In September 2020, the Complainant added her mother-in-law to a funeral policy with the Respondent. Following her mother-in-law’s death in November 2023, the Complainant submitted a claim for R10,000, which was acknowledged but only partially paid (R3,000), with the remaining R7,000 still outstanding.

The issue was whether the Respondent failed in its contractual and regulatory duty to process and pay the claim in full. The FAIS Act and the Policyholder Protection Rules (PPR) stipulate that insurers must assess and finalize claims within specific timeframes and communicate decisions transparently. The Respondent failed to comply with these rules and did not provide evidence of a valid dispute or repudiation. Furthermore, the Respondent appeared to be operating without an underwriter, in breach of regulatory requirements.

This Office found that the Respondent’s conduct violated Treating Customers Fairly (TCF) principles and its obligations under the FAIS Act.

The complaint was upheld, and the Respondent was ordered to pay the outstanding R7,000 plus interest.