Insurance Appeal Deadlines: Don't Miss Your Window to Fight Back

When insurance denies your claim, you have a limited window to appeal. The deadline depends on your country and sometimes your insurance type. Miss the deadline, and you lose your right to appeal forever. You cannot get a second chance.

Understanding your specific deadline is critical. Here's how to find yours and ensure you don't miss it.

USA Appeal Deadlines

In the United States, deadlines vary by claim type and insurance plan.

Group Health Insurance (Employer-Based)

Internal appeal: You have 180 days from the date you receive the denial letter to file an internal appeal with your insurer.

External review: If insurance denies your internal appeal, you have 4 months from the date of the internal appeal denial to request external review. External review must be completed within 30 days (72 hours for urgent/emergent care).

Individual Health Insurance (ACA-Compliant)

Internal appeal: 180 days from the denial letter date.

External review: 4 months from the internal appeal denial.

Medicare

Redetermination: 120 days from the denial letter.

Reconsideration: 180 days from the redetermination denial.

Administrative Law Judge (ALJ) Hearing: 60 days from the reconsideration denial.

Medicaid

Deadlines vary by state, typically:

• Internal appeal: 30-90 days
• Fair hearing request: 30-90 days from the internal appeal

Check your state's Medicaid website for specific deadlines.

Workers' Compensation

Deadlines vary by state. Generally:

• Appeal: 30 days from the denial letter
• Hearing request: 30-60 days

Check your state's workers' comp rules.

United Kingdom Deadlines

FCA-Regulated Insurers

Complaint to insurer: Should be responded to within 8 weeks (or 4 weeks if you escalate complaint after 2 weeks).

Escalation to Financial Ombudsman Service (FOS): You must file within 6 years of the event that caused the complaint, or 3 years from when you discovered the loss (the "discovery rule"). If the insurer provides a final response rejecting your complaint, file with FOS within 6 months of that response.

Australia Deadlines

Private Health Insurance

Complaint to insurer: They must respond within 30 days.

Escalation to Australian Financial Complaints Authority (AFCA): File within 2 years from the date of the event, or 2 years from when you discovered the loss.

General Insurance (including travel, car, home)

File AFCA complaint within 2 years of the event or discovery.

Singapore Deadlines

Insurance Company Complaint

Internal appeal: File with the insurance company. Respond required within 4 weeks of receipt.

FIDReC Complaint: File with the Financial Industry Disputes Resolution Centre within 1 year of the denial letter.

Hong Kong Deadlines

Insurance Authority

Complaint to insurer: They must respond within 4 weeks.

Escalation to Insurance Authority (IA): File within 3 years of the event that caused the complaint.

Insurance Arbitration (IARB): For disputes under HK$600,000, file within 3 years.

Malaysia Deadlines

Ombudsman for Financial Services (OFS)

Internal appeal to insurer: They must respond within 30 days.

OFS Complaint: File within 2 years from the date you became aware of the loss.

What "Deadline" Means Exactly

The deadline is when you must file your appeal, not when you must receive a response.

Important distinctions:

• Filing deadline: When YOU must submit your appeal (what matters for the deadline)
• Response deadline: How long insurance has to respond (different timeline)

You miss the deadline if your appeal isn't received by the deadline date, regardless of when insurance responds.

How to Calculate Your Deadline

If the deadline is "180 days from the denial letter":

1. Find your denial letter date
2. Count 180 days forward
3. That's your deadline

If you received the denial on June 1, your 180-day deadline is November 28.

If the deadline is "by a certain date" (like "by December 31"), that date IS your deadline.

What Happens If You Miss the Deadline

You lose your right to appeal. Most regulators have no exceptions to appeal deadlines. Even if insurance wrongly denied your claim, if you miss the deadline:

• You cannot file an internal appeal
• You cannot escalate to a regulator
• You have no legal recourse (except potentially a lawsuit, which is expensive)

Missing a deadline can cost you thousands or tens of thousands of dollars.

Extensions and Exceptions

Some regulators allow deadline extensions in limited circumstances:

USA (ACA Plans)

Exceptions exist for:

• Lack of proper notice of the deadline
• Severe mental or physical incapacity
• Call center/system errors preventing filing

Request an extension in writing with explanation and supporting evidence.

FOS (UK)

Can extend deadlines in exceptional circumstances but rarely do. Request must be made before the deadline with compelling justification.

AFCA (Australia)

Can accept complaints after the deadline in limited circumstances (lack of notice, hardship, etc.). Request in writing explaining why.

FIDReC (Singapore)

Limited discretion to extend. Request in writing explaining hardship or exceptional circumstances.

Extensions are difficult to obtain. Don't count on them—file by the deadline.

Strategic Timing: Don't Wait Until the Last Day

Although you have up to the deadline to appeal, don't wait.

Reasons to appeal early:

• Insurance may process faster if they see active pursuit
• You get more time to address any issues in the appeal
• If you miss a deadline, an early appeal shows good faith
• Regulators are more sympathetic to people who act quickly
• The longer you wait, the more evidence may be lost

Best practice: Appeal within 2 weeks of receiving the denial.

If You Think You Missed the Deadline

All hope is not lost. Try these options:

Request for Reinstatement or Reconsideration

Write to your insurance company and your regulator explaining:

• You missed the deadline due to [specific reason: illness, hardship, lack of notice, language barrier, etc.]
• You're now providing the appeal
• Request reinstatement of your appeal rights

Some regulators will reinstate in cases of genuine hardship.

Legal Consultation

Consult a lawyer about:

• Whether the deadline was properly communicated
• Whether exceptions apply in your situation
• Whether a lawsuit is feasible

Some lawyers handle these cases on contingency.

Contact Your Regulator Directly

Explain your situation to your country's insurance regulator. They may have discretion to help in exceptional circumstances.

Deadlines by Country: Quick Reference

Country	Agency	Deadline
USA (Group)	Insurer	180 days
USA (External Review)	External Reviewer	30-72 hours
UK	FOS	6 years from event, 3 years from discovery
Australia	AFCA	2 years
Singapore	FIDReC	1 year
Hong Kong	IA	3 years
Malaysia	OFS	2 years

Get Your Deadline in Writing

When you receive your denial letter, do this immediately:

1. Check the denial letter for the deadline
2. Write the deadline on a calendar (physical or digital with alerts)
3. Write down the insurance company and regulator name and contact info
4. Set a reminder for 1 week BEFORE the deadline to file

Don't rely on memory. Make it official.

Getting Help Before Your Deadline Expires

Appeal deadlines are unforgiving. Once they pass, your chance to appeal is gone forever. You need to act quickly and ensure your appeal is complete and persuasive.

ClaimBack helps you file your appeal quickly, ensuring you don't miss your deadline. We analyze your denial, prepare your appeal, and guide you to submission within your deadline window. You review, edit, and submit—you maintain full control while meeting your deadline.

Start your appeal now before your deadline expires →

---

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.

Ready to fight your denial? Start your free claim analysis →