Insurance complaints and the National Financial Ombud
How a client's complaint about an insurer reaches South Africa's National Financial Ombud Scheme, and how a broker helps build a file that holds up.
By Achekam · · 4 min read · For Insurance businesses in South Africa
Every broker eventually has a client who is sure the insurer got it wrong. A household contents claim paid at a fraction of what the client expected. A business-interruption claim turned down on an exclusion nobody remembers discussing. A life policy that lapsed while the client was in hospital. The client wants to fight, and wants to know whether it will cost them anything.
South Africa has a free route for exactly these disputes: the National Financial Ombud Scheme South Africa, known as the NFO. A broker who understands how a complaint reaches it, and who helps the client assemble a clean file, can make the difference between a complaint that is resolved and one that drifts. This piece walks through the route.
Who the NFO hears, and what it costs
The Ombud Council has recognised the NFO as an industry ombud scheme, under recognition number OC/001/24. It deals with complaints that consumers bring against participating banks, credit providers, and life and non-life insurers, and it does so without charging the person who complains.
For a client who has just had a claim declined, "without charge" is often the most important fact in this piece. Many people assume that challenging an insurer means a lawyer and a bill. For a complaint within the NFO's scope, it does not.
Step one is the insurer, not the ombud
The NFO will only consider a complaint once the consumer has first taken it to the bank, credit provider or insurer concerned. Going straight to the ombud only delays matters, because the NFO cannot look at the complaint until the insurer has had its chance to answer it.
So the first job is a clear written complaint to the insurer. It should say:
- who is complaining, with the policy and claim numbers;
- what the insurer decided, and when;
- why the client believes the decision is wrong, point by point;
- what outcome the client wants;
- which documents are attached.
Keep the insurer's acknowledgement and every reply. If the insurer's final answer does not resolve the matter, the same letter and file become the basis of the complaint to the NFO.
Participation by financial services providers
The NFO tells financial services providers that their organisation is required to participate in it. Its own page states this without citing the legal provision behind it, so check the requirement with your compliance officer as it applies to your licence category.
For brokers, the practical consequence is to know where your own firm stands: check whether the participation requirement applies to you, and keep good records of the advice you gave and the disclosures you made. Those records protect you whichever forum a complaint ends up in, and they help the client's case against an insurer too. Keeping representative qualification files covers one part of that record.
Vulnerable complainants
The NFO says that when a complaint is lodged, it makes every attempt to establish and record whether the complainant should be treated as a "vulnerable complainant".
Clients in that position might be elderly, seriously ill, recently bereaved, or struggling with language or literacy. If that describes your client, tell the NFO when the complaint is lodged and explain why, so that it can take that into account from the start. A broker who knows the client is often better placed to say this than the client is.
What the NFO reports returning to consumers
The NFO reports that in its second year of operation it returned R442.9 million to financial consumers, against R328.5 million in its first year. Those figures cover all the complaints it handles, not insurance alone, and they say nothing about any individual case. What they do show a doubtful client is that complaints to the NFO are not a formality: money is recovered.
A complaint file the broker can share and show unchanged
Complaints succeed or fail on documents: the policy schedule and wording, the claim form, the assessor's report, photographs, the insurer's letters, and the client's own records. Build the file once, in order, and keep it intact.
In Achekam, Document Centre gives each complaint a folder where files, or whole folders, are uploaded, previewed, tagged, searched and later archived. When a document is replaced with a newer version, the earlier versions stay available, so the original claim form is never lost under a corrected one.
Each file stored receives a SHA-256 fingerprint calculated from its contents, which changes if the file changes. Executable files are turned away by default, and each upload is checked for malware. If the insurer later questions whether a photograph or a letter has been altered, the fingerprint recorded when the file was stored helps you show that it has not.
When the insurer or the NFO needs the documents, send them by a personal link sent to the recipient's e-mail address. Each link can carry an expiry date, an optional one-time code, and a setting that allows or blocks downloads, and it can be withdrawn at any time. Withdraw it once the matter closes. Sharing claim documents by secure link goes further into that habit.
The National Financial Ombud Scheme's website explains how to lodge a complaint, what the scheme covers and how it treats vulnerable complainants.
The next time a client says "I want to complain", help them write to the insurer first, start the complaint folder that day, and note every reply. If the insurer will not move, the file is ready for the ombud.
General guidance only, not advice on your own circumstances. Tax and payroll rules change: check the current position with the authority or your adviser.
