Business insurance claims and complaints: what the Rules say you are owed

If an insurer turns down your business claim, the Policyholder Protection Rules require a written decision within 10 days, with reasons, and give you at least 90 days to answer back. A complaint goes first to the insurer, then to the National Financial Ombud Scheme. Time limits for legal action are separate, so note your dates.

What must an insurer do when I claim?

The Policyholder Protection Rules (Short-term Insurance), 2017 apply to all new and existing policies unless a rule says otherwise (Rule 1.2). Rule 17 deals with claims. It requires an insurer to run a claims management framework that, among other things, enables claims to be assessed after reasonable steps to gather and investigate all relevant information, and does not impose unreasonable barriers on claimants (Rule 17.2.1).

Three practical duties follow.

1. A decision within a reasonable period. Under Rule 17.6.1 the insurer must accept, repudiate or dispute a claim, or the amount of a claim, within a reasonable period after receiving it.
2. A written notice within 10 days. Rule 17.6.2 requires written notice of the decision within 10 days of the insurer taking it.
3. Plain language. Rule 17.8.2 requires all communication with a claimant to be in plain language.

The Rules do not fix a single number of days for the decision itself. "Reasonable" depends on the claim.

What must a refusal notice say?

If the insurer repudiates or disputes a claim, or the amount, Rule 17.6.3 requires the notice to tell you, in plain language:

• the reasons for the decision, in enough detail to let you dispute them;
• that you may make representations within a period of not less than 90 days after receiving the notice;
• how the insurer's internal escalation and review process works;
• that you may complain to the relevant ombud, with contact details and the time limits and other legal provisions about doing so;
• any time limit in your policy for starting legal action, and what it means for you; and
• if your policy has no such time limit, the prescription period that applies under the Prescription Act 68 of 1969.

If the person who refused your claim is not the insurer itself, such as a claims administrator, Rule 17.6.4 requires that notice to give the insurer's name and contact details and to say that queries must go to the insurer.

What happens if I answer back?

If you make representations, Rule 17.6.5 requires the insurer to say in writing, within 45 days of receiving them, whether it accepts, repudiates or disputes the claim. If it still refuses, Rule 17.6.6 requires it to give its reasons in enough detail for you to dispute them, to include the facts that informed the decision, and to repeat the information about escalation, the ombud and time limits.

Practical tips:

• Write down the date you received the first notice. The 90 days run from receipt.
• Say clearly what you disagree with and attach evidence.
• Ask for any report or document the insurer relied on.
• Keep a copy of everything you send and of proof that it was received.

Is there a deadline for going to court?

Possibly. Two things can apply.

A time limit in the policy. Under Rule 17.6.8, a time limitation clause in a policy entered into on or after 1 January 2011 may not count the 90-day representations period in its calculation, and must give at least 6 months after that period ends to start legal action. Rule 17.6.9 lets a claimant ask a court to condone non-compliance with such a clause where good cause exists for the failure and the clause is unfair to the claimant.

Prescription. Section 11(d) of the Prescription Act 68 of 1969 sets three years for "any other debt" unless an Act of Parliament provides otherwise. Section 12(3) says a debt is not due until the creditor knows the debtor's identity and the facts from which the debt arises, and the creditor is deemed to know what reasonable care would have revealed. Rule 17.6.10 provides that, for section 12(1) of the Act, a debt is due after the 90-day representations period expires.

How these fit together on your facts is a legal question. If a large claim is refused, speak to an attorney early rather than late.

When can an insurer cancel my business policy?

Rule 19 deals with termination. Rule 19.2.1 says that, where the insurer intends to terminate a policy for reasons other than non-payment, a material change in the risk that the policy itself deals with, or a legal requirement for immediate termination, it must give at least 31 days' written notice despite what the policy says. Rule 19.2.2 keeps the insurer liable for the shorter of 31 days after it receives proof that you were told, or until it receives proof that you have taken another policy for similar risks.

Rule 15.1 requires a policy to contain a period of grace for paying premiums of not less than 15 days after the due date, and for a monthly policy that applies from the second month. Rule 7.1(e) makes void any provision that lets an insurer repudiate a claim because a premium was not paid on the due date if payment was made during the grace period, whether or not the payment came before the event.

How does a complaint reach the ombud?

Rule 18 requires insurers to run a complaints process, and Rule 18.10 requires them to make the contact details of the relevant ombud available, including when a claim is repudiated.

The National Financial Ombud Scheme (NFO) is the ombud scheme that handles insurance complaints. Its site says it can only look at a complaint after you have first lodged it with your bank, credit provider or insurer. Its non-life insurance page lists commercial insurance complaints about service, policy administration, settlements and rejected claims. The page does not state monetary limits or time limits, so ask the NFO about those before you rely on any.

What should I keep ready before I ever claim?

A claim goes more smoothly when the paperwork is already in one place. Keep these together, on paper or in a folder you can reach if the premises are not available:

• the policy schedule and the full wording, including every endorsement;
• the contact details for notifying a claim, and any deadline for doing so (ask for these in writing, as Rule 17.8.3 requires the insurer to disclose them);
• a list of your assets with serial numbers and purchase dates;
• photographs of the premises, stock and equipment;
• your latest financial statements, which are often needed to show a loss of income; and
• the dates and contents of every letter or message between you and the provider.

None of this is a legal requirement for you. It is a way to avoid delay on the day you most need speed.

How does Olvian fit in?

Olvian is a lead-referral service paid a fee by licensed providers. It does not handle claims, decide complaints or advise on disputes. If you have a problem with a claim, take it to the insurer first, then the NFO.

Sources

Checked on 31 October 2026. This guide is information, not advice.

• Policyholder Protection Rules (Short-term Insurance), 2017, Rule 1: Application
• Rule 7: Void provisions
• Rule 15: Periods of grace
• Rule 17: Claims management
• Rule 18: Complaints management
• Rule 19: Termination of policies
• Prescription Act 68 of 1969, section 11 and section 12
• National Financial Ombud Scheme, its complaints process and non-life insurance page