Life cover claims: what the insurer must do, and what you can do if it says no

When a claim is made on a life cover policy, Rule 17 of the Policyholder Protection Rules says the insurer must decide within a reasonable period, tell you its decision in writing within 10 days, and give plain-language reasons if it declines. You then have at least 90 days to respond before taking the matter to an ombud.

Who can make a life cover claim?

The person who claims is usually someone you named as a beneficiary, after your death. The Rules use the word "claimant" for any person who makes a claim, and Rule 17.8.9 deals with the case where the claimant is a member of a group scheme or a beneficiary: the insurer must, when it receives the claim, either obtain the claimant's contact details so that all communications can go to the claimant directly, or obtain the claimant's consent to communicate through the policyholder.

That rule matters because the person claiming is often grieving and may not be the person who bought the policy. The insurer owes its claims-handling duties to the claimant, not only to the policyholder.

Who is named, and in what order, is set by the policy and the details you gave. Keep those details up to date. The licensed provider that calls you can explain how it records beneficiaries.

What must the insurer tell you when a claim comes in?

Rule 17.8.3 requires the insurer to disclose to the claimant:

• the type of information it needs from the claimant;
• where, how and to whom the claim and related information must be submitted;
• any time limits on submitting claims;
• details of any administrative fee payable in relation to managing the claim; and
• any other responsibilities of the claimant.

Rule 17.8.4 says a claim is treated as received on the day the insurer, its representative, or an intermediary, binder holder or other service provider mandated to manage claims, receives notice of it. Within a reasonable time the insurer or that party must acknowledge receipt and tell the claimant the process, including the contact details of the person or department handling the claim, indicative timelines for finalising it and details of any outstanding requirements. Rule 17.4.3 supports this: a claim received by an intermediary or a mandated service provider is treated as received by the insurer itself.

Rule 17.8.7 requires the insurer to record the claim by the first business day after it is first received, and not to wait until every document has arrived. Rule 17.8.5 limits what it can ask for: only information or documentation that is essential to assessing the claim.

Rule 17.8.6 gives you a right to be kept informed of the progress of the claim, of the causes of any delay, with revised timelines, and of the decision.

How long does the insurer have to decide?

Rule 17.6.1 says the insurer must "accept, repudiate or dispute a claim or the quantum of a claim" within a reasonable period after receiving it. For life cover, the Rules do not set a fixed number of days for the decision itself. The insurer's own claims framework must document the expected timeframes for each stage and the circumstances in which they may be extended (Rule 17.3.1(c)), and it must set out when interest is payable on late payment and at what rate (Rule 17.3.1(d)).

What the Rule does fix is the speed of the notice. Rule 17.6.2 says that within 10 days of taking a decision the insurer must notify the claimant in writing.

Funeral and microinsurance policies have tighter, specific deadlines under Rule 2A.8. Those do not automatically apply to a life cover policy. Our guide on how life cover differs from funeral cover explains the difference.

What if the insurer declines or disputes the claim?

Rule 17.6.3 sets what the written notice of a repudiation or dispute must contain. It must be in plain language and must tell the claimant:

1. the reasons for the decision, in enough detail for the claimant to dispute them;
2. that the claimant may, within not less than 90 days after receiving the notice, make representations to the insurer;
3. the details of the insurer's internal claim escalation and review process;
4. the right to complain to an ombud, with contact details, time limits and other relevant legislative provisions;
5. if the policy has a time limit for starting legal action, that provision and what it means; and
6. if the policy has no such limit, the prescription period under the Prescription Act, 1969 and what it means.

If you make representations, Rule 17.6.5 gives the insurer 45 days from receiving them to tell you in writing whether it accepts, repudiates or disputes the claim. If it holds to its decision, Rule 17.6.6 requires it to give reasons, the facts that informed the decision and the information in items 3 to 6 above.

Rule 17.10.1 lists practices an insurer may not engage in. It may not dissuade a claimant from using an attorney or an adjuster, deny a claim without a reasonable investigation, or deny a claim based solely on the outcome of a polygraph or similar test.

Can the insurer require a lie detector test?

No. Rule 7.1(a) of the Rules makes a policy term void to the extent that it provides that you or the claimant may be obliged to undergo a polygraph, lie detector or truth verification test connected to a claim. Rule 7.1(b) and (c) also void terms that offer an inducement to take such a test voluntarily, or that treat a failed test as a reason to repudiate or void the policy.

Rule 7.1(d) separately voids a term saying that a dispute can be resolved only by arbitration. After a dispute has arisen, the parties may still agree to arbitrate (Rule 7.2).

Can a late premium cost a claim?

There is some protection. Rule 15A.1 says that if a premium is not paid by its due date, the insurer must notify the policyholder of the non-payment within 15 days, and the policy and the cover must stay in force for a period after the due date: 15 days where premiums fall due at intervals of one month or less, or one month where the intervals are longer (or a longer period agreed between the parties).

Rule 7.1(e) makes void any term that lets the insurer repudiate a claim because a premium was not paid on the due date, if payment was made during that period, whether or not it was paid before the event that led to the claim. Rule 17.11.1 adds that when a valid claim arises from an event during the grace period, the value of the claim may be reduced by the unpaid premium.

If the premium is not paid by the end of the period, the policy is dealt with under Rule 15A.2 and 15A.3, which depend on the remaining value of the policy.

What time limits apply to going to court?

Two sets of rules matter here. The first is the policy itself. Rule 17.6.8 says that a time-limitation clause in a policy entered into on or after 1 January 2011 may not count the 90-day representations period toward the limit, and must allow at least 6 months after that period ends for starting legal action. Rule 17.6.9 lets a claimant ask a court to condone non-compliance with such a clause if the court is satisfied, among other things, that good cause exists and that the clause is unfair to the claimant.

The second is the Prescription Act, 1969. Section 11(d) sets three years for any debt not covered by another paragraph, unless an Act of Parliament provides otherwise. Rule 17.6.10 says that, for the purposes of section 12(1) of that Act, a debt is due after the 90-day period in Rule 17.6.3(b) has expired. How these apply to a particular claim is a legal question. A lawyer or the ombud can answer it. The notice you receive must explain which applies to your policy.

Where do you complain?

Start with the insurer. Rule 17.5.1 requires an insurer to maintain an internal process for escalating and reviewing claim decisions and resolving claim disputes, and Rule 17.5.2 says it must not be overly complicated or impose unduly burdensome paperwork. Rule 18 sets the complaints framework, and Rule 18.7.2 says that if a complaint is rejected the insurer must give clear and adequate reasons and explain any escalation or review process and time limits.

If that does not resolve it, the National Financial Ombud Scheme (NFO) is the industry ombud. It began operating on 1 March 2024 by merging four earlier schemes, including the Ombudsman for Long-term Insurance (OLTI). It says its service is free to the complainant and that it can look at a complaint only after you have first lodged it with the insurer. OLTI reported that most of its complaints were about claims being declined.

If your complaint is about the conduct of an intermediary who sold you the policy, the FAIS Ombud is a separate scheme. It says that you should first try to resolve the matter with the provider, which has six weeks, and that you then have six months from the final response to complain to the Ombud. The Financial Sector Conduct Authority supervises the market conduct of financial institutions and accepts enquiries and complaints about legislative matters.

What should you keep?

A claim moves faster when you can show what happened and when. Keep the policy document and the evidence of cover the insurer must send you, proof of payment of premiums, copies of everything you submit, and a note of the date, time and person for every call. Ask for decisions in writing, because Rule 17.6.2 gives you a right to the decision in writing.

How does Olvian fit in?

Olvian is a lead-referral service. We pass your request to licensed providers who pay us a fee and then call you. We do not issue policies, handle claims or give advice. If you already have a policy and need to claim, go to your insurer.

Sources

Checked on 31 October 2026. Olvian is not a financial services provider and this guide is information, not advice.

• Policyholder Protection Rules (Long-term Insurance), Rule 17: claims management
• Rule 18: complaints management
• Rule 7: void provisions
• Rule 15A: payment of premiums
• Prescription Act 68 of 1969, section 11
• National Financial Ombud Scheme: media release of 28 June 2024 and home page
• FAIS Ombud: complaint process
• Financial Sector Conduct Authority: role and complaints