Insurance Claim Rejected?
The NFO Can Help
Receiving a letter saying your insurance claim has been ‘rejected’ can be incredibly frustrating.
Whether your claim is about a vehicle accident, a damaged home, a cell phone theft or maybe even a disputed life insurance claim, many consumers assume the insurer’s decision is final.
That’s not always the case.
South Africa’s National Financial Ombud Scheme (NFO) offers consumers a free, independent way to have insurance disputes reviewed before going the expensive legal route, and fighting over the matter at court for months and years.
Types Of Insurance Disputes
The NFO has two divisions that deal specifically with two types of insurance complaints.
Their Life Insurance Division considers disputes involving life insurance, funeral policies, disability cover, dread disease (critical illness) cover, income protection, investment linked life products and, where applicable, retrenchment cover.
Their Non-life Insurance Division handles complaints relating to motor vehicle insurance, homeowners and household contents insurance, cell phone and travel insurance, credit protection insurance, commercial insurance, as well as many other personal non-life insurance products.
More Than Rejected Claims
Not every complaint heard by the NFO has to specifically be about a rejected claim.
There are other important things that they can consider and ensure are being done correctly.
The NFO regularly help with disputes involving partial settlement offers, policy cancellations, policy wording, excessive excesses, underinsurance, misrepresentation and non-disclosure allegations, delays in handling claims or even just poor service.
On the life insurance side, common complaints they deal with include rejected death claims, repudiated disability claims, waiting periods, policy lapses, premium disputes, misrepresentation allegations and certain beneficiary disputes. When considering a complaint, the NFO looks at the policy wording, any available evidence, relevant legislation and common industry practice to determine what is fair in the circumstances.
If you believe your insurer has treated you unfairly, your first step should always be to use the insurer’s own internal complaints process. If the matter cannot be resolved internally, then you can lodge a complaint with the NFO at no cost.
Consider Approaching the NFO For Help
Before giving up on a claim or other dispute with your insurer, remember that an independent review could provide a solution.
Knowing your rights and making use of the NFO can help ensure that insurance companies are held accountable and that you receive fair treatment.
