Background:

1.) The Complainant stated that in 2020, due to COVID-19 business restrictions, he requested a review of his commercial insurance policy to reduce costs.

2.) The Complainant reported a verbal agreement with the Respondent to remove specific policy sections temporarily. He later received written confirmation on 11 May 2020 that theft, money, glass, fidelity, goods in transit, broad form liability, accidental damage, employers liability, motor, and electronic sections were removed.

3.) The Complainant believed the removed sections would be reinstated once COVID-19 restrictions ended. However, when he submitted a theft claim in 2025, the insurer rejected it on the grounds that fidelity cover had not been restored.

4.) The Complainant argued this outcome was inconsistent with his expectations and instructions, as he believed all coverages removed during COVID-19 would return to their pre-pandemic status.

5.) The Complainant also stated that the Respondent did not provide adequate support or conduct an in-person review of his insurance needs, despite changes in his business.

6.) The Respondent denied receiving any instruction to reinstate the fidelity guarantee cover. It stated there was no record of a telephone call, follow-up, or other request from the Complainant and asked him to provide evidence of such an instruction.

7.) The Respondent also disputed the Complainant’s claim that he only learned in 2025 that fidelity cover was not reinstated. It referenced a 22 September 2021 correspondence that informed the Complainant of an updated commercial crime offering, including impersonation fraud, and invited him to consider the cover. The Complainant had an opportunity to respond.

8.) The Complainant later provided an email from the Respondent dated 21 December 2020, confirming the Respondent’s instructions to amend the policy, effective 17 December 2020, and specifically stating that the theft section was reinstated.

9.) The Complainant stated that he believed reinstating the theft section included all theft-related coverage under the policy.

Assessment of Evidence:

10.) The Office reviewed the parties’ submissions and documentary evidence, including the documents dated 11 May 2020 and 21 December 2020, as well as the relevant policy schedules.

11.) Section 3(1)(d) of the General Code of Conduct for Authorised Financial Services Providers and Representatives, provides, when a provider renders a financial service, the service must be rendered in accordance with the contractual relationship and reasonable requests or instructions of the client, which must be executed as soon as reasonably possible and with due regard to the interests of the client which must be accorded appropriate priority over any interests of the provider.

12.) The evidence showed the Complainant instructed the Respondent to remove certain cover sections during COVID-19 for affordability reasons. However, there was no objective evidence that he instructed the Respondent to restore all removed sections to their pre-pandemic status.

13.) The Office noted that the correspondence dated 21 December 2020 was significant. The Respondent confirmed the policy amendment and specifically stated the theft section was reinstated. The amended policy schedule reflected this, while other sections, including fidelity, remained excluded.

14.) This was consistent with the Respondent’s earlier correspondence of 11 May 2020, which identified theft and fidelity as separate covers. The December 2020 correspondence also allowed the Complainant to review and identify any errors in the amendments.

15.) The Office considered the Complainant’s belief that reinstating the theft section included fidelity cover. However, this assumption was not evidence of an instruction to reinstate the fidelity section.

16.) There was no documentary evidence of an explicit instruction to reinstate fidelity cover, nor evidence that the Complainant questioned its exclusion or requested clarification after receiving the amended policy schedule.

17.) The Office also reviewed the Respondent’s 22 September 2021 correspondence about its updated commercial crime offering. The Complainant did not provide evidence of responding or otherwise engaging with the Respondent regarding fidelity or commercial crime cover.

18.) Based on the evidence, the Complainant may have misunderstood the scope of cover reinstated in December 2020. However, there was no indication that this misunderstanding resulted from any error, omission, misleading statement, or failure by the Respondent to follow instructions.

19.) Accordingly, it was not established on a balance of probabilities that the Respondent failed to exercise the required care, skill, or diligence under section 2 of the FAIS General Code of Conduct or breached its duty of care regarding reinstatement of the insurance cover.

20.) There was therefore insufficient basis to hold the Respondent liable for the Complainant’s financial loss due to the absence of fidelity cover under the policy, and the complaint was not upheld.

Outcome:

21.) The complaint was dismissed in terms of Rule 7(2)(a) of the Ombud Council Rules for the Ombud for Financial Services Providers, 2024, as it lacked any reasonable prospect of success.

22.) The file was subsequently closed.