Insurer cannot rely on policy terms after adviser’s misrepresentation
A policyholder’s godfather was recorded as her father despite the adviser knowing the true relationship, leading to a ruling that the insurer must pay the claim.
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Not every medical non-disclosure justifies claim rejection
The Appeal Tribunal found that an undisclosed diagnostic test was not material to the insurer’s assessment of the risk and ordered the claim to be paid.
Income protection dispute turns on 10% increase versus CPI cap
The Appeal Tribunal found that voluntary pre-claim benefit increases were distinct from post-claim escalation and could not be used to support a fixed 10% increase.
Life Division complaints rise 18.8% as funeral disputes dominate
The division recorded more formal investigations in 2025, but improved turnaround times and secured almost R300 million for complainants.
NFO rules cancer claim turns on disease, not confirmation date
The life insurer could not rely on the date of the pathology report to deny cover after premiums had already lapsed.
When insurance claims are declined: how exclusions work
A complaint reviewed by the National Financial Ombud Scheme highlights how exclusions linked to unlawful conduct are assessed.
NFO’s Life Division recovers over R202m for consumers in 2024
Complaints about life-benefit payouts climbed to 36% of the Division’s cases, from 34% in 2023.
Does ‘sitting on the mattress’ matter? Ombud rules on insurance policy dispute
The NFO decided that failing to follow customary mourning rituals did not prevent the recognition of a customary marriage, awarding the claim based on fairness.
