Insurance Company Not Responding to Your Appeal? Here's What to Do

Insurance Company Not Responding to Your Appeal? Here's What to Do

You submitted your insurance appeal weeks ago. No response. You've called, you've emailed, and you're getting silence or endless runarounds. This is not just frustrating — it may be illegal. Insurance companies have legally mandated response timeframes for appeals in most jurisdictions, and failure to respond triggers additional rights that you can use.

Here's what to do when your insurer goes silent.

Why Insurers Don't Respond (and Why It's Significant)

Insurance companies sometimes fail to respond to appeals for several reasons:

• Administrative overwhelm (legitimate but doesn't excuse violating legal deadlines)
• Strategic delay (hoping you'll give up or the deadline passes)
• Lost documentation (your appeal wasn't properly logged or forwarded)
• Internal routing errors

Regardless of the reason, failing to respond within the legally required timeframe is itself a violation — and creates additional rights for you.

Required Response Timeframes by Jurisdiction

United States (Health Insurance)

Under ACA regulations (and ERISA for employer plans):

• Standard internal appeal: The insurer must decide within 60 days of receiving your appeal
• Urgent/expedited internal appeal: The insurer must decide within 72 hours
• External review request: After you file, the IRO must decide within 45 days (standard) or 72 hours (expedited)

If the insurer fails to decide within the required timeframe:

• The denial is considered "deemed denied" — you can request external review immediately without waiting further
• Under federal regulations, you do not need to wait for the internal appeal decision if the insurer fails to decide within the required period

State laws may impose even shorter deadlines. Check your state's insurance regulations.

United Kingdom

Under FCA rules (DISP):

• Insurers must acknowledge complaints within 5 business days
• Insurers must issue a Final Response within 8 weeks
• If 8 weeks pass without a Final Response, you can refer to the Financial Ombudsman Service (FOS) immediately

Australia

Under AFCA rules:

• Insurers must acknowledge complaints within 24 hours
• For complex complaints, resolution should occur within 45 days for general insurance and 45 days for life insurance
• If the insurer fails to respond in time, you can escalate to AFCA or PHIO immediately

Singapore

Under MAS guidelines:

• Insurers should acknowledge complaints within 2 business days
• Resolution should occur within 14 days (simple) to 8 weeks (complex)
• After 6 months (or when the insurer issues a final response), you can file with FIDREC

Malaysia

Under BNM guidelines:

• Insurers must acknowledge complaints within a reasonable timeframe
• Resolution should occur within 60 days for standard complaints
• After 60 days without resolution, you can escalate to the OFS

What to Do When Your Insurer Doesn't Respond

Step 1: Document Every Attempt to Contact the Insurer

Create a detailed log of:

• Every call (date, time, representative name, what was said)
• Every letter sent (with certified mail receipt number)
• Every email sent (keep copies)
• Every response (or non-response) received

This documentation is essential for regulatory complaints and, if necessary, legal action.

Step 2: Send a Formal Follow-Up Letter

Send a written letter (certified mail) to the insurer's appeals department and simultaneously to the insurer's CEO/President and General Counsel (senior executives). This letter should:

"This letter is written to formally notify [Insurer Name] that no response has been received to my appeal letter dated [Date]. Under [applicable law/regulation], you are required to respond to my appeal within [60 days/8 weeks/applicable period]. As of today, [X] days have passed without any decision or substantive communication.

Please be advised that I will take the following actions if I do not receive a substantive response within [7] business days:

1. File an immediate complaint with [applicable regulator]
2. Request external review of this decision (treating the failure to decide as a deemed denial)
3. Consult legal counsel regarding additional available remedies

I request your immediate attention to this matter."

Step 3: Request External Review Immediately (US)

If the ACA/ERISA mandated 60-day decision period has passed without a response, request external review immediately. Under federal regulations, the insurer's failure to decide within the required period is treated as a final adverse determination — you don't have to wait longer.

Contact the insurer and request external review initiation, citing the failure to decide within the required period.

Step 4: File a Regulatory Complaint

File a complaint simultaneously with:

US: Your state's Department of Insurance (find at naic.org). State insurance regulators take response deadline violations seriously and can impose sanctions. File a complaint online — most state DOI websites have online complaint portals.

UK: Financial Ombudsman Service (financial-ombudsman.org.uk). After 8 weeks without a Final Response, you can file with the FOS regardless of whether the insurer has resolved the complaint.

Australia: PHIO (ombudsman.privatehealth.gov.au) or AFCA (afca.org.au). If the insurer has exceeded required response times, AFCA can take jurisdiction.

Singapore: MAS (mas.gov.sg/complaints) and FIDREC (fidrec.com.sg) — you can file with FIDREC 6 months after the dispute arose if the insurer hasn't resolved it.

Malaysia: OFS (ofs.org.my) or BNMLINK (bnmlink@bnm.gov.my).

Step 5: Escalate to Senior Management

In parallel with regulatory complaints, write directly to the insurer's CEO or President and the Head of Claims. Senior executives respond differently to complaints than frontline claims staff. Your letter should:

• Briefly explain the claim and the denial
• State the number of days without response and the legal deadline that has been violated
• State that you have filed a regulatory complaint and will take additional legal action if necessary
• Request that a senior manager personally review and respond to your appeal within [7] days

Step 6: Contact Your State's Insurance Commissioner (US)

Your state's Insurance Commissioner is an elected or appointed official who has political accountability for insurer conduct. Many Insurance Commissioner offices have consumer assistance divisions that directly assist with complaints and apply pressure on insurers. A call or letter to the Insurance Commissioner's office — specifically noting that the insurer has violated the mandated response deadline — often produces faster results than other channels.

Step 7: Consult an Attorney

If the insurer continues to be unresponsive to a legitimate claim:

• In the US, consider consulting an attorney specialising in insurance bad faith
• Insurance bad faith occurs when an insurer unreasonably delays or denies a legitimate claim
• Remedies for bad faith can include the value of the claim, consequential damages, and in some states, punitive damages
• Many insurance attorneys offer free consultations and work on contingency

Step 8: Consider Media and Social Media Pressure (Last Resort)

For clear, documented cases of insurer non-responsiveness:

• Local news media often run consumer protection stories about insurer misconduct
• Social media posts (particularly on Twitter/X, LinkedIn, and Facebook) tagging the insurer's official accounts sometimes produce rapid responses
• Patient advocacy organisations for your specific condition may have experience amplifying similar cases

Use this option judiciously — ensure your facts are accurate and documented before going public.

Preventing Non-Response Issues

Always send appeal letters by certified mail: Creates proof of delivery and a legal record.

Follow up in writing after calls: After any telephone contact with the insurer, send a brief email or letter summarising what was discussed and what next steps were agreed.

Keep copies of everything: A complete paper trail is your protection if non-response issues arise.

Note all deadlines: Know the legal response deadline applicable to your appeal (60 days for ACA health insurance, 8 weeks for FCA-regulated UK insurers, etc.) and mark your calendar.

Conclusion

An insurer that doesn't respond to your appeal may actually be doing you a favour — because the failure to respond within the legally required period triggers additional rights, including the right to immediate external review. Document everything, file regulatory complaints, and request external review. Use ClaimBack at claimback.app to generate a professional appeal letter with clear escalation language that makes clear you know your rights.

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Related Reading:

• How to Negotiate with Your Insurance Company
• How to Write an Insurance Demand Letter
• Insurance Bad Faith: Your Rights When an Insurer Wrongfully Denies
• How to Find Your Insurance Ombudsman