Claims help · Disputes and complaints
Your claim was rejected. Here’s how to escalate it to the National Financial Ombud
The ombudsman for short-term insurance in South Africa is now the National Financial Ombud. It’s free, it’s independent, and it only works well if you follow the steps in order.
The short-term insurance ombudsman is now the National Financial Ombud
Since 1 March 2024, the National Financial Ombud Scheme has handled short-term insurance disputes through its Non-life Insurance Division. It replaced four separate schemes: the Ombudsman for Short-Term Insurance (OSTI), the Ombudsman for Long-Term Insurance, the Ombudsman for Banking Services and the Credit Ombud. Anyone still searching for “OSTI” ends up in the same place. The NFO’s launch release (2024) describes it as a single, one-stop dispute service, and its FAQs confirm the service is free to complainants.
The scale is significant. In 2025, the NFO’s non-life division received 10,054 complaints and resolved 11,428. Its average turnaround improved to 105 working days, from 117 the year before (FAnews, 2026). Across all its divisions, the NFO opened 50,065 cases and returned almost R443 million to consumers (Daily Maverick, 2026).
Those numbers don’t mean every complaint succeeds. The ombud is impartial, and many rejections are upheld because the policy wording supports them. The process still depends heavily on what your insurer has to tell you when it says no.
When an insurance claim is rejected: what the letter must tell you
A South African short-term insurer must give you its decision in writing within 10 days of making it. If it rejects or disputes the claim, the letter must explain why in enough detail for you to challenge it. That duty comes from Rule 17.6 of the Policyholder Protection Rules (Short-term Insurance), 2017, which apply to every licensed short-term insurer.
Under Rule 17.6.3, the notice must tell you, in plain language:
- The reasons for the decision, in enough detail to dispute them.
- Your right to make representations to the insurer within a period of not less than 90 days after you receive the notice.
- How the internal escalation and review process works, which the insurer must have under Rule 17.5.
- Your right to complain to the relevant ombud, with contact details and any time limits.
- Any time limit in the policy for taking legal action, or the prescription period under the Prescription Act if the policy has none.
If you make representations, the insurer must reply in writing within 45 days (Rule 17.6.5). If it confirms the rejection, that reply must give its reasons and the facts behind the decision. If your letter is missing any of these elements, note it. A vague or incomplete rejection is itself something you can raise with the insurer and the ombud.
Once you know exactly what the insurer relied on, you can decide whether to challenge the facts, the interpretation of the wording, or both. That choice shapes everything that follows.
How to escalate a rejected insurance claim, step by step
The fastest route to a fair outcome is usually a well-documented internal challenge, followed by an NFO complaint only if that fails. The NFO’s own rules require it to check that you have used the insurer’s internal complaints process first. If you haven’t, it will normally send the complaint back to the insurer as a “premature complaint” (NFO Rules, 2024, Rule 7.3).
Ask for the reasons and the evidence in writing
If the letter is vague, ask the insurer to identify the specific clause relied on and to share the assessor’s report, photographs or other evidence behind its decision. Keep every reply.
Tip: keep a dated timeline of every call, email and promise. The NFO has criticised insurers that leave claimants without updates.Gather your own evidence
Collect your policy schedule and wording, the claim form, photographs, repair quotes, police or accident reports, maintenance records and any independent reports. For motor claims, our guide on what to do after a car accident lists the evidence that matters most.
Make written representations within the deadline
Write to the insurer’s claims escalation or complaints team within the period stated in your letter, which must be at least 90 days. Explain point by point why you believe the decision is wrong, and attach your evidence. Stick to facts and the policy wording.
Wait for the insurer’s review decision
The insurer must respond in writing within 45 days of receiving your representations. If it confirms the rejection, it must set out its reasons and the facts that informed the decision.
Lodge your complaint with the NFO
Use the NFO online complaint form, email, phone (0860 800 900) or a walk-in visit. Include the insurer’s name, your policy number, your contact details, a factual summary and copies of all correspondence (NFO, How to Complain). You can complain in any official language.
Respond promptly during the investigation
The NFO asks the insurer for a written response, usually within 21 working days, and may try conciliation or mediation. If the matter isn’t settled, it issues a recommendation. If either side rejects that, an ombud issues a formal ruling.
Decide whether to accept the ruling
If you accept a ruling, it is final and binding on both parties, subject to the insurer’s right to seek leave to appeal within 30 days. If you don’t accept it, you are not bound and can pursue the matter elsewhere.
Most of the work happens before you reach the ombud. A clear, evidenced internal challenge sometimes resolves the matter outright. If it doesn’t, the same bundle becomes the core of your NFO complaint.
The deadlines that matter
Missing a deadline is one of the few ways to lose a dispute you might otherwise have won. The table below brings together the time frames from the Policyholder Protection Rules and the NFO scheme rules. Always check your own letter and policy, which may set longer periods.
| Stage | Time frame | Source |
|---|---|---|
| Insurer notifies you of its decision | Within 10 days of deciding | PPR Rule 17.6.2 |
| You make representations to the insurer | Not less than 90 days after receiving the notice | PPR Rule 17.6.3(b) |
| Insurer answers your representations | Within 45 days of receiving them | PPR Rule 17.6.5 |
| Insurer responds to a first-time complaint the NFO passes on | Six weeks | NFO FAQs |
| Insurer gives the NFO its written response | Usually 21 working days | NFO, How to Complain |
| Outer limit to complain to the NFO | Three years from when you knew, or should have known, there was cause to complain | NFO Rule 4.2.2(e) |
| Object to a jurisdiction or dismissal decision | 30 days | NFO Rules 4.3.2 and 9.2.2 |
| Apply for leave to appeal a ruling | 30 days from the ruling | NFO Rule 10.2 |
There is one important protection. Under Rule 6.1 of the NFO Rules and section 216 of the Financial Sector Regulation Act, the NFO’s receipt of a complaint suspends prescription and contractual time-bars until the complaint is withdrawn or finalised. The clock starts running again afterwards, so don’t let the matter drift once the NFO has closed its file.
Your escalation checklist
Use this checklist to keep your dispute on track. Enter the date you received the rejection letter to see planning dates. Your ticks are saved in this browser only.
0 of 8 done
Planning dates are estimates based on minimum periods in the Policyholder Protection Rules. The deadlines in your own letter and policy apply.
What the NFO can and can’t decide
The NFO can order an insurer to pay a claim, pay interest or pay compensation for poor service, but only within its jurisdiction and monetary limits. For non-life insurance, it can’t consider complaints over R5 million for most cover, or over R10 million for homeowners’ or buildings cover. The exceptions are where the insurer agrees to exceed the limit or you agree to cap your complaint (NFO Rules, Schedule A). The same limits apply to personal and commercial policies.
| Route | Best for | Cost | Watch out for |
|---|---|---|---|
| Insurer’s internal review | Every rejected or under-settled claim, as the first step | Free | The at-least-90-day window in your letter |
| National Financial Ombud (NFO) | Disputes with the insurer about claims, settlements, service and policy administration | Free | R5m or R10m limits; the three-year outer limit; complaints already taken to court |
| FAIS Ombud | Complaints about the advice or intermediary service you received from a financial services provider | Free | It is a separate jurisdiction from the NFO |
| Court | Disputes above the NFO limits, complex legal questions, or if you reject an NFO ruling | Legal costs | Prescription and policy time-bars |
The NFO may also dismiss a complaint that has no reasonable prospect of success, that has already been decided, or that a court is better placed to decide (Rule 9.2). It decides what is “equitable, fair and reasonable in all the circumstances”, having regard to the law, previous rulings and industry practice (Rule 8.1). In other words, it looks beyond the strict wording to how the insurer behaved, but the wording still carries great weight.
Why short-term claims get rejected, and where complaints succeed
Motor and homeowners’ policies drive most disputes, and the same few rejection reasons come up again and again. In the NFO’s 2025 report, motor vehicle insurance made up 35% of non-life complaints and homeowners’ insurance 27%. Accident claims were 70% of vehicle disputes, and theft and hijacking 8% (FAnews, 2026).
- Motor: the leading cause of disputes was rejection over alleged driving under the influence, followed by disputes over lack of due care or reckless driving.
- Homeowners: acts of nature made up 42% of complaints and burst geysers 15%. The main rejection reasons were gradual deterioration, lack of maintenance, wear and tear, defective design and poor construction. Our geyser and water-damage guide covers how these exclusions play out.
- Non-disclosure: incorrect or incomplete information at application stage, or changes you didn’t report, can affect a claim years later.
- Policy conditions: for example, a required tracking device that wasn’t working, or a security condition that wasn’t met.
“Know your policy: the cover, exclusions, and conditions. This will help you to understand whether your insurer was correct in rejecting a claim.”National Financial Ombud Scheme, Non-life Insurance Tips
Complaints also succeed on how a claim was handled, not only on whether it was valid. One case in the NFO’s 2025 report involved a storm-damage claim lodged in December 2024. The insurer rejected it four months later, having left the claimant without feedback for long stretches. The NFO found “maladministration and a breach of Policyholder Protection Rule 17” and awarded R3,000 compensation, which the insurer initially resisted (Daily Maverick, 2026). The lesson it drew was simple: “Keep a timeline. Record every call, email and promise.”
This is why the way you prepare matters as much as the merits. An organised file makes it easier for the ombud to see where the insurer’s reasoning or conduct fell short.
How a broker can help, and where the limits are
A broker can help you understand the rejection, find the relevant wording and prepare a clear, evidenced challenge. The insurer still makes the claims decision, and the NFO decides the complaint independently. Best Care is an authorised financial services provider (FSP 8754) that arranges cover with insurers. It does not underwrite policies or decide claims.
In practice, that help often means reading the schedule and wording with you, checking whether the insurer followed the Policyholder Protection Rules, and making sure your representations address the actual reason given. You can find more in our complete claims guide, on the claims help page and in the claims FAQs. If your concern is about Best Care’s own service, our complaints process and FAIS disclosure set out how to raise it.
The best defence against a rejected claim is a policy that fits your risk in the first place. That’s where working with a broker and comparing policies on wording, not just premium pay off.
FAQs about the short-term insurance ombudsman
These answers cover the general South African position. Your policy wording, rejection letter and facts remain decisive.
Who is the ombudsman for short-term insurance in South Africa now?
Since 1 March 2024, short-term insurance complaints are handled by the Non-life Insurance Division of the National Financial Ombud Scheme (NFO). The NFO replaced the former Ombudsman for Short-Term Insurance (OSTI), together with the banking, credit and long-term insurance ombuds.
Does it cost anything to complain to the NFO?
No. The NFO’s service is free to complainants. You do not need a lawyer to lodge a complaint, and you can submit it online, by email, by phone or in person, in any official South African language.
Do I have to complain to my insurer before going to the NFO?
You should. The NFO’s rules require it to check whether you have used the insurer’s internal complaints process. If you have not, it will usually refer the complaint back to the insurer first. For first-time complaints, the NFO says it gives insurers six weeks to respond.
How long do I have to lodge a complaint with the NFO?
The NFO may dismiss a complaint if three or more years have passed since you became aware, or should reasonably have become aware, that you had cause to complain, unless an ombud finds the delay was not your fault. Separate deadlines in your policy and rejection letter may be shorter, so act early.
Is the NFO’s decision binding on the insurer?
If the NFO makes a formal ruling and you accept it, the ruling is final and binding on both parties, subject to the insurer’s right to apply for leave to appeal within 30 days. If you do not accept a ruling, you are not bound by it and can pursue the matter elsewhere, such as in court.
What is the maximum claim amount the NFO can consider for short-term insurance?
Under the NFO’s monetary limits, non-life complaints are capped at R5 million for most types of cover and R10 million for homeowners’ or buildings cover, unless the insurer agrees to exceed the limit or the complainant agrees to limit the complaint to that amount.
Does lodging a complaint with the NFO stop prescription?
Yes. Under the NFO rules and section 216 of the Financial Sector Regulation Act, receipt of a complaint by the NFO suspends prescription and contractual time-bars until the complaint is withdrawn or finalised. The clock starts running again afterwards.
What if my complaint is about my broker’s advice rather than the insurer’s decision?
Complaints about the financial advice or intermediary service you received generally fall under the FAIS Ombud, not the NFO. If the dispute is about the insurer rejecting or under-settling a claim, the NFO is the usual route.
Get a second pair of eyes on the rejection
Questions about a rejected claim or about your own cover? Contact Best Care.
This article is general education, not legal or personal financial advice. Claim decisions are made by the relevant insurer, and complaints are decided independently by the NFO under its rules. Time frames and limits are drawn from the Policyholder Protection Rules (Short-term Insurance), 2017 and the NFO Rules approved on 23 February 2024; check the current versions and your own documents before acting. Best Care Insurance Brokers CC, registration 1992/100995/23, Authorised FSP 8754. See the FAIS disclosure.