Patterns and outcomes of health insurance disputes in Saudi Arabia: an analysis of appealed judicial precedents
Year: 2026
Type: article
Abstract: Introduction: The expansion of health insurance systems has generated a rise in insurance disputes. Health insurance litigation can have negative consequences spanning beneficiaries, healthcare providers and broader healthcare systems. This dynamic is particularly relevant to Saudi Arabia as its health insurance system is experiencing rapid transformation and growth. Thus, the study analyzed patterns and outcomes related to health insurance disputes in Saudi Arabia. Methods: The study employed a retrospective analysis of 38 appealed judicial precedents related to health insurance in Saudi Arabia between 2015 and 2024. Data were extracted from published documents by the General Secretariat of the Committees for Resolution of Insurance Disputes and Violations. Extracted data included two dependent variables: final verdict and ratio compensation. The independent variables included variables related to the plaintiff, defendant, insurance policy as well as litigation-related variables. Data were analyzed using descriptive statistics and the associations between the dependent and independent variables were examined using the Fisher's Exact test. Results: The largest volume of the judicial precedents originated from the Western region with 16/38 precedents (42.1%). Patients were the primary plaintiffs (55.3%), while insurance companies predominated as defendants (94.7%). The majority of the disputes were related to medical insurance (65.8%), driven primarily by complaints regarding lack of insurance coverage (55.3%). The results indicated that most cases resolved within one year or less. The appeal committee affirmed most verdicts issued by first-instance committees. A total of 26/38 (68.4%) defendants were found liable and 15/38 (39.5%) of plaintiffs were awarded full compensation. Discussion: The study's finding reflects a high stability and conformity between committee levels. However, the heavy concentration of cases involving medical coverage denials and patient-led litigation underscores the critical need for clear regulations to minimize insurance conflicts. The findings highlight several implications for policymakers and healthcare practitioners as Saudi Arabia's health insurance sector continues to expand. Key priorities include enhancing the transparency and systematic publication of judicial precedents, clarifying coverage and exclusion terms in policy contracts, and standardizing the formal documentation of claim denial reasons.
Source: Frontiers in Public Health
Institution: Imam Abdulrahman Bin Faisal University
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7222950558