Insurance Claim Denied in the UK? Your Rights and How to Appeal

An insurance claim denied UK isn't final. The UK has one of the world's toughest consumer protection systems, and you have powerful rights to challenge any rejection. This guide shows you exactly how to appeal, escalate, and win.

Whether it's health insurance, travel, pet, or income protection, the process is similar. The Financial Conduct Authority (FCA) oversees every insurer, and they've set strict rules about how denials must be handled and justified.

Here's your roadmap to reclaim what you're owed.

Your Legal Rights When an Insurer Rejects Your Claim

The UK insurance market is one of the most regulated in the world. Here's what this means for you:

FCA Authority: The FCA regulates all insurance companies in the UK. They set binding standards for claims handling, appeals, and fair treatment.

The 8-Week Rule: This is crucial. Your insurer has exactly 8 weeks to respond to a complaint. If they don't, you can escalate to the Financial Ombudsman Service (FOS) immediately.

Right to Appeal: You have a statutory right to escalate any complaint that isn't resolved internally.

Independent Review: The Financial Ombudsman Service is free, independent, and has no financial interest in ruling for or against the insurer.

Compensation Right: If the FOS finds the insurer was wrong, they can award compensation for your financial loss plus an extra amount for inconvenience.

This isn't about being nice—it's about the insurer following the law. If they denied your claim without proper justification, they've likely broken FCA rules.

Step 1: Get a Written Explanation

The first thing you need is clarity. Your insurer must provide a detailed, written explanation for the denial—and this must reference your specific policy wording.

If you only received a phone call or vague letter, that's already a breach. Demand a full written explanation that includes:

• The specific policy clause or condition they relied on
• How your claim failed to meet that clause
• What evidence they reviewed
• Why that evidence was insufficient
• Confirmation they've reviewed your full file

Don't accept vague reasons like "not covered" or "claim rejected." Push back. Ask them: "Which policy clause exactly am I in breach of? Quote it for me."

Many denials fall apart at this stage. Insurers rely on confusion and people giving up. Once you ask for clarity, some insurers will reconsider.

Step 2: File Your Internal Complaint

Under FCA rules, every insurer must have a documented complaints procedure. Here's how to use it properly:

Timing: File your complaint within 12 months of the denial. (The sooner the better, though.)

How to Lodge:

1. Write to the insurer's Complaints Department
2. Mark the letter: "FORMAL COMPLAINT UNDER FCA RULES"
3. Reference your policy number, claim number, and the date of the denial
4. Explain why you believe the denial was wrong
5. Request a final response within 8 weeks

What to Say:

• "I am lodging a formal complaint about the denial dated [date]"
• Explain specifically why the denial doesn't match the policy
• Attach any new evidence (medical reports, letters from your doctor, treatment guidelines)
• Be factual and calm—not emotional
• State: "Please respond within 8 weeks as required by FCA rules"

Send It Properly:

• Registered mail with signature confirmation, OR
• Email with read receipt, OR
• Online via the insurer's complaints portal

Save proof of sending. You'll need it.

What Happens Next:

• The insurer acknowledges receipt (usually within 2-3 days)
• They review your complaint file (can take up to 8 weeks)
• They send a "Final Response" letter

The Final Response either:

• Accepts your claim (and issues payment)
• Upholds the denial and explains why
• Offers a partial settlement

If they uphold the denial, you now have the right to escalate to the FOS.

Step 3: Escalate to the Financial Ombudsman Service (FOS)

This is where your real power lies. The FOS is independent, free, and impartial. They have authority over the insurer.

Who is FOS? The Financial Ombudsman Service is the UK's independent complaint resolver for financial services. They're not funded by insurers (they're funded by a levy on the industry). They handle around 200,000 complaints per year.

When Can You Use FOS?

• After the insurer has given you a Final Response, OR
• 8 weeks have passed since you lodged your complaint and the insurer hasn't responded

How to Lodge with FOS:

1. Visit the FOS website (financial-ombudsman.org.uk)
2. Complete their online form or print and post a paper form
3. Include: your name, policy number, claim number, insurer name, what happened, why you disagree with the decision
4. Attach: the denial letter, your internal complaint letter, the Final Response, and any supporting evidence
5. Submit

No fee. No lawyers required. No catch.

What Happens:

• FOS receives your case
• They may ask you or the insurer for more information
• An ombudsman reviews the case
• They issue a decision (binding on the insurer, not binding on you—you can reject it and pursue legal action, though that's rare)
• If they rule in your favour, the insurer must pay your claim plus compensation

Timeline:

• Cases usually take 2-6 months, sometimes longer if they're complex
• FOS aims to resolve 80% within 6 months
• You'll be kept updated throughout

Step 4: Use the IPID (Insurance Product Information Document)

Here's a secret that swings many appeals: the IPID.

When you bought your insurance, the seller (insurer or broker) was legally required to give you an IPID. This document explains exactly what the policy covers, in plain language.

If your IPID said the condition or treatment was covered, but the insurer is now denying it, you have a strong case. The IPID is a legal contract—insurers can't ignore it.

Find your IPID. If the coverage is mentioned there but the insurer is denying it, emphasize this in your appeal: "The IPID document provided at point of sale stated [coverage]. The denial contradicts this."

Common UK Denial Reasons—And How to Fight Them

"Pre-existing condition": The insurer says your condition existed before the policy started. Counter with: doctor's letter confirming the condition date, medical records showing when symptoms began, policy wording proving you disclosed what you should have.

"Not medically necessary": The insurer claims the treatment wasn't justified. Fight back with: doctor's letter explaining clinical necessity, treatment guidelines (NICE, BMA), evidence that similar patients receive the same treatment.

"Excluded by policy": They claim the policy specifically excludes the type of treatment. Counter with: policy wording that contradicts this, evidence of industry standards, IPID clarification.

"Waiting period": For some policies, certain conditions have waiting periods. This is hard to overturn unless the insurer failed to make the waiting period clear at point of sale.

"Insufficient claim documentation": Ask exactly what's missing. Then provide it. If the insurer is vague, that's a negotiation point.

What Evidence Wins FOS Cases?

Don't just argue—prove it. Gather:

Medical Evidence:

• Doctor's letter supporting your claim
• Medical records and test results
• Treatment guidelines (NICE, BMA) supporting the treatment
• Evidence the condition was diagnosed before the exclusion period

Policy Analysis:

• Highlighted policy wording supporting your coverage
• IPID documentation
• Communications from your broker (if used) about what was covered
• Terms and conditions vs. what you were told

Communication Records:

• Emails or letters showing what you told the insurer
• Proof of how the insurer communicated with you
• Timeline of events

Comparable Cases:

• Evidence that similar claims have been approved by the same insurer
• Industry precedents

The 8-Week Rule: Your Key Weapon

Here's a powerful tactic: if your insurer doesn't respond within 8 weeks of your formal complaint, you can immediately escalate to FOS without waiting for a Final Response.

Many insurers rely on delays to wear people down. Don't let them. At the 8-week mark, go to FOS. You don't have to wait for the insurer's Final Response.

Track this carefully:

• Week 0: You lodge your formal complaint
• Week 8: If no response, escalate to FOS

FOS takes this seriously. Missing the 8-week deadline is a violation that FOS will hold against the insurer.

What If You Used a Broker?

If you bought the insurance through a broker, your broker has a responsibility to you. If the broker:

• Misrepresented the coverage
• Failed to explain exclusions clearly
• Sold you an unsuitable policy

...then the broker may be liable, even if the insurer is right to deny the claim under policy wording.

You can escalate a complaint against the broker to FOS separately. This opens another avenue for compensation.

Timeline and Expectation Setting

• Internal complaint: 8 weeks
• FOS escalation: 2-6 months
• Total: 4-8 months in most cases

In the meantime:

• Don't pay disputed medical bills if you can avoid it
• Keep all communications with the insurer
• Don't accept the insurer's first decision as final

Writing a Winning Appeal Letter

Your appeal is your chance to convince the insurer (or FOS later) that they got it wrong. It needs to be:

• Clear: Simple sentences, no jargon
• Specific: Reference your policy clause, your medical evidence, the regulation they've breached
• Calm: Professional tone, not emotional
• Evidenced: Backed by documents, medical reports, or policy language

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

We'll analyze your denial, your policy, and your medical records, then generate a professional letter tailored to FCA and FOS requirements. You review it, send it, and watch your insurer take you seriously.

Key Checklist Before Escalating

• I have a full written explanation of the denial
• I have filed a formal complaint and received the Final Response
• I have copies of my policy and IPID
• I have gathered all medical evidence
• I have proof the insurer is wrong (policy wording, guidelines, doctor's letter)
• I have proof of how I sent my complaint (registered mail, email receipt)
• I know FOS's website and contact details
• I have checked the 8-week deadline from my complaint

The UK system is designed to protect 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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Ready to fight your denial? ClaimBack analyses your case and writes a professional appeal letter in minutes — Start Free →