liable if they misrepresented coverage
• You can complain about the broker/agent to the CBI and FSPO separately

If the broker/agent's misconduct caused the problem (e.g., they didn't disclose a health condition you told them about), include this in your complaint.

Pre-Appeal Checklist

• I have my denial letter with detailed reasoning
• I have filed an internal complaint and received the response
• I have gathered all medical evidence
• I have my full policy document highlighted with relevant clauses
• I understand which CBI codes the insurer may have breached
• I have organized all evidence chronologically
• I have visited fspo.ie and reviewed their process
• I have drafted a clear, evidence-backed complaint
• I have proof of how I'm submitting (registered mail or email)

Ireland's FSPO system is designed for you. Use 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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