Claim Denial Rates by Line of Business (2026)

How often do insurers deny claims? The answer changes substantially depending on the line of business - and what the dataset counts as a denial.

A rejected medical bill, a motor claim closed below the deductible, and a declined travel insurance claim can all appear in discussions of unpaid claims. They describe different events, with different implications for customers and insurers.

The most useful claim denial rate statistics make those differences visible. This article compares the evidence available in September 2026 across health, auto, homeowners, travel, home warranties and extended warranties. It also explains where the public data supports a benchmark and where it does not.

Claim denial rate statistics at a glance

The following figures should be read as separate benchmarks, rather than a ranking of which insurance line treats claimants best.

For the UK entries, subtraction uses rounded published acceptance figures. These are rejected claims relative to claims registered under the FCA’s reporting rules, not a final-outcome study of one submission cohort. Source: FCA value-measures definitions.

Start with the denominator

Before comparing insurance claim rejection rates, establish what sits above and below the line in the calculation.

Post-service claim denial rate measures rejected claims after a service has been provided. Prior authorization denial rate measures decisions on requests for approval before the relevant care. Claims closed without payment describes an outcome that can arise for several reasons, including a covered loss falling below the deductible.

A partial payment adds another complication. A customer may receive some of the amount requested while disputing the rest. Depending on the reporting framework, that can count as an accepted claim even though it remains a source of dissatisfaction.

Timing matters too. Claims received this year can be paid next year. Claims rejected this year can have been registered in an earlier period. Without a consistent cohort or reporting-period method, a ratio can shift because the queue changed.

For an internal dashboard, define initial denial, final denial, partial acceptance, pending evidence and withdrawal separately. Then keep the definitions stable across reporting periods.

Health insurance claim denial statistics: substantial variation within the market

KFF’s March 2026 analysis found that HealthCare.gov insurers’ 2024 in-network denial rates ranged from 3% to 36%. These figures concern a defined ACA Marketplace population; they should not be generalized to every U.S. health plan or employer-sponsored arrangement. Source: KFF.

The range raises questions about administration, benefit design and business mix. It does not, on its own, explain which of those factors caused the difference.

KFF also found that administrative reasons accounted for 25% of reported in-network denial reasons. These reason categories do not provide a clean count of unique patients or services permanently left unpaid; the data can include repeated submissions and multiple reasons. Source: KFF.

That creates a useful operational distinction. A coverage exclusion needs a different response from an incorrect identifier, a coding issue, or a request for missing information. Combining them into one denial bucket makes it harder to see which work could have been avoided.

Appeals are an additional measure, with their own selection effect

Fewer than 1% of denied claims in the KFF analysis were appealed. Insurers upheld the original denial in 66% of internal appeal decisions. A denied original claim also does not necessarily mean the underlying service was never paid: a replacement submission may have been paid separately. Source: KFF.

Low appeal activity cannot establish that the remaining decisions were correct. Equally, the outcomes of appealed cases cannot be applied to every denied claim. Cases selected for appeal are a different population.

Claims leaders need both measures: how often a decision is challenged and what happens when it is reviewed.

The 2026 update: new prior authorization data covers 2025

Public reporting is improving. KFF’s August 2026 analysis examined insurer-posted metrics for standard, non-urgent prior authorization requests in 2025. It reported these enrollment-weighted denial rates:

Source: KFF’s analysis of 2025 prior authorization disclosures.

The analysis used 14 distinct insurers across the segments and represented approximately 69%, 54% and 74% of enrollment in those respective markets. Its results are weighted by enrollment, rather than calculated from a complete national count of requests. Prescription drugs are excluded. Source: KFF.

For comparison, a separate KFF analysis of CMS’s broader 2024 Medicare Advantage data found 7.7% of prior authorization requests were fully or partly denied; 11.5% of denials were appealed, and 80.7% of appeals were fully or partly overturned. Source: KFF’s 2024 Medicare Advantage analysis.

It would be misleading to treat 7.7% and 12% as a straightforward year-over-year increase. The sources use different populations, request groupings and weighting methods.

The new disclosures expand what professionals can examine. They do not remove the need to read the methodology.

Auto and home: unpaid does not automatically mean denied

An analysis published by the Casualty Actuarial Society’s Actuarial Review estimated that the U.S. private passenger auto share of claims closed without payment increased from 24.1% in 2020 to 25.6% in 2024. The authors derived these estimates from the NAIC’s Market Conduct Annual Statement scorecard. Source: Actuarial Review.

The article calls this a denial measure. For comparison purposes, retaining its underlying definition - closed without payment - is more informative.

Consider a collision with a repair estimate below the policyholder’s deductible. A file closed with no indemnity payment does not necessarily mean the insurer disputed coverage. That outcome should be distinguishable from a claim rejected under an exclusion.

The UK motor figure in the overview uses a different reporting system. It should not be placed beside the U.S. estimate as evidence that one country’s insurers deny claims 25 times as often.

For motor portfolios, useful comparisons separate first-party physical damage from liability, identify the applicable deductible, and distinguish full rejection from a dispute over repair scope or valuation. Otherwise, changes in coverage mix can look like changes in claims behavior.

Home insurance: compare definitions before comparing percentages

The same Actuarial Review analysis estimated an increase in U.S. homeowners claims closed without payment from 29.8% in 2020 to 31.0% in 2024, excluding Citizens Property Insurance Corporation. Source: Actuarial Review.

The NAIC’s homeowners reporting instructions explicitly include below-deductible claims in the closed-without-payment category. They also include certain investigated claims where no relevant policy was in force. Source: NAIC homeowners data-call definitions.

That makes this a useful measure of claim outcomes, but an incomplete measure of coverage denials.

For UK home insurance, the FCA says inconsistencies in firms’ reporting mean its acceptance figures should be used cautiously. Source: FCA 2025 value measures.

An insurer investigating its own results should go deeper than the overall rate. Segment by peril, catastrophe event, deductible and policy version. Separate a water-damage exclusion dispute from an accepted claim where the final repair value remains contested.

The practical question is whether the reporting can explain the outcome - not simply display it.

Travel insurance claim denial rate statistics need benefit-level context

Travel combines several promises within one policy: cancellation, interruption, medical expenses, baggage and delay benefits. A single event can trigger more than one of them.

Under FCA reporting guidance, a claim with an accepted element and a rejected element is not treated as a wholly rejected claim. Some first contacts about uncovered actual losses are counted as both registered and rejected. Source: FCA REP019 guidance.

This is why acceptance alone does not show whether a customer received everything requested.

Travel claims teams should preserve both the overall file outcome and each benefit decision. That allows a cancellation coverage issue to be analyzed separately from a medical reimbursement delay or a baggage sublimit dispute.

The same distinction helps product development. Repeated disagreements over one benefit may identify unclear eligibility questions or evidence requirements that can be improved without changing the rest of the package.

Warranties: where the evidence runs out

For U.S. home warranties, this research did not establish a current, independently verifiable industry-wide denial rate with a consistent numerator, denominator and reporting population.

That gap should be stated plainly.

Home warranties also need to be separated from homeowners insurance and new-home builder warranties. The FTC describes a typical home warranty as a separately purchased service contract covering specified repairs or replacements, such as appliances and air-conditioning systems. Source: FTC guidance on home warranties.

A provider’s customer review score cannot supply the missing denial rate. Neither can the number of complaints without knowing how many service requests the provider handled and which requests were eligible for coverage.

For procurement or benchmarking, ask the provider for completed service requests, full and partial declines, repair authorizations, cash settlements and reopened cases. Request the definitions alongside the figures. An approval rate calculated only after an initial eligibility screen may exclude precisely the cases a buyer wants to understand.

Extended warranty claim denial rate statistics: define the product first

The evidence gap is similar for an all-market U.S. extended warranty denial rate. Vehicle service contracts, appliance plans and electronics protection products do not form one standardized claims population.

The FTC distinguishes separately purchased extended warranties or service contracts from warranties included with a product. Coverage and contractual obligations vary. Source: FTC warranty guidance.

Before using a provider’s percentage, establish what counts as a claim. Is it the first service request, an approved diagnostic visit, a repair authorization, or a completed repair? Are accidental damage and mechanical breakdown included in the same denominator?

These are substantive questions. A plan can authorize a technician visit without approving the requested replacement. A repair may be accepted while uncovered components remain payable by the customer.

Until those outcomes are separated, an apparently precise approval or denial rate can conceal more than it explains.

Build a denial dashboard that leads to better decisions

External denial statistics are most useful when they sharpen an internal view, the same lesson the wider insurance claims data keeps producing.

A practical dashboard should include:

• Initial and final outcomes: link resubmissions, appeals and reopened files to the original claim.
• Reason codes: distinguish exclusions, missing evidence, administrative errors, deductibles and suspected fraud.
• Partial decisions: retain benefit-level or claim-line outcomes alongside the overall file status.
• Time to resolution: show the full elapsed journey, including time waiting for information.
• Review results: track reversals and identify whether they follow new evidence or correction of an earlier decision.
• Customer impact: examine complaints, repeated contacts and payment shortfalls alongside acceptance.

Use both claim counts and monetary amounts. A portfolio with many small accepted claims and a few large contested losses can look very different depending on the measure.

Where AI and automation fit

Automation can be evaluated for tasks such as checking document completeness, identifying inconsistent data and routing cases for specialist review. Those tasks have observable outcomes: fewer repeated requests, less rework and shorter queues.

Measure those outcomes before treating automation as an improvement. In particular, a model-generated recommendation should remain traceable to the policy wording and evidence considered, with appropriate human review for adverse or complex decisions.

For insurers updating their operating model, Openkoda provides configurable workflows, claims administration and reporting. A useful implementation starts with agreed decision categories and a record of how a claim moved between them.

Better denial reporting gives claims, underwriting and product teams a shared account of what happened. That is what turns a percentage into something they can improve.