Appealing a Rejected Health Insurance Claim: How to Do It

You've received a notice that the claim you filed with your insurer was rejected, and it's not clear why — or whether there's anything you can do about it. A rejection is not necessarily the end of the road: in most cases you can ask the insurer to explain the decision, appeal it, and if needed, turn to additional bodies. This guide explains in plain language what is typically done when a health insurance claim is rejected, and stresses throughout that you should keep a copy of every document and piece of correspondence — because the exact process, wording, and timelines vary between insurers and between cases.

Why insurers reject claims

A health insurance claim can be rejected for a range of reasons, and it's worth knowing the common ones to understand your own case:

• Missing documents or referrals — for example a medical opinion, a treatment referral, or original receipts that weren't attached to the claim.
• Policy exclusions — the treatment or medical condition falls under the exclusions list of your specific policy.
• Treatment without prior approval — when the policy requires advance approval from the insurer and the treatment was received before it was obtained.
• A link to a pre-existing condition — when the claim is connected to a condition or diagnosis that predates the policy and was explicitly excluded.
• Treatment outside the network or terms — when the treatment was received at a facility or from a provider that doesn't meet the policy's conditions.

These are the commonly cited reasons, but every claim is assessed against your policy's specific wording and the circumstances of the case, so it's worth confirming the exact basis the insurer relied on.

The first step: contact the insurer in writing

When a rejection notice arrives, the typical first step is to contact the insurer in writing and ask for two things: the exact reason for the rejection, and the specific policy clause it's based on. A written request, rather than only a phone call, helps keep an organized record of every step in the process.

If the original submission wasn't complete or accurate, this is also a good time to make sure the claim was filed correctly in the first place — see our guide on how to file a health insurance claim for the typical steps, documents, and deadlines. If you don't have your full policy documents on hand to check the clause the insurer relied on, it's worth first getting your full policy documents and reading them carefully.

Alongside requesting the reasoning, it's also worth explicitly asking for a reconsideration of the decision — usually called an "internal appeal" or "review" — and attaching any medical document, opinion, or clarification that could support the claim. Keep a copy of every letter, email, and response you receive from the insurer, as they may be needed later in the process.

If it isn't resolved: filing a complaint with the Capital Market, Insurance and Savings Authority

When a direct approach to the insurer doesn't lead to a resolution, and you have reason to think the rejection isn't justified, there is an additional route: filing a complaint with the public inquiries unit of the Capital Market, Insurance and Savings Authority, the body that supervises insurers in Israel. The unit handles complaints against insurance companies, including cases of rejected claims.

This is an administrative route that can prompt the insurer to reconsider the claim, but it is not a substitute for legal action and doesn't guarantee a particular outcome. The process, required documentation, and timelines vary from case to case, so it's worth checking the current details with the Authority itself before filing.

If it's still unresolved: a lawsuit and the statute of limitations

If the complaint to the Capital Market, Insurance and Savings Authority still doesn't produce a satisfactory result, the remaining option is filing a civil lawsuit against the insurer. Before reaching that stage, it's important to know a critical time limit: the statute of limitations for a health insurance claim is commonly cited as three years from the insurance event — significantly shorter than the general seven-year civil limitation period.

The practical implication: don't assume you have years of "spare time" just because it's an insurance dispute. Ongoing correspondence with the insurer or the Authority doesn't necessarily stop the limitations clock, so it's important to track the timing and not wait until the last moment. We cover this in more depth, including important exceptions, in our separate guide on health insurance claim deadlines.

When it's worth consulting a lawyer

Not every rejection requires legal help — in many cases a clear written request to the insurer, followed if needed by a complaint to the Capital Market, Insurance and Savings Authority, is enough to resolve the dispute. That said, for a complex claim, a high-value claim, or a rejection resting on a disputed legal interpretation of a policy clause, it's commonly recommended to consult a lawyer experienced in insurance claims before taking further steps.

A lawyer can help assess the merits of the claim, help draft the request or appeal, and review the options available to you — including whether and when it's worth turning to the courts. The decision on whether to involve a lawyer, and at what stage, depends on the specific circumstances of the case.

How Ravit can help

Ravit helps you understand what your policy actually says, both before you file a claim and after a rejection. You send your policy documents on WhatsApp, ask in free language — for example "Was the treatment I received supposed to be covered?" or "What's the clause about a pre-existing condition?" — and get an answer grounded in your specific policy, with a pointer to the relevant clause so you can verify it yourself with the insurer. When the information is partial or ambiguous, Ravit says so honestly and flags low confidence instead of guessing.

The information in this article is general only and does not constitute legal, insurance, medical, or pension advice, and is not a substitute for reading your policy terms or consulting a licensed professional, including a lawyer. Processes, authorized bodies, and timelines may vary between insurers and between cases — always verify against your own specific policy and an authorized professional.