In April 2020, the Complainant purchased a funeral policy with the Respondent, covering family members for a funeral benefit of R10,000 each. After the death of the two insured under the policy in early 2024, she submitted valid claims but only received a partial payment of R2,500, despite multiple follow-ups and promises from the respondent.

The question in this case was whether the Respondent failed in its contractual and regulatory duty to process and pay the claims in full. Under the FAIS Act and the Policyholder Protection Rules (PPR), insurers are required to assess and settle claims quickly and communicate decisions clearly. The Respondent did not fulfill these obligations and did not follow Treating Customers Fairly (TCF) principles.

Additionally, the Respondent operated without a current underwriter, raising further regulatory issues.

This Office determined that the Respondent’s conduct was a breach of its duties and ordered it to pay the remaining R17,500 plus interest.