When to Complain
You have the right to complain about any aspect of your insurance experience that you believe is unfair, unclear, or non-compliant. Common grounds include:
- A claim that was unfairly declined
- A premium increase that was not properly communicated
- Failure to pay a claim within a reasonable time
- Mis-selling — being sold a product that was not suitable for your needs
- Poor service or unresponsive communication
Step 1: Internal Complaint
Start with the insurer's internal complaints department. Every licensed insurer is required to have one. Write a clear, factual letter or email that includes:
- Your policy number
- A summary of the issue
- The outcome you are seeking
- Copies of relevant documents
Keep a copy of everything you send.
Step 2: Wait for a Response
The insurer should acknowledge your complaint within a few days and provide a substantive response within six weeks. If they do not, this itself becomes grounds for escalation.
Step 3: Escalate to the Ombud
If the internal process does not resolve your complaint, escalate to the relevant ombud:
- Long-term insurance (life, funeral, disability): Ombud for Long-term Insurance at ombud.co.za
- Short-term insurance (vehicle, household, commercial): Ombud for Short-term Insurance at osti.co.za
The ombud's services are free to consumers. They will investigate your complaint, request information from the insurer, and issue a determination.
Step 4: FSCA Referral
If the ombud is unable to resolve the matter or if the insurer does not comply with the ombud's determination, you can escalate to the Financial Sector Conduct Authority (FSCA) at fsca.co.za.
Tips for Effective Complaints
- Be factual, not emotional
- Reference specific policy terms, dates, and amounts
- Quote the Policyholder Protection Rules where relevant
- Keep a written record of every interaction
Contributed by Socinga Africa Holdings (FSP 46620). This is educational content only and not financial advice.