South Africa's Life insurance ombud recovered R140.6 million for beneficiaries since January
Denise Gabriels, Lead Ombud of the Life Insurance Division at the National Financial Ombud Scheme says people can seek assistance if a insurer has unfairly denied a life insurance claim.
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Dealing with bereavement is a challenging time for all families and life insurance matters can make the situation more difficult, however complaints can be taken to the Life Insurance Ombud at the National Financial Ombud Scheme (NFO).
The Life Insurance division offers free, independent assistance to beneficiaries who feel an insurer has unfairly declined a life insurance claim.
According to a statement from the NFO, the division has, from January 2025 to date, recovered a total of R140.6 million in respect of all claims including declined claims that were reversed, and compensation awarded for poor service.
Denise Gabriels, Lead Ombud of the Life Insurance Division of the NFO, said: “Our mission is to resolve financial services complaints fairly, impartially, and efficiently. We operate independently and without fear or favour, always guided by our values of excellence, integrity, passion, and vision.
“Sometimes our interventions mean that claims once declined are paid in full, delivering life-changing outcomes for families.
“Since the beginning of this year, our interventions have resulted in millions of rand being paid back to complainants, alongside additional compensation in cases of poor service. Beyond the numbers, these outcomes carry profound personal impact.”
Gabriels cited a recent final ruling that ordered Metropolitan Life to pay a funeral claim of R20 000, which was initially declined on the grounds that the deceased did not qualify as a parent under the policy.
The case centred on a misrepresentation by a Metropolitan financial advisor, who had knowingly listed the deceased (described by the policyholder as her godfather and mother’s ex-partner) as her “father” during the policy application.
The insurer argued that the insured did not meet the definition of a parent in the policy contract and that the policyholder should have verified this upon receiving the documents.
The case was considered in a meeting of adjudicators chaired by the Lead Ombud who ruled that the advisor’s conduct created a legitimate expectation that the cover was provided.
Citing long-standing legal principles, the ruling stated that a party cannot benefit from its own error at the expense of another and Metropolitan accepted the decision and paid the benefit in full.
“An insurer cannot escape liability by pointing to a policyholder’s oversight if the policy was issued based on incorrect information provided by its own representative. This ruling serves as a critical reminder to insurers of their obligations in ensuring transparent and accurate policy information and reinforces the protection of policyholders.
“On the other hand, consumers must answer questions at application stage fully and honestly. Always request and keep a copy of your policy document and read the terms and conditions carefully,” Gabriels added.