Saudi health insurance appeals: retrospective analysis of 38 published judicial precedents

A retrospective analysis of 38 published judicial precedents found that most appealed Saudi health insurance disputes concerned medical coverage, patients were the most frequent plaintiffs, and appeal committees affirmed 76.3% of first-instance verdicts. Among the 38 cases, defendants were ultimately held liable in 26 (68.4%), while plaintiffs received full compensation in 15 (39.5%), partial compensation in 11 (28.9%), and no compensation in 12 (31.6%).

The study, published in Frontiers in Public Health, used a retrospective design and systematic content analysis of appealed health insurance precedents from Saudi Arabia between 2015 and 2024. Investigators identified 96 health insurance records across three cumulative editions published by the General Secretariat of the Committees for Resolution of Insurance Disputes and Violations, excluded 58 duplicates and analyzed the remaining 38 unique precedents. Two researchers independently extracted the data, with a third senior researcher resolving discrepancies by consensus.

The precedents covered civil and administrative disputes involving medical insurance and medical malpractice policies. Extracted variables included final verdict, compensation ratio, geography, clinical specialty, plaintiff and defendant characteristics, complaint type, case duration, first-instance verdict and appeal decision. The compensation ratio was calculated as compensation awarded divided by the amount requested, multiplied by 100; cases were classified as rejected at 0%, partially compensated above 0% but below 100%, and fully compensated at 100%. Descriptive statistics and Fisher’s exact tests were used to examine the data.

Patients filed 21 cases (55.3%), healthcare providers filed 11 (28.9%), and insurance companies filed two (5.3%). Insurance companies were the defendant in 36 cases (94.7%). Medical insurance policies accounted for 25 precedents (65.8%), while medical malpractice policies accounted for 13 (34.2%). Complaints about lack of insurance coverage were the most frequent, appearing in 21 cases (55.3%), followed by violations of insurance policy in seven (18.4%), compensation-related disputes in five (13.2%), public policy issues in three (7.9%) and insurance premiums in two (5.3%).

The Western Region accounted for the largest share of hearing locations, with 16 cases (42.1%), followed by the Central Region with eight (21.1%), Southern Region with five (13.2%) and Eastern Region with three (7.9%); the location was not reported for six cases. Surgery and obstetrics and gynecology were the most frequently represented specialties, each appearing in nine cases (23.7%). These geographic and clinical distributions describe the selected precedents and do not establish the regional or specialty distribution of all Saudi health insurance disputes.

First-instance committees found defendants liable in 29 cases (76.3%) and not liable in nine (23.7%). The appeal committee affirmed 29 verdicts (76.3%) and reversed nine (23.7%), leaving final outcomes in which defendants were liable in 26 cases (68.4%) and not liable in 12 (31.6%). Requested compensation ranged from SAR 1,500 to SAR 1,702,500, with a mean of SAR 164,893.8 (SD SAR 300,992.9) and a median of SAR 57,687.8. Awarded compensation ranged from SAR 0 to SAR 500,000, with a mean of SAR 57,917.2 (SD SAR 104,660.1) and a median of SAR 16,787.8.

Most of the selected disputes were completed within one year or less: 36 of 38 (94.7%) were resolved within that period, while two took more than one year. The study did not include pending, settled or unpublished disputes, case-complexity measures or comparative operational benchmarks, so its duration results cannot establish that the committees were more efficient than other dispute-resolution systems. The authors noted that electronic dispute management, accelerated tracks and electronic session scheduling were introduced by the General Secretariat beginning in 2016, but the analysis did not directly test their effect on case duration.

Fisher’s exact tests found no statistically significant association between final verdict and plaintiff category (p = 0.35), policy classification (p = 1.00) or complaint type (p = 0.12). Compensation ratio was likewise not significantly associated with plaintiff category (p = 0.23), policy classification (p = 0.51) or complaint type (p = 0.24). Policy classification was associated with plaintiff category (p < 0.001) and complaint type (p = 0.004): 20 of 21 patient-filed cases involved medical insurance, while all 11 provider-filed cases involved medical malpractice policies. The authors cautioned that the sample size limited statistical power, making the outcome-related non-significant results inconclusive rather than evidence of no underlying association.

The selected precedents provide a baseline for the judicial handling of health insurance disputes but are not a census of filed cases. General Secretariat records showed that health insurance disputes submitted to the committees increased from 119 in 2016 to 818 in 2024; in 2024, they represented 3.21% of 25,515 insurance disputes submitted and ranked second to motor insurance. The authors identified greater transparency and systematic publication of precedents, clearer coverage and exclusion terms, standardized documentation of claim-denial reasons, and coordination between the Insurance Authority and Council of Health Insurance as priorities as the sector expands.

Subject of Research: Retrospective analysis of 38 published Saudi health insurance appeal precedents from 2015–2024

Article Title: Patterns and outcomes of health insurance disputes in Saudi Arabia: an analysis of appealed judicial precedents

Article References: Alotaibi, S., Alhawdar, G., & Almubarak, S. (2026). Patterns and outcomes of health insurance disputes in Saudi Arabia: an analysis of appealed judicial precedents. Frontiers in Public Health, 14, Article 1908431. https://doi.org/10.3389/fpubh.2026.1908431

Image Credits: AI Generated

DOI: 10.3389/fpubh.2026.1908431

Keywords: Saudi Arabia, health insurance, insurance disputes, judicial precedents, legal appeals, coverage denials, compensation, claim decisions, Patterns, outcomes, health, insurance